The Nature of Hospitals

Hospitals that are new but alreadybehind the times and fail to addressthe question:What really happens here?Future scenario B

PUTTING IT IN CONTEXT:EVOLUTION OF HOSPITAL DESIGNWhere we’ve beenWhen Ms. Nightingale begannursing in 1851, hospitalswere squalid places withhorrid working conditions…

EVOLUTION OF HOSPITAL DESIGNWhere we are now“…in relative terms, today’shealth care institutions are notmuch better, & the workenvironment (let alone thehealing environment) continuesto be disgracefully bad.”Andre Picard, The Globe and Mail

EVOLUTION OF HOSPITAL DESIGNWhere we are now55% of all nurses responding toa study said:they would NOT recommendnursing as a profession for theirchildren and friends

EVOLUTION OF HOSPITAL DESIGNWhat does this mean?•! Unprecedented rates of burnout•! Higher overall ERROR rates•! Exits outpaced recruitment•! Typical retirement age is 56•! Loss of skilled mentor pool

Who is going toHeal the Healers?

EVOLUTION OF HOSPITAL DESIGNTechnology?Context:1960 & 70’s fascinationwith space travel &pop culture

EVOLUTION OF HOSPITAL DESIGNTechnologyResult:Expression of technology inhospital design as a symbolof leading edge care andprogressGermany

EVOLUTION OF HOSPITAL DESIGNIs modern health care planningand technology:TechnologyThe differentiator?Cutting edge?or…One element of sucess?

EVOLUTION OF HOSPITAL DESIGNPresent situationHigh-tech or High-touch ?Bank hallor…Home likeor…Over the top interior design?

EVOLUTION OF HOSPITAL DESIGNPresent situationThere is rapid technologicalchange that lies in the eye ofthe beholderTechnology is a given &expected…but not a differentiator!

EVOLUTION OF HOSPITAL DESIGNThe face of high-tech?Bill Gate’shome in SeattleWashingtonBohlin Cywinski Jackson; Cutler Anderson Joint Venture Architects

EVOLUTION OF HOSPITAL DESIGNMinimum standardWe hear we need“...modern and efficient hospitals” to:•! Increase technological effectiveness•! Lean planning effectiveness•! Increase operational efficiency•! Increase clinical efficiency•! Increase energy efficiency

Is that it?

A spiritual place of hope &comfort…Health lensCredit Valley Hospital

Dismal buildings that fail to answerthe most fundamental question…What really happens here?

How can we gain the attentionrequired for this magnitude ofchange thinking?How can we begin?

We must examine ourexpectations of our hospitalseconomic assetsurvivingExpectationsLifting the spiritpromoting healthillness preventionstress-reducing“doing no harm” (?)functioningsurvivingeconomic liability

…the quality of the environment hasa significant effect on healing andstaff effectivenessHow much more evidence do we need?

Do we have the confidence tocreate this health future?ConfidenceWellesley Central Place, Canada

Will we passively manage the same oldcosts of sickness or should were-imagine a new role?Health care or illness care?Alexandra Hospital at Yishun Master Plan, Singapore

This is the time to create strongmemorable symbols of healthMemorable symbols of healthCredit Valley Hospital main lobby

Have phrases such as‘patient-focused care’,‘evidenced based design’&‘healing gardens’A natural environment?been reduced fromfundamental principles toempty words?Has ‘natural’ & ‘restorative’environments been reduced to‘one-liners’?An example of a typical North American nursing station

We must advocate for and deliverintegrated places that truly enhancehealth & hopeHealth & hopeNational Oncology Centre, Trinidad; Presently under construction

Places where light is embraced as anessential life affirming forceSpiritual dimensionCVH cancer treatment bunker entry Thunder Bay Hospital entry NWORCC cancer treatment bunker entry

. . . Drawing intentionally on regional& natural themes to createmeaningful & relevant placesBreathe and healNorfolk General Hospital, Canada

Places that respond to the innatehuman desire to connect with ournatural surroundingsWhere Design Meets the LandNorfolk General Hospital, EntryThunder Bay Hospital river floor pattern

Places rooted in the principles ofhuman scale, health, not illnessand connections to place.Common GroundTechnologySolutionsDesign ofthe WholeCulturalIdentitiesLocalGeographies

•! Credit Valley Hospital•! Thunder Bay Regional Health Sciences•! Providence Legacy VancouverHealing & hope

A 430-bed acute care hospital with anintegrated specialty ambulatory care &cancer centre.Credit Valley HospitalMississauga, Canada

‘CVH’s ambition is to be the finesthospital in Canada in the hearts &minds of people they serve.’President and CEO Wayne FyffeAmbitionSite planMain entry drop off

