In Humanism in the Art of Healing (Hospital News February 2001) Tye Farrow wrote of the symbiotic relationship between the quality of hospital design and the overall psychological well-being of patients and staff. “If the delivery of health care and the creation of architecture share the common goal of improving the quality of life,” says Farrow, “then the role of health-care architecture has never been more important in our communities.” Knowing that a poorly designed facility will have a negative impact on patient recovery, he offered recommendations for improving its qualitative aspects.
At the root of his patient-centred approach is a desire to heal the body, mind and the spirit. It is based on the idea that concern for human values is of the utmost importance to the care of the sick, and manifests itself in visually pleasing environments that have a connection to our inner selves; places that evoke images and sentiment through the use of natural materials, access to sunlight, and the union of architecture and open space.
But can these ideas move beyond the theoretical to deliver inspiring environments along with the quantitative benefits for patients and the hospital facility itself?
As two hospital-development projects near completion – The Credit Valley Hospital in Mississauga and The Thunder Bay Regional Health Sciences Centre – it is now possible to continue this discussion by examining the challenges encountered and highlighting the benefits achieved.
Architects often describe the buildings they design in terms of spaces. Farrow infers that we should first design places; individual moments that transcend the usual conflict between form and function to become places where people feel comfortable for their work and healing. And it is in these places, where private and public overlap that opportunities to respond to our inherent emotions are created.
The first case in point is The Credit Valley Hospital, a 320,000 square foot, $85 million dollar ambulatory and cancer care centre currently under construction, the first phase of a three phase redevelopment. Designed by Farrow Partnership Architects, the main lobby – or living room – is punctuated by a dynamic canopy of curving wooden beams. Conceived as trees in a courtyard, the structure gently bends like the branches of a tree to recreate the sensation of an outdoor treed patio. “The structure is constantly in motion and ever changing as you move through it,” says Farrow, “the idea is to keep patients’ minds off why they are there by creating an unexpected experience.”
Beyond aesthetics, the main lobby also serves as a functional hub from which front-of-house circulation routes and public programmes radiate. Flooded with light and softened by the warmth of the wood, the lobby is designed to become a congregational point for patients, staff and the community at large.
At the new Thunder Bay Regional Health Sciences Centre, a 375-bed, 680,000 square foot green-field project, wood is also used as a design feature. Responding to the spirit of the northern context is a three-storey wood and glass walkway that serves as the main public corridor. Sympathetic to the local pulp and paper industries, “the corridor is not dissimilar to the heavy timber railway trestles so prevalent in the region,” says Farrow, Partner in Charge of Farrow Partnership, one of two successor firms to Salter Farrow Pilon Architects, the architects of the project. By design, the glazed arcade curves to follow the path of the sun to allow deep penetration of light and enhance the comforting perception of the hospital. Other front-of-house circulation routes run perpendicular to this main spine and provide a direct connection to natural light. It is also the first cancer center in Canada to incorporate skylights within the radiation treatment rooms without compromising user safety while enhancing the therapeutic experience for patients and staff alike.
To dissolve standard approaches and adopt new methodologies, innovations to the design process must be embraced. The most salient issue in both cases were Ontario Building Code requirements for fire and safety. As wood is a combustible material, its structural use is limited. By working directly with OBC staff and the Ontario Fire Marshal specific technologies were incorporated to achieve compliance ratings and illustrate that wood is an acceptable design and performance equivalent to steel.
In the case of Credit Valley, a unique fogging, or mist-system was specified, as conventional sprinklers could not adequately protect the large amount of shielded surface on the curving beams. Approval was granted only after a full-scale mock-up of one of the trees was successfully fire tested by the National Research Council in Ottawa. At Thunder Bay, design safeguards were achieved by separating the wood and steel elements into separate fire zones, undetected though by the public.
A common perception is that it is difficult to reconcile innovative designs with functionality and still realize quantitative results. This is simply not true. When compared to conventional steel, the cost of the Credit Valley solution was notably less. Interestingly, the project was also tendered under budget despite the complexity of the wood. At Thunder Bay, building orientation and intentional sunshades will help the hospital achieve passive solar energy gains and reduce its mechanical operating costs throughout its life, which will now be monitored.
Clearly, the qualitative results of these designs speak for themselves. Lending credibility is a 2003 joint study conducted by CABE (the Commission for Architecture and the Built Environment) and the RCN (Royal College of Nursing). When 85% of people surveyed agree that better quality buildings and spaces improve the quality of people’s lives, reduce patient recovery times, and improve staff morale, the advantages embracing Humanism are self-evident.
That hospitals are designed with patient care and functionality as top priorities is a basic expectation. However, we must continually work to challenge our assumptions if we are to demystify our health-care environments. Ultimately, the measure of success lies in the ability of a facility to respond to the changing needs of its community without compromising the underlying philosophy of Humanism itself. Having seen the results, it is a challenge worth rising to.