Table Of Content

Hospitals — A Design Manual A Design Manual Hospitals Cor Wagenaar Noor Mens Guru Manja Colette Niemeijer Tom Guthknecht Contributions by Giuseppe Lacanna Peter Luscuere Birkhäuser Basel We would like to thank the organizers of the ‘Building the Future of Health’ conference, www.btfoh.eu, for their kind support of this publication. Layout and cover design Jenna Gesse, Berlin Graphic design concept of ‘Design Manual’ series Oliver Kleinschmidt, Berlin Cover Akershus University Hospital, Oslo, C. F. Møller Architects; photo: Torben Ekserod Frontispiece Surgical Clinic La Croix-Rousse, Lyon, Atelier Christian de Portzamparc; photo: Erick Saillet Concept Cor Wagenaar, Noor Mens Project texts Noor Mens, Cor Wagenaar Copy-editor Harvey L. Mendelsohn, Cambridge, Massachusetts Editorial supervision Ria Stein, Berlin Production Katja Jaeger, Amelie Solbrig, Berlin Lithography bildpunkt Druckvorstufen GmbH, Berlin Paper BVS matt, 150 g/m2 Printing Medialis Offsetdruck GmbH, Berlin Library of Congress Cataloging-in-Publication data A CIP catalog record for this book has been applied for at the Library of Congress. Bibliographic information published by the German National Library. The German National Library lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are available on the Internet at http://dnb.ddb.de. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in databases. For any kind of use, permission of the copyright owner must be obtained. This book is also available as an e-book (ISBN PDF 978-3-0356-1125-0; ISBN EPUB 978-3-0356-1126-7). © 2018 Birkhäuser Verlag GmbH, Basel P.O. Box 44, 4009 Basel, Switzerland Part of Walter de Gruyter GmbH, Berlin/Boston Printed on acid-free paper produced from chlorine-free pulp. TCF ∞ Printed in Germany ISBN 978-3-03821-473-1 9 8 7 6 5 4 3 2 1 www.birkhauser.com Principles of the Hospital Building 8 Preface Cor Wagenaar, Noor Mens 9 Introduction Cor Wagenaar, Noor Mens DEFINING THE HOSPITAL DESIGNING HOSPITALS PUBLIC SPACES TREATMENT AREAS OF TOMORROW 12 23 52 67 Paradigm Change? Distribution of Healthcare Zoning and Traffic System Planning: an Integral The Perspective of the Patient Facilities: Centralization, Tom Guthknecht, Peter Approach Cor Wagenaar, Noor Mens Decentralization and the Luscuere, Guru Manja, Colette Tom Guthknecht Network Hospital Niemeijer, Cor Wagenaar 15 Guru Manja, Colette Niemeijer, 69 Healthcare as a Public Service Cor Wagenaar 58 Outpatient Department Cor Wagenaar, Noor Mens Arrival and Entrance Tom Guthknecht, Guru 27 Noor Mens Manja, Colette Niemeijer, 19 The Design of Hospitals: Cor Wagenaar The Business Case Care Pathways 61 for Hospitals Guru Manja, Colette Niemeijer, Public Spaces in and Around 75 Guru Manja, Colette Niemeijer Cor Wagenaar the Hospital: Streets, Inpatient Wards Squares, Patios, Waiting Tom Guthknecht, Guru 22 32 Areas, Healing Gardens Manja, Colette Niemeijer, Changing Healthcare Needs Processes and Spaces: Giuseppe Lacanna, Cor Wagenaar Cor Wagenaar, Noor Mens the Example of the Maternity Cor Wagenaar Department 83 Guru Manja, Colette Niemeijer, 65 Diagnostic Imaging Cor Wagenaar Wayfinding: Signage and Tom Guthknecht, Guru Manja, Orientation Systems Cor Wagenaar 37 Noor Mens Evidence-Based Design for 85 Healing Environments Operating Theater and Cor Wagenaar Recovery Area Tom Guthknecht, Guru 42 Manja, Colette Niemeijer, The Building Type and Cor Wagenaar its Emergence Noor Mens 100 Intensive Care Unit Tom Guthknecht, Guru Manja, Colette Niemeijer, Cor Wagenaar 108 Emergency Department Tom Guthknecht, Guru Manja, Colette Niemeijer, Cor Wagenaar 111 Laboratory Department Tom Guthknecht Selection of Projects GENERAL HOSPITALS CHILDREN’S HOSPITALS UNIVERSITY HOSPITALS 118 140 160 188 Circle Bath Hôpital Riviera-Chablais Nemours Children’s Hospital Center for Surgical Medicine Bath, UK Rennaz, Switzerland Orlando, Florida, USA University Hospital Foster + Partners Groupe-6; GD architectes Stanley Beaman & Sears Düsseldorf Düsseldorf, Germany 122 142 164 Heinle, Wischer und Partner Butaro District Hospital Medisch Spectrum Twente Randall Children’s Hospital Butaro, Rwanda Enschede, the Netherlands at Legacy Emanuel 192 MASS Design Group IAA Architecten Portland, Oregon, USA St. Olav’s Hospital ZGF Architects Trondheim, Norway 124 148 Nordic – Office of Architecture; Private Hospital Rey Juan Carlos Hospital 168 Ratio Arkitekter Villeneuve d’Ascq Madrid, Spain Juliana Children’s Hospital Lille, France Rafael de La-Hoz The Hague, the Netherlands 196 Jean-Philippe Pargade MVSA Architects Akershus University Hospital Architectes 152 Oslo, Norway Meander Medisch Centrum 172 C. F. Møller Architects 128 Amersfoort, the Netherlands Mother-Child and Extension Kolding Hospital Atelier PRO architekten Surgical Center 200 Kolding, Denmark Kaiser-Franz-Josef-Spital Reconstruction of the Johann Schmidt Hammer Lassen 156 Vienna, Austria Wolfgang Goethe University Architects Cleveland Clinic Abu Dhabi Nickl & Partner Architekten Hospital Abu Dhabi, Frankfurt am Main, Germany 130 United Arab