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H

HEALING HOSPITAL
Upycling the OLD for a healthier NOW
H

HEALING HOSPITAL
Upycling the OLD for a healthier NOW

Master Thesis Report


by
Maria Soledad Larrain Salinas
H
Thanks to...

My family for all the support during all this time apart and en-
couraging me to take risks, travel and believe in my projects,
specially when that meant to be apart so far and for so long.

Alice Lindström for her guidance through the very complex sub-
ject of health care and believing in my proposal and the rel-
evance of its outcome. And with her to all the staff of Malmö
University Hospital and Regionservice Malmö for letting me in-
vade their premises and for their valuable time answering my
questions and showing everything, but above all their tremen-
dous disposition to help me.

To my teachers for their advice on assuming this subject and


allowing me to see it through.

To my classmates for opening my world to so many cultures,


and giving me the chance to experience so many different lan-
guages, food and places, and above all for making me want to
go to all those places afterwards and visit.

To my swedish friends for always asking me: why did I came so


far away to the dark and eternal winter? Which let me appreci-
ate what Sweden is and take as much as I can of this experi-
ence.

To my chilean friends in Sweden, for their unconditional pres-


ence and being my family away from home.

To UMA School of Architecture for creating a great space to cre-


ate and propose, and letting me be part of it.

And to everyone that was part of this great experience.


Master Thesis Proyct by Marìa Soledad Larraìn Salinas

Healing Hospital: Upcycling the old for a healthier now.

Examiner: Michael Eden


Professor: Walter Unterrainer
External Supervisors: Juri Soolep and Peter Kjaer.

Umeå universitet _ UMA School of Architecture


LSAP Laboratory for Sustainable Architectural Production Master Program 2010-2012

4 5
CONTENT

PART 1 : RESEARCH
THESIS STATEMENT 8

MOTIVATION 10

HEALTHCARE 12
Health: What is and How to Achieve it? 14
Healthcare through time 18
The Hospital now 24

THE HEALING ENVIRONMENT 28
What to take into account 30
Factors and effects 34
Evidence Based Design 42

PART 2 : MALMO UNIVERSITY HOSPITAL


HISTORY AND CONTEXT 46

VISION 48

ANALYSIS AND MAPPING 50

STRATEGY AND MASTERPLAN 52

BUILDING 65 54

NEW PROPOSED BUILDING 62

CONCLUSIONS 76

6 7
THESIS STATEMENT

In the world today cities are getting overwhelmed to keep up with the demographic explo-
sion, not only they have to grow, but densify; not only to provide infrastructure, but to update it.
One of the most high impact areas is health care, which gives an opportunity of a never
ending process, since a Hospital is never finished and it is a continuous building site, making the
health sector be always in need of re-using, re-cycling and new proposals.
Skåne University Hospital (SUS) in Malmö is responsible not only for the city but the whole
region. In combination with Lund’s University Hospital with a recent addition, they are responsible
of taking care of more than 1.5 million people in southern Sweden. Nowadays it is situated in a
The healthcare system founds itself ill from the fact “­that it has no philosophers in its complex urban plot, with invisible layers and links. In the same spirit as the region council, who’s
midst. That means it thinks too little about basic things, such as: the one running the projections of the institution, the hospital has to improve its services, in-
crease its surface and beds, and upgrade its quality, not only technical but spatial and functional.
what is happiness, actually?” The re use of its current infrastructure is required, but an assessment is needed to see
what can comply with the new requirements for what the call “the future wards” which are to be
Shmid, Wilhelm. In: Brink, Nana: Erste Hilf thought over, introducing a new health concept. The role of the hospital, and the experience of
Die Zukunft der Krakenhäuser. Deutchlandra Kulture, being in one are changing and Malmö Hospital has to stay updated and take action toward the
12 February 2005. new techniques and demands.
The challenge is to create a new ward within the existing structure, in the heart of the hos-
pital. Proposing its communication system and how it would insert itself in the dynamic system,
focusing in: clear circulation for patients and visitors, efficient flows for staff and equipment, and
fast delivery of results and information. The aim of this proposal is to create and efficient system
while focusing on the healing environment in the different spheres: patients, visitors and staff,
making the hospital a healthier place to be.

8 9
WHAT?
MOTIVATION
RE_USE

WHERE? HOSPITAL

WHY?
The urban migration is expanding cities in an extreme way, to avoid
these we have to re conquer and re use our city centres and find a new way
to inhabit them.
We have to start recycling more than plastic. Our attitude toward re
using has to go further than a fashionable thing, to a social strategy. The aim
IMPACT is to implement this attitude into one of the most important engines of the
city, where great impact can be achieved: the hospital.
By getting involved and assuming a propositional attitude, the idea is
to demonstrate that not only we can re use resources but also you can create

HOW?
better realities, by rethinking health and what is being healthy.

UPCYCLE

WHO? COLLABORATION

10 11
H

HEALTHCARE
What is health? Upycling the OLD for a healthier NOW

The World Health Organisation (WHO) defined health in


1948 as ‘a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity’.1 This
coincides closely with the holistic view seeing the patient first as
a person within their family, community and workplace, and rec-
ognising the positive and negative influences each can have on
the person. Helping an ill person back to better health requires
due account to be taken of factors other than their physiology
and anatomy; meeting psychological, social, spiritual and envi-
ronmental needs are important.

1 World Health Organization. 2006. Constitution of the World Health Or-

ganization - Basic Documents, Forty-fifth edition, Supplement, October 2006.


URAL, ENVIRONM
ULT EN
C ,C TA
I L

WELLBEING
M W ORKING CO CO
O D ND
N AN IT N
O G IO D

SICKNESS
C IN
V EA LTH CARE N
LI H S S

-E

IT
E
TO RV

IO
S IC

CI
ES CES AND

HEALTHCARE:
UEN

NS
E

SO
FL SO

C
IN C

S
AC
CTORS AN

IA
FA

Y
D

- +

IT

L
L

UN

SU
TIC FA ELEVATED

LI
NE
PREMATURE

INDIVIDU
LEVEL OF

COMM

FE
What it is and How to achieve it.

