Sophie Eastwood considers how planners and designers of new healthcare facilities can apply valuable experience from other sectors, such as residential and commercial, both to speed project completion, and to create a more harmonious, non-institutional feel which both aids patient recovery, and provides an enhanced working environment for medical and clinical personnel.
The healthcare sector looks set to face a difficult year, with spending dominating the debate over the NHS, and a general election only months away. Staff numbers will no doubt be axed, and all budgets reviewed, as billions of pounds’ worth of cuts are made, and yet sustaining a good and consistent level of service will still be required. Capital expenditure, although not expected to be as severely hit as other areas, will have to work harder, and to drive more efficiency and operational effectiveness for the benefit of the health service as a whole. The question is: as the NHS now needs to milk every penny, are there unexplored ways of improving performance? The answer is yes. With the recession making every organisation more receptive to different methods and approaches, we have taken a look at some other market sectors, masterplanning, and even Mother Nature, and asked what can be learned from them for the good of healthcare delivery.
A touch of home
We have all heard that “home is where the heart is” and, while cliché, the phrase cannot help but evoke feelings of being safe, warm, comfortable, and relaxed, surrounded by personal possessions that make one happy and put one at ease. Transfer these qualities to a hospital or healthcare environment, and the ambience created inspires wellbeing and health, and is known to speed recovery. This, in turn, takes significant pressure off resources, and aids efficiency. The North West London Hospitals NHS Trust was very keen to embrace this approach when, working with Barbara Weiss Architects, it created the UK’s first free-standing birth centre, the Brent Birth Centre. Having earned high praise from the Commission for Architecture and the Built Environment (CABE) for its “homely environment”, the project won a Civic Trust Award, and was a finalist in the Prime Minister’s Better Public Building Awards. One of the key principles behind the centre’s design was to make sure it would feel non-institutional, safe, inclusive and comfortable – “just like home” – to both mothers and staff. It “delivered” because, first and foremost, it was residential in scale and look – a low-key, elegant, and very private, single-storey building wrapped around a sheltered landscaped garden, built using an unusual variety of pale yellow bricks and natural materials wherever possible. In creating a domestic feel for the Birth Centre, layout was very important. Spaces created are open and welcoming, and the large corridors encourage movement, and provide the freedom for labouring mothers to walk around. The spacious rooms were fitted with double beds for partners, further removing any institutional feel. Standard NHS-supplied furniture, re-covered in more stylish fabric, was mixed with a few “designer” items, delivering comfort and visual interest; close attention to all types of storage requirements made a huge difference to the qualities of space and calm. Most importantly, the Brent Birth Centre bedheads have folding doors that can be closed to conceal medical apparatus, including taps for gas and air, so as not to be intimidating when entering the room.
Natural light is another essential ingredient in creating a residential effect. Cleverly exploited by the architects throughout the Brent Birth Centre, it is used to particularly notable effect in breaking up what traditionally would have been boring, long corridors. The result is a stunning, calming, multi-purpose top-lit circulation space that threads its way through the building. Elsewhere, a 9 metre-high atrium down the middle of the building is also filled with light; and, in the delivery rooms, large picture windows with cherrywood window seats provide comfort and allow natural light and views of the garden to stream in. When blinds are down, light still comes in via clerestory windows at high level. All artificial light was also selected based on its domestic appearance and effect. Barbara Weiss, principal at Barbara Weiss Architects, a practice that boasts a large private residential project portfolio, alongside a prestigious public sector one, speaks passionately about the importance of recreating a “home” in healthcare. She says: “Any healthcare environment, whether for maternity, mental health, acute services, or minor injuries, must be a safe haven that promotes recovery. By taking the time to really think about optimal layout, natural light and views, materials and storage solutions, a welcoming, comfortable, and eminently flexible environment can be created to suit a large variety of requirements and to stand the test of time.” The Brent Birth Centre’s lessons should not be forgotten, especially as we enter a period where more new high quality maternity units are in high demand. Statistics just released show that, in 2009, with a new surge of births, hospitals across the country, unable to cope with demand, closed their doors to more than 350 expectant mothers, while the number of C-sections is increasing dramatically across the UK. More Brent Birth Centres would undoubtedly plug the hole, while encouraging families to experience birth as the ultimate natural event.
