Healthcare design – Green Sky Thinking

What will the hospitals of the future look like? The audience for a recent Green Sky Thinking event got an insight from four specialists with different perspectives on designing for healthcare.

Maggie's Manchester Exterior. Credit: Nigel Young Foster + Partners

Maggie’s Manchester Exterior. Credit: Nigel Young Foster + Partners

Laura Lee, CEO of Maggie’s Centres (dedicated to helping people with cancer) opened by explaining why the design of the centres is so important. “People with cancer can feel they’ve lost control of their life. We try to give them that back. We try to take away the feeling of being ‘processed’ – that’s why there’s no reception desk for example.”

Design features strongly on the Maggie’s website: ‘Warm and welcoming and full of light and open space, our unique Centres are designed by leading architects to be uplifting places for people with cancer and their families and friends. Great architecture is vital to the care Maggie’s offers; and to achieve that, we work with great architects, whose expertise and experience is fundamental to the success of our Centres. Each architect offers a unique interpretation of the same brief, based on the needs of a person living with cancer, to create the calm environments so important to the people who visit and work in our Centres.’

Maggie's Manchester interior. Credit: Nigel Young Foster + Partners

Maggie’s Manchester interior. Credit: Nigel Young Foster + Partners

The design of the Centres perhaps runs counter to conventional thinking on what cancer patients might want. They are very open but Lee said, “Privacy doesn’t necessarily mean enclosure.” The support of other people in a similar situation is an important part of the Maggie’s approach and the design, including domestic elements, promotes this interaction and makes people feel at home.

Rather than soothing pictures, the Centres often feature more challenging and distracting artwork. “We don’t want people to lose the joy of living in the fear of dying,” commented Lee.

Healthcare planner Lucy Kalogerides identified three trends in healthcare projects: innovation, meaningful engagement and flexibility. She highlighted that innovation does not necessarily mean “new” as ideas can come from other sectors such as hospitality.

Foster + Partners, hosts for the evening, do not claim to be healthcare specialists but they are clearly learning fast. Head of studio Nigel Dancey described their first project, University of Iowa Stead Family Children’s Hospital; a new hospital for the University of Pennsylvania in Philadelphia and the Aswan Heart Centre in Egypt.

The Stead Family Children’s Hospital is designed as a “healing environment to minimise stress, encourage hope, and provide comfort.”

Every patient has a large (average 360 sq ft) private room with a large window. All post-anesthesia care unit and preoperative/postoperative recovery rooms are also private. Rooms are uniform in size, shape, and layout. Standardising rooms provides a smooth transition for families that must stay frequently, says the hospital. Every patient room includes a family zone with a foldout sofa.

Rooms are same-handed in design, which gave the designers a few problems! However this does mean that beds never share a common wall, reducing noise transfer between rooms.

As the session’s chair, the AJ’s sustainability editor Hattie Hartman, commented, all-private room hospitals divide opinion. Are the benefits of privacy offset by issues of supervision and possible isolation?

At the University of Pennsylvania construction is underway on a new hospital providing 500 private patient rooms and 47 operating rooms in a 1.5m sq ft, 16-storey facility. The new hospital will be the largest capital project in Penn’s history and Philadelphia’s most sophisticated and ambitious healthcare project.

The design and planning process for the Pavilion has been orchestrated by PennFirst, an Integrated Project Delivery (IPD) team comprising healthcare design firm HDR, Foster + Partners, consulting engineers BR+A, as well as construction management firm L.F. Driscoll and infrastructure group Balfour Beatty.

As Nigel Dancey explained, the IPD approach means 120 people working together. Staff from each group, as well as Penn Medicine clinical, facilities, and patient experience experts, work collaboratively in a specially designed “integration space” to ensure cohesion and strategic planning and reduce waste at each step of the project.

The Pavilion will house inpatient care for cancer, heart and vascular medicine and surgery, neurology and neurosurgery, as well as a new emergency department.

The design is flexible to adapt to the rapidly evolving healthcare field. Foster + Partners say: “Special care was taken in the development of the urban realm, creating pedestrianised routes and landscaped gardens and plazas to enhance the public experience.”

“From the moment of arrival, the patient experience is reframed by breaking down the scale of the hospital into smaller neighborhoods which provide a sense of community. The hospital is designed for health and wellbeing providing daylight and landscape views to patients and visitors and the ability to personalise each room.”

The team used extensive, full-scale mock-ups to test the design. Nothing can probably substitute for a physical representation but I wonder if VR and AR could help to bring designs to life for the people who will use them?

The final project presented was the most stunning – the new Aswan Heart Centre to be built on the banks of the Nile. It will include living and lab space plus rooftop gardens. From the visuals we were shown (sadly not available) it will look like a cross between the Eden Project and a colony for a new planet.

As environmental designer with Foster + Partners Anis Abou Zaki pointed out, healthcare buildings tend to have large environmental footprints – they are carbon, energy and water intensive. Buildings are generally sealed, full of energy using equipment, and generate toxic and contaminated waste.

The Heart Centre is planned to be carbon neutral, powered by a new solar farm as part of the project.