POR
AND PRE-

BIO-GE
WELLBEING

CT
VENTABLE

STYLE
AND PER-

ORS
SICKNESS

T
HEALTH HEALTH FORMANCE
AND DEATH
CAPACITY

If we take the matter in a simple way, hospitals are the strategies and agricultural legislation, all actions impact on the
institutions that implement society’s health care, but we start final personal health.
with a void: what is health care? Who are we caring for? And Actually today some of the diseases that are affecting
what should they care about? a majority of the populations and collapsing our health system
When people is asked about the role of a hospital, in the come from unhealthy and uninformed behavioural choices in a
majority of cases the concept: take care of the sick, comes up. daily basis. According to WHO (World Health Organization) in
But when asked what is health and being healthy, more choices their 2009 Report, “Global health risks: mortality and burden
come to mind. Health as a more general understanding is not of disease attributable to selected major risks”, the risk factors
on high-income countries are directly linked to non intelligent
choice of life style and lack of health education, such as: to-
bacco use and high blood pressure, more than to environmental
20% 19%
factors, such as water pollution and sanitation infrastructure.

10%
As a matter of fact the most important factor that will
determine our health is life style. Over a 50% of our health con-
dition will be guided by our life choices in matters like: eating,
exercising, sleeping, smoking and relaxing2. Many of this items 51%
are not seen as very influential in ones life, but more and more
is been proven that on a medium/long term, simple things like
exercising constantly will have a bigger impact in someone’s
Sjuk hus = Building of the
future condition than treating the resulting disease afterwards.
sick, comes from the middle High Ger-
just a state, but also “a resource for everyday life, not the ob- Though many factors seem further than our personal
man siecen-hûs, which was designated
jective of living. Health is a positive concept emphasizing social range, it’s important to realize how health is a joint cause and
a hospital for lepers.
and personal resources, as well as physical capacities.”1 every actor involved has it own role to play, from local gov-
(New Hospital Buildings in Ger- As the early word comes from a less medical root, hospi- ernment to social institutions. Health as we know is not just
many, page 12) tal per se comes from the sense of hosting, where there are two about not being sick, but a whole range of other aspects, that
actors in a dynamic relation: the host and the guest, each hav- is why today health care is not seen just like a hospital, but a
mid-13c., “shelter for the ing its role. The concept of hospitality is born as offering comfort dynamic network, wived into the urban fabric. The hospital till
needy,” from O.Fr. hospital, ospital and guidance to strangers, which during time has been lost in now appeared as the safety net of the system, when nothing
“hostel” (Mod.Fr. hôpital), from L.L. the hospital duty and responsibility. Is here where information, else worked, but latest trends involve the hospital’s mission with
hospitale “guest-house, inn,” neuter of but specially trust come into place, two concepts that are natu- broader issues than just treatment.
Latin adjective hospitalis “of a guest or rally there but should be implemented and strengthened. As In a broad look there is a clear process that guides
host,” from hospes (gen. hospitis); see was mentioned health is a double relationship, where we get healthcare, and will in an end point guide the planning of a
host (1). Later “charitable institution to cared for when in sickness, but there is much more to do before. hospital. We can identify five very distinct stages where society,
house and maintain the needy” (early Our health is bounded to external factors such as genetic and or in this case the patient, move through. Its important to un-
15c.); sense of “institution for sick environmental agents. From our transport system to our politic derstand that though the different stages are always present in
people” is first recorded 1540s.

1 World Health Organization. 1986. Ottawa Charter for Health Promotion, 2 McGinnis, J. M. and Foege, W.H. (1993). “Actual Causes of Death in the
http://www.etymonline.com/
adopted at the First International Conference on Health Promotion, Ottawa, 21 No- United States,” Journal of the American Medical Association, Volume 270, Number
index.php?term=hospital
vember 1986 - WHO/HPR/HEP/95.1. 18: 2207-2212

14 15
PREVENTION DETECTION DIAGNOSE TREATMENT END OF LIFE

Five main processes in healthcare:a citizen perspective; Bo Bergman, Duncan Neuhauser, Lloyd Provost. Downloaded from qualitysafety.bmj.com on February 28,