It is not, however, just recreating the ambience of residential accommodation that can benefit the healthcare sector; we can also learn from its building practices. In the residential market, off-site manufacture (OSM) is tried and tested, and is beginning to gain momentum in delivering temporary and permanent healthcare facilities. Last year, the £25 million Watford Acute Admissions Unit (AAU), the UK’s largest, was built using this modern method of construction. West Hertfordshire Hospitals NHS Trust chose OSM because of its speed and flexibility. The Trust had an immediate need, and existing buildings on site had to be demolished and the ground prepared, which would have caused significant delays with traditional construction. Instead, 142 modules, complete with partitions, windows, electrics, plumbing, and sanitaryware, were delivered over three weeks, providing 120 beds. The whole process only took a year, 50% faster than traditional construction. The project, delivered in conjunction with Yorkon, won the Building for Health Award at the Builder and Engineer Awards 2009, and Best Off-site Health Project at last year’s Off-site Construction Awards. Colin Gush, head of healthcare sector at contractor Obsorne, which was responsible for the construction of the Watford AAU facility, says: “The healthcare sector must manage new development and ongoing refurbishment with minimum disruption to all stakeholders, while delivering the best available healthcare within tight budgetary constraints. OSM can help. It delivers high speed construction and programme certainty; reduces waste by up to 90%; safeguards quality; minimises disruption, as well as dust and noise, and makes light work of constrained sites. Crucially, it is also flexible, enabling expansion without the need to decant patients and staff. “It is obviously not right for every project,” Colin Gush conceded. “However, with in-depth planning it can provide a viable solution in many circumstances, offering clients best value overall.” Modular construction need also not necessarily be used for a whole project. HLM Architects often recommends modular rooms, and prefabrication and the pre-engineering of bathroom pods, recognising the similarity of 100% singlebedded ward accommodation to private and public residential accommodation. Leslie Welch, director and lead of healthcare at HLM Architects, says: “The layout, degree of repetition, and integration of en-suite facilities, are all similar to residential, so using knowledge of other sectors to improve costeffectiveness and delivery is the smart approach.”
Lessons from ‘secure therapy’
Another sector from which healthcare can learn is custodial. Learning from prisons might sound strange but, as Chris Liddle, chairman at HLM Architects, explains, prisons have evolved over the years – from places that aim to deter and reform, to those that constrain people, to “a more practical approach”. “The purpose of the prison service is the need to first keep prisoners securely; secondly to look after them with humanity; and thirdly to help them lead law-abiding and useful lives in custody, and after release,” says Chris Liddle. “Custodial facilities, therefore, must be highly function-driven, and create an atmosphere that encourages education, community, social interaction, and, ultimately, rehabilitation. “Secure healthcare units are very similar. Function is at their heart, and security is of paramount importance, for patients, as well as staff. They must provide a therapeutic environment where people can change for the better and return to society.”
A ‘village’ neighbourhood
A year ago, HLM Architects completed the South London and Maudsley NHS Trust’s New River House Medium Secure Unit at Bethlem Royal Hospital. It was designed to respond to the healing journey, incorporating the stages to recovery, and creates a healing environment that is synonymous with a village neighbourhood. The “village” is created through a self-contained grouping of buildings within the grounds of the hospital, and the design approach is infused with therapy, healing, and care. A range of different spaces are provided – for contemplation, social interaction, study, and private therapy, along with secure, landscaped, outside spaces. Exploiting the five senses with which we perceive environments – sight, smell, taste, touch, and hearing – as well as colour, the design can signal and encourage certain behaviours. It can also ensure that wayfinding remains intuitive and stress-free, as important in a mental healthcare unit as in a prison. Natural light is also critical to optimum healthcare and custodial facilities. At Bethlem, sunlight is allowed to stream in at the dawning of a new day, giving hope and the impression of a new start. In the areas where patients spend the remainder of the day, daylight is also maximised, continuing the bright, positive theme. In prison environments natural daylight is exploited where possible, to encourage rehabilitation and point to an outside world beyond the prison walls. Both secure unit patients and prisoners must be given the freedom, inspiration, and comfort, to improve.