Emirates 176 Nickl & Partner Architekten AZ Groeninge HDR Ann & Robert H. Lurie Kortrijk, Belgium Children’s Hospital 204 Baumschlager Eberle Chicago, Illinois, USA Erasmus MC Hospital and Architekten ZGF Architects Education Center Rotterdam, the Netherlands 134 182 EGM architects; KAAN Zaans Medisch Centrum Royal Children’s Hospital Architecten Zaandam, the Netherlands Melbourne, Australia Mecanoo Billard Leece Partnership; Bates Smart SPECIALIZED HOSPITALS OUTPATIENT CLINICS REHABILITATION APPENDIX AND HEALTH CENTERS AND SUPPORT CLINICS 210 232 248 268 Cleveland Clinic Lou Ruvo Ruukki Health Clinic Maggie’s Centre West London The Authors Center for Brain Health Ruukki, Finland London, UK Las Vegas, Nevada, USA alt Arkkitehdit; Architecture Rogers Stirk Harbour + Partners 268 Frank Gehry Office Karsikas Index of Places 250 212 234 Maggie’s Centre Gartnavel 270 Surgical Clinic Municipal Healthcare Glasgow, UK Index of Names La Croix-Rousse Centers San Blas, OMA Lyon, France Usera, Villaverde 271 Atelier Christian de Madrid, Spain 252 Illustration Credits Portzamparc Estudio Entresitio Gheskio Cholera Treatment Center 216 238 Port-au-Prince, Haiti Milstein Family Heart Center UCLA Outpatient Surgery MASS Design Group NewYork-Presbyterian and Medical Office Building Hospital Santa Monica, California, USA 254 New York, New York, USA Michael W. Folonis Architects Cancer Counseling Center Pei Cobb Freed & Partners Livsrum, Denmark 240 EFFEKT Arkitekter 220 New QEII Hospital National Center for Welwyn Garden City, UK 258 Tumor Diseases Penoyre & Prasad Healthcare Center Heidelberg, Germany for Cancer Patients Behnisch Architekten 242 Copenhagen, Denmark Outpatient Clinic Nord Architects 224 Hospital-Asilo of Granollers Institut Imagine Granollers, Spain 262 Paris, France Pinearq Rehabilitation Center Ateliers Jean Nouvel; Groot Klimmendaal Valero Gadan Architectes Arnhem, the Netherlands Koen van Velsen Architects 228 Cancer Centre at Guy’s 266 London, UK Anti-Aging Life Rogers Stirk Harbour + Partners Center Chaum Seoul, South Korea KMD Architects Preface Hospitals — A Design Manual is a book for architects, hospital administrators and plan- ners, medical specialists and policy makers about the latest trends in hospital architecture and it aspires to be a tool for change. As used in this manual, the term ‘design’ encompass- es more than spatial configuration, the use of materials, color, windows, doors and furni- ture. The authors present the hospital as a composition of components, each of which can be designed in various ways. We offer a range of choices, many of which are determined by programming decisions. Weighing various options is an essential part of the architect’s task in designing a hospital. The publication’s focus is on people and processes rather than on medicine and technology. Caring for people and optimizing the processes they undergo are constant concerns in hospitals, no matter how quickly and fundamentally medicine and technology change. In hospital design, there are no standard solutions. Each hospital rep- resents a unique combination of design decisions that is determined by its specific context, including the characteristics of the population it serves, demographic trends, healthcare systems, economic realities, etc. If the reader comes away with a heightened awareness of the many questions architects and decision makers have to consider, then this book will have served its purpose. The projects documented here have been selected because they represent fundamental trends. Revolutions in healthcare architecture are always slow – paradigm changes take time to materialize. Some of the trends illustrated by the case studies have been underway for quite some time, others are more recent, but both testify to the gradual emergence of new hospital landscapes. The manual is the result of teamwork. Tom Guthknecht, an internationally renowned healthcare architect, theoretician and consultant, helped define the main principles of hospital planning as well as identify current trends and challenges in designing specific functional components. Kirk Hamilton, a prominent healthcare architect, is also an expert on evidence-based design; his input focused on the use of science in architecture. Peter Lus- cuere, a leading professional in hospital construction, general layout models and clean air technology, contributed to the parts of the book dealing with these issues. Guru Manja and Colette Niemeijer, who specialize in the reconceptualization of the hospital from the patient’s perspective and in hospital programming, were responsible for describing the close link between patients’ needs, the program, logistics and business matters, on the one hand, and architecture and distribution models, on the other. Laura Bulau, Marien Kleizen and Kees de Wit at CEANconsulting produced all the graphs and diagrams. Many people have helped in making this book happen — we mention only two of them. We thank Ria Stein for staying with us when for a number of reasons the project came to