The future of healthcare was a major issue during the UK election campaign. As I sat listening to these accounts of applied expertise and innovation I couldn’t help wonder if our NHS will benefit from the same investment and attention to detail. Is it all about money or are there wider lessons here?

Learning environments

When most investigation and communication is mediated through screens do we still need specialised spaces for learning? Or is contact and collaboration the key to successful education and research? What do work places and learning places have in common?

Learning Environments: Future-Proofing our Education Spaces, a one day event organised by the team behind Workplace Trends, explored these and many other issues last week at the new campus of Central St Martins in the Granary complex at Kings Cross.

The rather conventional lecture theatre was packed to capacity (well over 100 people attended), with architects and designers strongly represented alongside estates and facilities people from more than 30 universities and colleges.

The theme that speakers returned to again and again was the response of those commissioning and running buildings to what was called the ‘new pedagogy’.  Steve Howe, director of estates for the University of the Arts (which comprises six colleges including Central Saint Martins) described the new Learning Zone, located alongside a more traditional library, as providing for “social learning and activity-based work within an ambience that facilitates collaboration and creation”.

Central St Martins is interesting because as well as access to online resources and print material students need layout space and equipment for photography and model making. The space has to cater for concentrated, individual work alongside collaboration. The students seem to like it: “There’s space and quiet. Feels like home but with equipment. You can feed off others’ creativity and work ethic. Good for group work.”

Key to the success of such spaces appears to be a fairly relaxed management regime. The idea is to encourage a culture of student ownership, to create a facility that is “welcoming and informal in character, with few rules in place.” Mark Kelly of architects Hassell talked of “self-organising” and “user-managed” spaces.

See the article by Rachel Shaw on social learning in Learning Spaces e-journal issue 2.1

According to Kelly, the shift from a “conceptual age” to a “sharing age” coupled with mobile technology and ubiquitous networks is leading to a merging of space types  -the workplace, collaboration hubs, learning environments.

Universities are subject to the same pressures to use space efficiently as other organisations, perhaps more so. Howe said that the utilisation of traditional lecture spaces (such as the room we were sitting in) is not great. The college is looking at other spaces which can be used for both student activities and teaching.

Lecture theatre

Image courtesy of Jamtree

This point was picked up later by Wendy Sammels of Jamtree who said that new types of lecture theatre allow more collaboration between students and with lecturers (see image above). Such spaces are increasingly being used outside formally programmed sessions, increasing utilisation.

Eleanor Magennis from the University of Strathclyde shared her research into effective learning spaces. One particularly interesting development has been the Student-Centered Active Learning Environment with Upside-down Pedagogies (Scale-Up – the acronym has changed over time) initiative from Dr Robert Beichner,  a physics professor at North Carolina State University.

He has changed how students study STEM subjects  at more than 100 institutions. The Scale-Up approach uses digital technology combined with innovative teaching centred on hands-on activities and roundtable discussions. There’s a good video at http://scaleup.ncsu.edu/

If we truly are in a sharing age then learning will be an essential part of all activity and spaces will need to facilitate it. Commercial and other organisations can learn a lot from what is happening in education right now.

The art of placemaking

As part of the London Festival of Architecture (1st – 30th June) I went along this week to the site of Riverlight, a new residential development by St James (part of the Berkeley Group) in Nine Elms beside the Thames. I was especially interested because I used to live across the river and played in Battersea Park in the early ‘60s.

It’s a challenging site in a neglected area. The new buildings will sit between a pumping station, a cement works and a waste transfer station – that’s a tough sell to prospective purchasers. Change is on the horizon though, with the transformation of the iconic Battersea Power Station to the west finally set to commence this year and the new US Embassy due to open down the road in 2017.

Riverlight comprises six buildings, stepping up west to east from 12 to 20 storeys, set perpendicular to the river and providing 806 apartments, 106 of them affordable. On the lower level there’ll be commercial uses, including a health club. The footprint of the buildings is just 25% of the site, 75% is open space, with 60% of that accessible by the public. It will all be fairly exclusive but this is not meant to be a gated community.

As the design team of architects Rogers Stirk Harbour and landscape architects Gillespies took visitors through the thinking behind the project, I was struck just how much care goes into some developments. From orientation to materials, from the history of the site to the involvement of artists (check out advisors Future City) this is an attempt to make a new piece of urban fabric, a place, rather than simply exploit river views for the benefit of a few.

Of course it’s not entirely altruistic – the developers need to make a return and quality sells. But the challenge of the location and site, a former FedEx depot, seems to have inspired the designers to look beyond the predictable.

Two thoughts – for a new community to work, you need people. If the apartments go to investors who rarely use them, then Riverlight may not have the vibrancy of the CGI images shown in the marketing suite. See recent comments from Simon Hughes MP.

London has too often turned its back on the river (although access and design are improving bit by bit) and this stretch of the embankment is pretty uninspiring.  Creating new open, public areas alongside the river is to be applauded but the key will be maintenance and management. The designs we saw on Tuesday evening were captivating – a pocket park, streams and ponds, weirs and a “beach”. But a few yards away is the harsh reality of Nine Elms Lane – a busy and unforgiving main road.

Riverlight could offer sanctuary and inspiration and not just to its residents. I hope it works and doesn’t become just another privatised space in the city. I look forward to returning.