2012 - Published by group.bmj.com

the health care system, some times the focus is invested in some of them instead than over the
whole cycle.
Prevent: This is the stepping stone of the system, cause this sometimes simple action
translates in further benefits for the whole system. Simple actions like: physical fitness, bed nets
against malaria, a good diet, clean drinking water, less use of tobacco, etc. Preventive action is
THE DETERMINANTS OF HEALTH
taken sometimes as a quite personal matter, but for it to have a real impact in the overall system
is necessary that is reinforced with social initiatives, such as proactive prevention of future ill-
ness. The whole point is in the line of a popular saying: “there is no better patient than the one
Many factors combine together to affect the health of individuals and communities.
that is not sick”. Whether people are healthy or not, is determined by their circumstances and environment.
Detect: Nowadays the healthcare system helps who comes with a condition, and some- To a large extent, factors such as where we live, the state of our environment, genetics, our
income and education level, and our relationships with friends and family all have consider-
times in that situation is already late, that is why proactive outreach on the part of the healthcare able impacts on health, whereas the more commonly considered factors such as access and
system is important. Monitoring and detecting conditions in early times is not only efficient for the use of health care services often have less of an impact. The determinants of health include:
the social and economic environment, the physical environment, and the person’s individual
system, but also beneficial for the patient. This strategy must be impulsed by the health institu-
characteristics and behaviours.
tions and also governmental campaigns, focusing and spotting behavioural and medical trends in The context of people’s lives determine their health, and so blaming individuals for
having poor health or crediting them for good health is inappropriate. Individuals are unlikely
the community, so they can be addressed before a condition becomes a disease.
to be able to directly control many of the determinants of health. These determinants—or
Diagnose: This is probably today’s one of the key processes in a hospital performance. things that make people healthy or not—include the above factors, and many others:
An on time and efficient diagnose is probably one of the most cost effective steps, where health
Income and social status - higher income and social status are linked to better
management can improve their performance. For the organization is a way to save resources health. The greater the gap between the richest and poorest people, the greater the differ-
and time, which translates in the possibility of relocating those resources where they are really ences in health.
Education – low education levels are linked with poor health, more stress and lower
needed. A miss diagnose can waste a lot of time and human workforce, but the most relevant is self-confidence.
also that the timeline of a diagnosis is critical for many disease paths. Physical environment – safe water and clean air, healthy workplaces, safe houses,
communities and roads all contribute to good health.
Treat: This is the core of health care’s mission today and through time, though this is a Employment and working conditions – people in employment are healthier, par-
very technical and specific process, it is the reason for why people resort to the health system. ticularly those who have more control over their working conditions
Social support networks – greater support from families, friends and communities
Though curing is important, caring has become a side concept, expanding the technical treatment is linked to better health. Culture - customs and traditions, and the beliefs of the family and
to a more complete view of recovery. community all affect health.
Genetics - inheritance plays a part in determining life span, healthiness and the likeli-
End life: Probably one of the most controversial stages in healthcare, has to do with giving
hood of developing certain illnesses.
life quality to whom is about to die. In difference as the other processes, this does not require of Personal behaviour and coping skills – balanced eating, keeping active, smoking,
drinking, and how we deal with life’s stresses and challenges all affect health.
specialist of different areas, but a more holistic approach that give relief and a good end period
Health services - access and use of services that prevent and treat disease influences
of life for people in that path. Is not about effective endless treatment trying to fix something health
broken, but to reflect on the general state of the patient and what is better for their case. For ex- Gender - Men and women suffer from different types of diseases at different ages.

ample there is no point to do a high risk operation to fix one organ on an old patient who’s entire
system is shutting down, but to improve its environment.

World Health Organization _ Health Impact Assesment


http://www.who.int

16 17
HEALTHCARE THROUGH TIME:
like state of induced sleep, in which they either received well-organized hospitals, staffed by doctors who were both
guidance from the deity in a dream or were cured by sur- male and female. Facilities included systematic treatment
gery. The worship of this god and the treatment rituals procedures and specialized wards for various diseases. The

The Hospital Journey. were kept by the Romans.


After Romans converted to Christianity, health cov-
Christian tradition emphasized the close relationship of the
sufferer to his fellow man, upon whom rested the obliga-
erage expanded through the empire. Following First Coun- tion for care. Illness thus became a matter for the Christian
cil of Nicaea in 325 A.D. construction of a hospital in every church.3
cathedral town was begun. Among the earliest were those Medieval hospitals in Europe followed a similar pat-
built by the physician Saint Sampson in Constantinople and tern. They were religious communities, with care provided
by Basil, bishop of Caesarea in modern-day Turkey. Called by monks and nuns. Some were attached to monasteries;
the “Basilias”, the latter resembled a city and included hous- others were independent and had their own endowments,
Hospitals have come a long way through history, not
ing for doctors and nurses and separate buildings for vari- usually of property, which provided income for their sup-
only in a formal point of view, but most important in their
ous classes of patients, with a separate section for lepers.2 port. Some hospitals were multi-functional while others
genesis. They have been a kind of reflection on society
Some hospitals maintained libraries and training programs, were founded for specific purposes such as leper hospitals,
all along, because the definition of health and health care
and doctors compiled their medical and pharmacological or as refuges for the poor, or for pilgrims: not all cared for
goes deeply rooted to what is the concept of person and
studies in manuscripts. Thus in-patient medical care in the the sick.
society. To understand where is the debate now, and why
sense of what we today consider a hospital, was an inven- In Europe the medieval concept of Christian care
has it got here, we need first to understand the journey of
tion driven by Christian mercy and Byzantine innovation. evolved during the sixteenth and seventeenth centuries
this institution, that through the centuries has been evolv-
Byzantine hospital staff included the Chief Physician (ar- into a secular one. It was in the eighteenth century that
ing looking for the right way.
chiatroi), professional nurses (hypourgoi) and the orderlies the modern hospital began to appear, serving only medical
Some of the earliest documented institutions aiming
(hyperetai). It can be said, however, that the modern con- needs and staffed with physicians and surgeons. The bour-
to provide cures were ancient Egyptian and Greek temples.
cept of a hospital dates from AD 331 when Constantine , geoisie started founding the new hospitals in the fast grow-
In ancient Greece, they were dedicated to the healer-god
having been converted to Christianity , abolished all pagan ing cities. Now they were civic buildings, commissioned by
Asclepius, known as Asclepieia. This temples presented
hospitals and thus created the opportunity for a new start. authorities , but usually managed by religious orders. Hos-
themselves as centres of medical advice, prognosis, and
Until that time disease had isolated the sufferer from the pital became the face of reason, of progress. Though the
healing1. At these shrines, patients would enter a dream-
community. By the twelfth century, Constantinople had two world was still runned by aristocracy and the church, the

1 Risse, G.B. Mending bodies, saving souls: a his- 2 Catholic Encyclopedia - [1] (2009) Accessed April 3 http://www.edwardtbabinski.us/history/hospital_
tory of hospitals. Oxford University Press, 1990. p. 56 2011. history.html

_Lepers are isolated from society


Military Hospital

_Black Death Plague


_Plague of Justinian
_Antidote to poison

Infirmaries
Monastery
_Athens Plague

Crusades
Academy

Convent

Charity
Temple

Temple

Church

Church
Bath

100 200

Inn

1000

1300
1100

1200
800

900
400

100

300
200
600

500

300

200

100

400

500

600

700
0
Technology

Nature
Human

Temple of Asclepios, Greece Medirigiriya Hospital, Sri Lanka Temple of Asclepios, Rome Valetudinarium Hospital, Rome Gundishapur’s Academy, Persia Saint Basil the Great, Cappadocia Xenodochium of Mérida, Spain Abbey of Saint Gall, Switzerland Hôtel-Dieu, of Paris, France Santo Spirito in Saxia, Italy
-600 -400 -293 -100 271 369 580 612 651 1204