a complete standstill — this manual is the result of its renaissance in the spring of 2014. We are particularly grate- ful to Harvey Mendelsohn with whom we have worked on many projects for many years; his editorial skills were indispensable. Cor Wagenaar and Noor Mens 8 Introduction COR WAGENAAR, NOOR MENS Only a decade ago, architects and critics considered hospital architecture to be a field ‘lagging behind the most inventive and progressive developments in the art and science of architecture, and indeed losing the commitment and skill required in the making of places that mean something to people’.1 Since then the situation has changed complete- ly. Hospitals are back in the frontlines of architecture. The world’s leading designers have discovered that this building type offers fundamental, indeed unique design challenges. Absorbing the latest findings in science, psychology, medical technology and the digital revolution, exploring the urban surroundings as a framework for integration and reflect- ing major economic trends and, most notably, the transfer of responsibility to the end user, hospitals address fundamental aspects of human life in ways no other buildings do. Few other institutions have such a direct impact on the quality of life of the people who rely on their services. Sometimes the stakes are even higher: whether a patient lives or dies may depend on the way a hospital performs. This book outlines how architecture can help hospitals increase the efficiency of the medical processes they house, while simultaneously improving financial performance and, most importantly, providing patients with better care. Since their architecture directly affects how hospitals function, we believe that the architect’s role goes beyond the realm of design in the strict sense. Architects involved in planning a hospital must address a host of issues: accommodating the flows of staff, patients and their visitors, balancing efficient use of facilities with the need to meet unpre- dictable peaks in demand and ensuring sufficient flexibility in the design to accommodate constantly evolving technology, to name but a few. They should be capable of assessing the impact of design solutions on the efficiency of medical processes and, therefore, of ex- panding the scope of their work to include the functional program: logistics, public spaces, wayfinding, patient transfers, the balance between single- and multiple-patient rooms, er- gonomics, etc. As the CEO of an American hospital stated, architects ‘…should want more control and be a more integral part of the medical team’.2 If they accept the reduction of their role to that of aesthetic and technical advisors responsible for a building’s form, appearance and representative qualities, they abandon what we see as a large area of their profession’s responsibilities, leaving behind a void that cannot be easily filled. Good hospital design can only flourish when its organization and processes, as well as its spatial logistics, infrastructure and programming are addressed in an integral manner.3 Ideally, this should culminate in a perfect fit between program and design. Hospitals are key elements in the healthcare system, which we view as a public service; they are obviously meant to enhance public health, which, ultimately, is measured by statistical data: life expectancy and the various other parameters used to define the quality of life. Often, the latter aspects are related to social and economic factors and lifestyle in- dicators. While medicine clearly has an impact on public health, its effects should be seen in a wider perspective. It is clear that city planning (by providing decent sewage and water supply systems and stimulating walking and physical exercise, for instance) and architecture (notably in the field of public housing) have been very important factors in improving life expectancy and quality of life.4 Investment of public money in medicine and medical facilities, it has been argued, should be proportional to their contribution to improved public health. In principle, the financial interests of hospitals do not always coincide with the objectives of public health. If a thorough upgrade of post-war housing projects yields better results in that regard than building new hospitals, then this is where the money should go. In many countries, only a small percentage of healthcare expenditure is allocated to prevention, while the cost of medical treatment continues to rise to unsustainable levels. Faced with the prospects of financial disaster, many public health systems need to improve their cost-effectiveness. If prevention of disease develops into the new frontier of public health, hospitals will be forced to reconsider their role and try to define their place in a con- tinuum of prevention, health promotion and medical intervention (care and cure). Franz Labryga uses the term ‘health houses’ to describe facilities that ‘(…) will primar- ily be places that provide information, support, surveillance and prevention. Diagnosis 9