Re-imagining the HospitalThis project re-imagines whata hospital could be:‘A nurturing investment incultural & physicalinfrastructure for its patientsand staff’Main lobby

When asked about priorities for design,cancer patients responded:‘something that gives us hope, something that is alive.’Innovation

OrganizationMain LobbyLight WellsCancer LanternsSection through main lobby, cancer & ambulatory care areas

Section through main lobby, cancer & ambulatory care areasOrganization

Section through main lobby, cancer & ambulatory care areasOrganization

OrganizationMain LobbyLight WellsCancer LanternsSection through main lobby, cancer & ambulatory care areas

The atrium is designed to resemble atree-lined courtyardMain lobby

Radiation treatmentLanterns

ChemotherapyClinical areas

DialysisClinical areas

From conceptual foam models tocomputer renderings, the projectsmain public areas progressed as anintegrated wood systemMaterialsOriginal foam concept model Wood scale model Computer model

The atrium is the most complex woodstructure in North America & believed inthe worldExecution

A fog mist system is used as analternative to ozone depleting chemicalagents – a first in hospitalsEnvironmentMist heads On site test Fire authority test

Ontario Hospital FoundationEvidenced Based Design FunctionalAnalysis Research StudyGood Design | Good BusinessMain lobby stairMain approach from regional road

‘Flower’ the Therapeutic Clownlounging in her homeGood Design | Good Business

A new 375 bed, 700,000 sq ft regionalhospital with an integrated cancercentreThunder Bay RegionalHealth Sciences CentreThunder Bay, Canada

Ron Saddington, the CEO of theThunder Bay Hospital, knew he had‘just one chance to get it right.’ContextSite planAriel view

Daylight: Main curved concourseOrganizationMain entranceMain concourse

Design strategy: primaryorganizing principles1. 2.Organization3. 4. 5.

Main curved concourse utilizes passive solarenergy in public areas, requiring virtually noheating in the winter or cooling in the summerDaylightExternal brise soleil, insolated glass and sunshades are designed to control heat gains while maximizing access to daylight.

The concourse expresses an expanding roleof the hospital as a place for learning &health, not sicknessDaylight

Skylights and natural vegetation in theradiation treatment rooms lift the spiritsof patients and staffDaylightSection thru radiation roomRadiation room interior

The choice of materials can tie the building tothe history & culture of the area. Here it evokesthe heroic curved railway bridges that link thecountry from sea to seaMaking connections

50% of Thunder Bay is employed in the forestryand pulp & paper industriesThe project uses wood extensively through out allpublic areas, first to gain approval in Canada as astructural elementInnovationMain EntryCancer radiation treatment areaEntry to radiation treatment room

Natural materials also have the powerto connect people to the places theyexperience on a daily basisInnovationSingle inpatient room Inpatient corridor Care centre

SustainabilityOne of the first of its type toharvest rain water to provide anaturalized system of ponds thatcleanses run-off water, createsfish spawning habitats andrecharges the adjacent coldwaterriver

A beacon of future health care thatreaffirms a belief in designing for thebody, mind & spiritLegacy

Providence HealthLegacy ProjectVancouver, British Columbia,With Busby Perkin & Wills Architects

The $1.2 billion Providence Legacy will laythe groundwork for the greenest newhospital design in North America & arguablythe worldVision

The first impression will be of a verdantwellness campus rather than a placeto heal the sickInspiration

Conceived as an interconnected villagein the city’s Downtown Eastside; aneighbourhood experiencing renewalContext

Providence Legacy responds to the humanconnections between building, site andprevailing natural conditionsResponse

Green design and health care are notmutually exclusive states. ProvidenceLegacy will achieve minimum LEED PlatinumEnvironment

Providence Legacy finds the commonground between sustainability,function and community prideLegacy

What principlesshould weremember whenbeginning a hospitalfor the future?

What Matters Most?Identify the salient issueswhen embarking on abuilding

Identify Success FactorsDetermine the mostcritical issues for thesuccess of this project:Set the bar higheconomic assetLifting the spiritpromoting healthillness preventionstress-reducing“doing no harm” (?)functioningeconomic liabilitysurviving

Nurture Great IdeasEnsure you have theright tools and teammembers, it is trulycollaborative and thenempower them toachieve innovativeresults

Anticipate the FuturePlan for the future ofclinical & researchenvironments

Results not EffortDemonstrate an abilityto exceed yourobjectives; avoid the‘say-do’ gap

Achieve Great OutcomesExpect to be carried farbeyond anything youcould have imagined

Tye S. Farrow, B Arch, M Arch UD, OAA, FRAIC, MAIBC, NSAA, NLAASeptember 28, 2010Design & Health Malaysia 2010www.farrowpartnership.comThe Nature of Hospitals