18 19
hospital became an island for the rational thinking and a pitals became full of new equipment, and with that the of sciences, as to become in effect a scientific instrument
symbol of what was coming after, started by the french services provided became out of reach for the poorest and not escentially different from the X-ray machine or the op-
revolution in 1789. needy, which till now was its objective crowd. Hospitals erating table which it encloses. It is hard for people to
A stepping stone was in 1772 when a big fire burned came from almshouses to top medical institutions, chang- imagine any relationship between such a building and taht
the Hotel Dieu in Paris, in icon of healthcare of the times. ing the aim from helping the ones in need to developing great tradition whose flowers are the Parthenon and the
After this event, there was an opportunity to re-think and technology. The pavilion system showed to be inefficient Cathedral of Chartres. It is hard to think of a hospital as a
propose new environments for the sick. Even though noth- with the long distances and communication issues, and the work of art”
ing was built right away, it fuelled the discussion, shifting expensive machinery forced to go back to concentration
the healthcare aims of the time. Now it wasn’t a place of resources. Now doctors, machines and the elite where J. Hudnut, ‘Architecture and the Art of Medicine’, in Journal of the

where to accommodate poor and sick people, but to take the inhabitants of the new hospital: the Block Hospital. American Institute of Architects, 1947, n°4, 147.

care of the “common man”. By 1859 Florence Nightingale, Highly concentrated and big scale representative build-
an Italian nurse with high knowledge on health statistics, ing conquered the city. This monumental creature lost the After the Second World War, and due to the social
noticed that the death rate in city hospitals was much feature and ambition to create healing environments that revolution that came with it, the “welfare state” concept,
higher than the patients in a same state treated outside would emulate nature. This machine like buildings accom- shook things for hospitals again. The late examples of
this institutions. This became a turning point on the ob- modated technology and resources in a efficient and cost technological sanctuaries had to open way back to the “
jectives of hospitals of those days. The urbanity of the effective way. Nature and small scale movement became common man” and safeguard its health. The hospital re-
time was faced with a mayor issue: hygiene, and hospitals an artistic ideal. gained its role as a social institution, and became a monu-
turned in search of clean air. This quest became the first This shift lead to over organized, technology ridden, ment for welfare, and entering a new age of science pro-
step towards natural environment, and relating nature to anti-human establishment, mostly blamed to the modern- gress as social justice.
the healing process. ist architecture. Though during the 20’s and 30’s avant- This new capitalistic oriented welfare found its face
Though the popularity of the pavilion type grew, the garde modern movement shared the nature-oriented view in the international style, which introduces back the refer-
importance of nature took a step to the side and medical of the beginning of the century, but didn’t got the chance ence to nature, taking this urban institution to the outsides
advances took over. Now the pavilion model was a repre- of taking those ideals to reality. of cities in the search of spacious locations. The architec-
sentation of medical specialization, a series of small hospi- ture became synthetic, a combination of three parts and
tals inside the original one. “No art is more widely misunderstood than the art characters: Patient ward, Medical Treatment, Daycare.
Everything changes by 1895, when Röntgen, a of achitecture, and no buildingd illustrates teh misunder- This became a grouping exercise and a typology test for
German physicist discovered and shared the X-Rays. Now standing more clearly than the hospital. The hospital has architects, resulting in during the 50’ and 60’ in several
health care was not so much about the care, but instead, become completely a product of the technologies of medi- types named after the letter they resembled: T, K, L, H.
technology took its place. With this turnaround now hos- cine and of manufacture, so precisely adapted to the uses During this time medical technology and science
Secular Institutions
_Colombus discovers America

Pavillion Hospital
Voluntary Charity

Military Hospital

Urban Hospitals
_Hotel Dieu burns down

Specialisation
Guest House
_Black Death Plague

_French Revolution
_Bubonic Plague

Statistics
Academy

100 200

Inn

1900
1600

1800
1700
1400

1500

Hospital San Pau, Barcelona Hospital of Jesús Nazareno, Mexico Hospital leeuwenberghkerk, Royal Hospital Chelsea, UK Hospital Charite, Berlin Hotel Dieu, Paris Vienna General Hospital, Austria Selimiye Barracks, Turkey Lariboisière Hospital, Paris St Thomas Hospital, London, UK
Guillem d'Abriell Pedro Vázques The Netherlands Sir Christopher Wren 1710 J.B. Leroy 1784 Florence Nightingale Pierre Gauthier H. Currey
20
1401 1421 1567 1681 1773 1854 1854 1865
21
where moving faster than the have ever done it before, This new shift pointed to a more natural society, plished, though shopping and social activities where under
and it was precisely this that became the biggest challenge giving the importance of the physical and social environ- the same frame, this were very different from the medi-
for architects and hospitals. Adaptability became an essen- ment for the well-being of people. So the challenge of the cal side, now the border was inside the hospital ground,
tial design aspect to keep up with the dynamic scene of new hospitals now was quite different: it was a balance instead of actually blurring the limits it was just a matter
technology. As a result of building experience during 50’s play between the individual and the collective; the per- of disguise.
and 60’ American Military Hospitals came with a strategy sonal experience of the patient and the medical needs of
for this changes. Most of the technological changes would the staff. The answer for this new approach was the instal-
occur in the treatment and outpatients area, so for this lation of basic, industrially built structure that would work
they would have a low horizontal building, easier to retrofit as a neutral framework where more individualized com-
and redesign, and the patient wards that was the area with ponents could be inserted, tackling the core of the hos-
less change could be concentrated in a high rise building. pital’s problematics. This “style” also had other concerns,
This was a building boom for hospitals, especially in Eu- beyond only the hospital building itself, but its urban role.
rope and the United States, where this new slick and high Stepping away from the monumental big scale building,
tech building took place, again an example of rationality, there’s mostly low rise buildings. This new projects try to
but this time was seen in another way. read the large scale grid, and integrate to the urban tis-
A counter culture, instead defined it as a bureau- sue. The hospital grid tries to follow the surrounding city,
cratic creature that represented the political and economi- becoming unrecognizable as a single building or institu-
cal establishment. The hospital became a bureaucratic tion. The strategy is to develop really flexible structure,
sphere, governed by politics or big companies, and this for the same reason they must be neutral and inexpres-
influenced the inner life of it. Patients were not treated like sive, the function of today won’t be the same as tomorrow,
a person anymore but like a “disease case”, and it could so the frame shouldn’t express neither. Another turn was
say that the patient concept almost disappeared from the the differentiation of the medical machine and the flows
hospitals concerns. The modern life was blamed to be the of visitors and patients, during the 80’ and 90’ hospitals
source of illness, society as a whole was seen as sick and where recognized by large halls and passageways, cov-
the ‘medical fortress’ was an accomplice. This views turned ered street and squares. This is the time where shops and
the scene around, where society had to shift from institu- urbanity jump inside the hospital structure, accompanied
tional power to citizen power, and this had a huge impact by change in the management vision, the hospital became
inside the hospital, where patients became the main actor more a social place than a medical one. But this attempt
in the new system: patient-centered care. to take part of city urban life, wasn’t completely accom-
Pavillion Hospital