On a broader scale, the healthcare sector can extract some valuable lessons from large, mixed-use schemes, where the attention to masterplanning and placemaking informs the development and design strategy, to create a successful overall community. The recently completed £70 million Queen’s Centre for Oncology and Haematology at Castle Hill Hospital in Cottingham, East Yorkshire, was designed by HLM Architects as a “village” rather than a hospital. Delivered by the Healthcare Solutions Consortium, it provides five ward areas for 116 in-patients, as well as outpatient care. It has won the RIBA Design Award - Best New Building, the RIBA White Rose Award – Gold Medal, the RIBA Best landscape Award – Commendation, and the RIBA Best Client Award, and has been shortlisted for the Public Private Finance Awards 2009 (to be presented next month) for Best community/user involvement. The theme, an East Riding village, influenced the layout, materials, and the centre’s blend with the surrounding hillside and woodlands. The primary entrance building represents the village hall, while wards and outpatient areas resemble residential cottages. Brick, render, glass, timber, stone-coloured blockwork, and small roof tiles, combine to create a residential impression. All users benefit from maximum daylight and natural views, with nearly all of the 800 rooms looking out over courtyards, gardens, or the surrounding landscape.
‘Holistic’ design approach
In line with a holistic design approach, sustainability informed the overall design, rather than detracting from it. As a result the site’s typography, the building envelope and orientation, the energy usage and so on, all help to deliver a 20% improvement on Building Regulations requirements, and an annual energy consumption of around 53.9 GJ/100m3, far better than the 65-69.9 GJ/100m3 range of most acute hospital facilities. Leslie Welch said: “Using our experience of masterplanning and placemaking, we were able to create a scheme for Castle Hill Hospital which creates a non-institutional, attractive, ‘residential’ community, where quality of life and a caring, therapeutic environment are of utmost importance. As with any major scheme, we invested time in the consultation phases, using dedicated user group discussions and constant dialogue to ensure the optimum result. “This project also shows how challenging sites can make Trusts and their teams think harder and create better facilities as a result,” he added.
Back to nature
Nature has been proven to reduce stress levels and aid recovery. It makes sense, therefore, for healthcare environments to exploit their natural surroundings to put patients at ease, and create environments that positively contribute to their recovery. One hospital has done just that. The £80 million, 41,500 m2 New Victoria Hospital in Glasgow, delivered by the Canmore Partnership and Balfour Beatty Construction, and designed by HLM Architects, will treat about 400,000 patients each year. It is a high-amenity, therapeutic environment, which is sensitive to its surroundings, and non-institutional. Its design theme is a “hospital in the park”. The hospital is a key civic building within a historic inner city community, and the “hospital in the park” concept is reinforced by creating a welcoming urban space, defined by a new crescent façade, which extends the parkland towards the main entrance of the building. A comprehensive landscaping strategy complements this theme, and the building has been positioned to allow maximum retention of existing mature trees on the site. The hospital basically comprises a wide range of outpatient clinics, configured around a series of linked internal courtyards to help make the experience as stress-free as possible. The courtyards are large, to maximise natural light and views throughout, particularly within the major circulation and patient waiting areas. An integrated healing arts strategy continues and enhances the nature theme. “This hospital has nature at its heart,” says Leslie Welch. “The site gave us an excellent opportunity to respect the history of the surrounding area, while creating a parkland setting which gives patients, staff, and visitors, a sense of calm and tranquillity. The park setting, and the attention to layout and orientation, also helped the hospital achieve an ‘excellent’ BREEAM rating.”
From the natural environment, to new communities, to residential and custodial schemes, now is the time to embrace the lessons that other sectors can teach us. More and more companies responsible for the design and delivery of facilities are looking to break into the healthcare sector, bringing with them experience of commercial, residential, retail, custodial, and mixed-use environments. They, along with others with the benefit of multisector expertise, offer new ideas and a fresh perspective that should be welcomed, and which can deliver a better healthcare estate – one which will challenge the status quo, and benefit patients in the long term.
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