The inner Street


City in the City
Health Suburb
Functionalism
Art Nouveau

Energy Issue
Hospital City
Monumental
Modernism
_X Rays

100 200

2000
1920

1980
1970

1990
1930

1940

1950

1960

2010
Hospital San Pau, Barcelona Paimio Sanatorium, Finland Beaujon Hospital, France Maimonide Hospital, Sn Fco, USA Princess Margaret Hospital, UK Vienna General Hospital, Austria Erasmus Hospital, Rotterdam, NL St. Mary’s Hospital, Newport UK Univ. Medical Center, Groningen, NL
Lluis Domenech i Montaner Alvar Aalto Plousey, Cassan, Walter Erich Mendelsohn Powell, Moya 1784 Medicine Faculty Rotterdam Ahrends, Burton, Koralek UMCG
1902 1929 1933 1946 1957 1972 1982 1997

22 23
THE HOSPITAL NOW:
The New Mission and Challenges of Today.

OUTSIDE THE
OUTSIDE
CITY THE
OUTSIDE
CITY
OWNING
OUTSIDE
THE CITY
THE
OWNING
THE
CITY
CITYTHE
OWNING
CITYALIEN
THE
OWNING
IN
CITY
THE
ALIEN
THE
CITY
CITY
IN THE
ALIEN
CITY
IN
BECOME
THE
ALIEN
CITY
THE
INBECOME
THE
CITY
CITYTHE
BECOME
CITY THE
BECOME
CITY THE CITY

NATIONAL Hospital and the City ity onto one person, but also creates the ghost of uncertainty
POLICIES
Today Hospitals face again a turning point, where not of work. All that comes to the most serious matter how it is
After studying the journey of this emblematic institution EDUCATIONAL REGIONAL
only the building is being questioned but the system at large. mental health.
CAMPAIGN POLICIES
the only thing that can be seen as permanent has been the More and more, the view of the hospital as a city has come In Sweden from the 90’ sickness absence and disability
continual change, not only in shape and strategies, but in its through, and the will to integrate to the urban tissue is dominat- retirement caused by mental problems and disorders have risen

?
core. Because of this continuous shifts it feels sometimes that ing, but what does this aim to? Is not about systems and repli- markedly. Concepts such as burnout, depression and chronic
hospitals are, one step behind or are just a bit too late to meet cating a model, it goes beyond that. The ultimate characteristic fatigue syndrome have been used increasingly in the media and
W H A T
current needs of society. That maybe is because a hospital pro- TRANSPORT COMMUNAL
that comes out from a good design city and what is lacking in are now part of everyday language.
SYSTEM TO DO PROGRAMS
ject is planned to be long term, taking into account that the life the healthcare area is integration that is a direct result from a These phenomena are probably the result of prolonged
cycle of one of this structures is of 50 years. Lately, as most living and active community. Which will translate in to a social stress processes, and the biological and medical risks of pro-
technical areas, has been growing and changing at much higher engine that will create a true platform for social, economic and longed stress have been highlighted recently (Lundberg & Wen-
rates than ever, leaving us with a complex scenario. cultural integration, because health has never been an individual tz 2004). Signs of reduced mental well being therefore deserve
WELLNESS SOCIAL
INFRASTRUCTURE INICIATIVES
matter but a social one, and for that it has to be understood as attention, since they may develop into serious health risks in
The hospital as a building has been adapting to time, but part of a bigger picture. Is mistakenly believed that if a hospital the long term.1
FOOD
INDUSTRY
without a complete solution. We can go back to the beginnings is located in an urban setting, this will be a guarantee for its
of the modern hospital in the enlightenment, where rationality integration, but this is a complete error, consequence of the lack Green Hospital
ruled the guidelines and nature had an important healing role, of understanding of the complexity of the health landscape. The As time goes “Green” approaches have appear in every
but the patient was not the focus, but its illness. After, moder- aim of re-urbanizing hospitals is not only so they fit in the city area and hospitals are no exception. Though is very true that
nity creates the most efficient hospitals, but falling into the trap on a functional way, but also to has to overcome built obstacles certification and regulation helps keeping matters in order, and
“Hospital mirror and project the consciousness and
of giving life to a machine, more focused on its functioning that and finally connect physically to the city. One example of this is a visible way for institutions to show their investments and
acceptance of responsibility of its society”
what this engine was producing. Then we come to today, due The Zitgeist is the University Medical Center Groningen, where even though standards to the community their serving, and in that way gain
to high regulation and the current bureaucratic apparatus, hos- is on a urban location its surrounded by built barriers and the its trust.
pitals have been victims of lack of planning and power games, only place that opens up, is in a monumental entrance hall with Until the mid 90’s hospitals and health care facilities en-
becoming complex messy buildings instead of better buildings. a “public plaza” towards a highway instead than the city itself. joyed a deceiving reputation the cleanest buildings, where peo-
The System itself is portrait in this kind of patchwork inside ple didn’t question their neatness, but after an eye opener re-
the institution, building from different times without any main GREEN
Industrialized Hospital port issued by the US Environmental Protection Agency, where
HOSPITAL
guide, just stacked together as the needs appear. Creating in- One criticism often voiced is the ‘industrialised’ nature medical waste incinerator, over 5.000 in North America, turned
FREE MARKET
timidating fortresses filled with a riddle of corridor mazes run HIGH TECH
HOSPITAL of care, heritage of the machine hospital of the modernists still the red alarm becoming the single biggest source of dioxin emis-
HOSPITAL
by bureaucracy. This anonymous institutional complexes are alive to this times. The high working pressures often put on the sions into the atmosphere. With this all heath institutions where
hardly ever functional, and most of the time are unfit for its

?
staff can sometimes exacerbate such rushed and impersonal put on the spotlight, and their attitude towards environmental
purpose, resulting in high factors of stress and anxiety, which treatment. The architecture and setup of modern hospitals of- policies and strategies had to change from a quite passive one,
undermines the patient’s recovery. This scenario is the result of ten is voiced as a contributing factor to the feelings of face- to a more active one, giving the industry the chance to lead the
WHERE HOLISTIC
an reactionary attitude toward health and well being, leaving COMMUNITY
less treatment many people complain about. The high stress in needed change.
HOSPITAL TO NOW HOSPITAL
the big pictured blurred for anyone to see, guiding blind throw health workers, not only affects their work and health but also Hospital are not only expensive, but also highly polluting
contingency. contributes to the already stressful experience of the patient. and stress producers.
According to a report about Work life and Health in Sweden Today the Healthcare sector is growing fast, and many
WELLNESS CLIMATE done by the National Institute for Working Life almost 40% of eyes are on it for its big impact, not only social, but also eco-
HOSPITAL FRIENDLY
HOSPITAL the health workforce is under an “unhealthy” work situation. In nomical, political and ecological. Now is the time where we
ENERGY addition to that, most of budget cut in health are solve by per-
EFFICIENT 1 Worklife and Health in Sweden 2004. Rolf Å Gustafsson,Ingvar Lundberg
HOSPITAL sonnel reduction, that not only puts more work and responsibil-
(eds.)
24 25
have to realize that they are part of an ecosystem, and so are all GOVERNMENT MANAGMENT
human creations. Its being proven that our wellbeing is directly
related to our environment, and for that we are not only linked
to the ecosystem around us, but part of it. This means that our
well being is directly related to the environments well being, and
you can’t have one without the other.
A hospital or any health institution can see that they
can no longer think of themselves as an isolated island, exempt
from its urban ecological context. We have come to a point
were healing the individual is directly connected to healing our
INSURANCE DOCTORS
planet. I might sound a bit to general or heroic, but no society COMPANY
will ever have healthy individuals, healthy families or healthy
communities if there is no clean air, clean water and healthy
soil. Hospitals in the US have “enormous carbon

Health care institutions should not build to meet a label, footprints”, being the second most energy intensive

since they will change with time, but use the existing resources building type behind that of the food service indus-

and make it efficient. The existing health infrastructure is there try and twice that of commercial buildings.

and is huge, the impact on the overall system, if they would be They are “extraordinarily water intensive”,

used, upgraded and renovated with a long term vision, it would averaging about 300 gallons per patient per bed per
day when there is a desperate need to reduce the PATIENTS NURSES
be more efficient that burying them and build new. The value of
the existing structures is great, not only for its cost and mate- water footprint.

rial, but for its location and existing relation with the city. The National Health Service (NHS) in Eng-
land has calculated its carbon footprint at more

Hospital as a Social entity than 18 million tons of CO2 each year — 25% of

Hospitals are today barely alive and serving its purpose: total public sector emissions.

healing sick people, though the purpose also has to change. Is Brazilian hospitals use huge amounts of en-

being sick wasn’t bad enough, patients are obliged to go to this ergy, accounting for more than 10 % of the coun-

intimidating place where they are stripped of any privacy, suffer try’s total commercial energy consumption.

of long waiting times, are exposed to uncontrollable noise and


HEALTHY
Towards a Green Hospital
get separated from family, taking into account that from the PERSON

start people in a hospital are already low in spirit hospitals today Speech held by Dr. Wolfgang Sittel at the Asia Pacific- CURRENT PURPOSES
only manages to get that spirit even lower, not only for patient Weeks in Berlin.
FOLLOWED BY HEALTH CARE
but also for the already overwhelmed staff. September 8ht 2011.
SECTOR:

+
Hospital staff is mostly disregarded in the discussions
and are seen as a pressure group, difficult to negotiate with,
but they are the direct link between the “machine” and the pa-
Enhance communica-
tient, they are the face of the system and the change starts
HEALTHY
HOUSEHOLD
HEALTHY
HOSPITAL tion between referring phy-
with them. Nurses and doctors have the opportunity to touch EDUCATION sicians and the hospital, im-
peoples life, making them important agents for changing think- prove team communications,
ing, behaviour, communities and patterns. The importance is to
streamline patient flow, and
not forget that Health care is health+care and that show be the
guide line for every decision and action.
decrease waiting time and
Now they are work as Medial Health Centres for the In- overall length of stay.
HEALTHY
dividual, but they must take the leading step towards the para- CITY
digm shift: Heath is not individual but collective. The challenge
for hospitals is to walk away from just being a building but a
leader of change and education, which is also the key in the
prevention of disease.

26 27
H

THE HEALING
ENVIRONMENT
Upycling the OLD for a healthier NOW
Heal:
‘To restore to health’

‘To cause an undesirable condition to be


overcome’
PATIENT:
“ As a patient, I want a private and comfortable room which has supportive
environment but flexible and have lots of function such as sit, stand, low-down and

HEALING ENVIRONMENT:
look outside. Outdoor environment must be quite good, the I can have a good view.
-Need of privacy A flexible space that could change quite easily and I can get all the things quite easy
-Need to socialize with and cured. A private room should be good but sometimes I want to communicate

What to take into account. others


-Healing Environment;
with other patient, doctor or nurse. So it may be just half-open. The room should
be a good place to release my stress and pressure, as comfortable as my home.
Indoor+Outdoor Also it should be a quiet place, cause I don’t want to hear other patients moan in
my room. Some connection with nature is needed, I know that I can’t be outside,
but I want to see nature.”

It is been a couple of decades now that hospitals have


been criticized for its poor spatial qualities and disregard to-
wards the patient, who is supposed to be in the genesis of it
core. And how it always works, if something gets criticized pro-
posals have to be suggested, is in this dynamic that the concept
of healing environment was created. But this shouldn’t be taken
lightly, because as its name says: the environment has to heal.
STAFF
But how do we know that? For that a method is needed.

Healing environment: describes a physical setting HEALTHY


and organisational culture that supports patients and families PATIENT SPACE
through the stresses imposed by illness, hospitalization, medi-
cal visits, the process of healing, and sometimes, bereavement.

During the second half of the last century, medicine took VISITOR
a scientific turn, in hand with evidence based medicine, the
whole field moved towards research, which is by the way today,

STAFF: VISITOR:
one of the biggest areas in the medical community not only
for it reputation but also because is highly financed, from that
hospitals couldn’t function without a research branch in their
system. -Need accessibility to -Smell of hospital
After World War II not only medicine was advancing in corridors and rooms -Walking through the
the research field, but from the contingency of the time envi- -Comfortable Working corridors
ronmental psychology stepped up, raising new discoveries but environment -Comfortable place to
also new questions. Is during the 80’ when the architect and -View to outside/ Relation to time relate to the patient
researcher Roger Ulrich saw in this investigation a rich source and space
of data, through a report exposing that surgery patients with
a view of nature suffered fewer complications, used less pain “Bob can meet his mother from 10 to 1 o’clock, then
“John gets home at 6 am. Takes the grocery list from his
medication, and were discharged sooner than those with a his mother goes to lunch. Then he’s able to see her from 3
wife who’s leaving for work. He has to dress his son that also
brick-wall view, and with this the effects on people of a certain to 7 in the evening. After work goes to the shop to buy some
got a cold thanks to the germs he brings home, he hates night
environment started to be measured. things for his mother and goes to the hospital, already being
shifts. He drops his son off, does his groceries and tries to catch
Rooting from this scientific approach the hospital’s critics around 5. He can meet a lot of visitors, cause most of them
a few hours of sleep. Even after all the years he hasn’t managed
had something to work from, and now evidence could support can only make it after work.
to adjust to the shift. Wakes up in time to make dinner and fetch
decisions not only in the field of architecture, but also designers He feels very unpleasant smells and sees very sick
his son from school. He waits for his wife and hopes she comes
and managers. Everything started to be measured: clinical out- patients. He’s afraid of that and of the possibility of getting
in time or he will have to leave his son at the neighbours. She
comes, staff efficiency and patients impression; since this was something himself. After passing several floors and corridors,
comes. They exchange a few words and off he goes. He will
an empirical approach, replacing philosophical matters, opin- he reaches the ward where his mother is. There are other
be going straight to the hospital from her elderly home for yet
ions and suggestions weren’t regarded because of their lack of people in the ward, so they can’t have a normal chat. They
another night shift.
objectivity, instead only “first reactions” were used as firm data, can go to the yard and talk more privately and have a walk.

30 31
NATURE POSITIVE D I S -
The view or perception of
TRACTION
nature brings the patient
Elements like art and activi-
a sense of calm, reducing
ties help to scape from the
stress levels.
though with time this has been also questioned. factors is stress reduction. It was discovered that over the exist- hospital environment, creat-
ing a break in the routine.
After building data and analysis of results, by publica- ing stress experimented by medical procedures, many features
tion on different matters, Evidence based Design (EBD) could of the same hospital actually help increase the environmental
be implemented in new projects and renovations through out level of stress for the patient.
the globe. This as a tool was perfect for architects to convince The reduction of stress is not important just for reducing
their clients, Institutional managers to guide their boards and stress itself, but for the side effects that come with it, not only LIGHT NOISE
The view or perception of Its reduction affects not
medical staff to demand changes. The body of research and in- for the patient but also for the staff and physicians .Shorter nature brings the patient only in the patient but also
formation is building day by day and not only that, it is getting outcomes, less medical errors and fewer prescribed medication a sense of calm, reducing the staff, translating in less
stress levels. stress and medical errors.
updated, which present a new challenge: what was efficient or are some of the benefits that addressing stress can mean for a
preferable yesterday, might not be today. health care facility, so it’s not only a better service but a more
As every architectural approach EBD has to respond to economic one also.
a multi-sensorial demand, in its core regards the health impact
of a particular environment on patients, staff and visitors as a Research has proven that the actual design can influence
guiding principle of design. So from Ulrich’s connection between medical outcomes by mitigating stress or increasing safety, SAFETY
AIR
Secure environment reduc-
view and pain, many studies and researches were made for dif- that is why the focus today for most facilities are : reduction Air transmitted infection is a
es stress, but in a higher
serious issue, since is a high
ferent factors as light, colour, sound, control and distance. After of stress, patient and staff safety, and energy and resource ef- degree avoids unnecessary
factor for extending stays
injuries and complications.
many actions were implemented in different settings the main ficient building. due to new complications.
factors for comparing results and weight its validity are: patient So what does a healing environment consist of? The
clinical outcome, staff recruitment and retention and facility op- main considerations that are mostly agreed in the overall com-
erational efficiency. munity are:
Though many factors are in play at the time of recovery _Connection to nature, Option and Choices, Positive Dis-
one that showed to be one of the most influential in all three tractions, Access to social support, Environmental stresses
SOCIAL SUPPORT CONTROL
Is an important factor for Is an important factor for
patients to feel at ease in a patients to feel at ease in a
new environment. new environment.

32 33
HEALING ENVIRONMENT: Noise
Frequent overhead announcements, pagers, alarms, and noisy
Factors and Effects. equipment in or near patient rooms are stressful for patients
and interfere with their rest and recovery.1 Single-bed rooms
with high performance, sound-absorbing ceilings and limited
overhead announcements can substantially improve the heal-
ing environment for patients.2

Stress 1 Nelson C, West T, Goodman C. The Hospital Built Environment: What Role

Might Funders of Health Services Research Play? Rockville, MD: Agency for Health-

Though is a very normal condition, today’s levels of stress are care Research and Quality; 2005 Aug. AHRQ Publication No. 06-0106-EF.

not only higher but also present in a larger group. The known 2 Ulrich R, Zimring C. The Role of the Physical Environment in the Hospital

risks, that everyone has experienced at least once, are only the of the 21st Century: A Once-in-a-Lifetime Opportunity. Concord, CA: The Center for

superficial signs of more relevant effects in the body. On top of Health Design; 2004 Sept.

everyday stress, patients accumulate a higher level provoked


by anxiety, confusion, fear and worries provoked by the medical
procedure and clinical environment. One of the characteristics
less know about stress is probably its duration that can last for
hours after an stressful event. Independent from the procedure
stress produces a hormone that also lowers the threshold of
pain, giving the patient a higher pain sensation.

Errors & Safety


But this condition actually not only affects the patient but in BRAIN AND NERVES
great measure affects the medical staff. By overloads of re- Headaches, feeling of despair, lack of energy,
sadness, nervousness, anger, irritability,
sponsibility, lack on material and staff, and inadequate facilities increased or decreased eating, trouble
for the required tasks, health workers become a highly stress concentrating, memory problems, trouble
sleeping, mental health conditions, such as : Medical Errors: Poor lighting, frequent interruptions two primary causes of patient falls. Many falls can be reduced
group, which is directly transferred to the patient, creating a panic attacks, anxiety disorders and depres-
and distractions, and inadequate private space can complicate
sion.
through providing well-designed patient rooms and bathrooms
vicious circle. filling prescriptions. Well-illuminated, quiet, private spaces al- and creating decentralized nurses’ stations that allow nurses
SKIN
low pharmacists to fill prescriptions without the distractions that easier access to at-risk patients.4
Acne , irritation other skin problems.
may lead to medication errors.
4 Transforming Hospitals:Designing for safety and Quality. Agency for
MUSCLES AND JOINTS
Patient rooms that can be adapted for the acuity of a
Muscle aches and tesion, especially in the Healthcare and Quality, US. 2007
neck, shoulders and back. Increased risk of patient can also reduce errors. Acuity-adaptable rooms reduce
reduced bone density.
the need to transfer patients around the hospital and lessen the
HEART burden on the staff to communicate information to caregivers in
Faster heartbeat, rise in blood preassure,
increased risk of high cholesterol and heart the patient’s new location.3
attack.
Patient falls: Patient falls, which are common in hospi-
STOMACH
Nausea, stomach pain, heartburn, weight gain. tals, can result in serious injuries, extend a patient’s stay, and
drive up the cost of care significantly. By 2020 the estimated
PANCREAS
Increased risk of diabetes annual cost of fall injuries for older people will exceed $30 bil-

INTESTINES lion.7,8 Now that the Centers for Medicare and Medicaid Ser-
Diarrhea, contipation and other digestive vices no longer reimburse hospitals for the cost of patient falls
28% problems.
that occur in their facilities, and insurers are likely to follow its
of health care workers report REPRODUCTIVE SYSTEM
lead, hospitals will bear a greater portion of this cost.
For women: irregular or more painful periods,
a higher than average degree of reduced sexual desire. For men: impotence, Poor placement of handrails and small door openings are
lower sperm production, reduced sexual
stress compared to 18% of the desire.
general population. 3 Ulrich R, Zimring C. The Role of the Physical Environment in the Hospital
INMUNE SYSTEM
of the 21st Century: A Once-in-a-Lifetime Opportunity. Concord, CA: The Center for
bmj.com Lowered ability to fight or recover from illness.
Health Design; 2004 Sept.

34 35
INFECTION
Single-bed rooms and improved air filtration systems
can reduce the transmission of hospital-acquired infections.
Infections can also be reduced by providing multiple locations
for staff members to wash their hands so they spend less time
walking to sinks and have more opportunities to sanitize their
hands before providing care.5 One of the most effectives meas-
sure in to have a sink in every room entrance, in plain sight and
in the nurses working path for accesibilyty and also the patient
can supervise the medical staff’s cleaning habits.

5 Ulrich R, Zimring C. The Role of the Physical Environment in the Hospital

of the 21st Century: A Once-in-a-Lifetime Opportunity. Concord, CA: The Center for

Health Design; 2004 Sept.

NATURE
On a first aproach we can all agree the looking at nature Environmental preference studies have shown that a
has a traquilising effect and that it provokes a positive outcome natural setting is the view of choice. Charles A. Lewis refers
in our current condition, for patient it has been proven that this to it as “green nature”(Spriggs et al., 1998). Gordon Orians
is more than just a personal impresion but a fact: and Judith Heerwagen, in their studies on landscape aesthetics,
have shown that people prefer open, distant views with scat-
“a view nature on a screen or view can reduce stress tered trees, water, and refuges and paths that suggest ease of
and pain” movement. In studies of users of some urban parks, properties
“Indoor Plants lift people’s mood and reduces self-re- such as vegetation, water, and savanna- like qualities, such as
ported symptoms of physical discomfort” scattered trees, grass, and spatial openness, seemed to cor-
Healing By Architecture, relate with ratings of restoration (Ulrich and Addoms, 1981). In
Agnes Van den Berg and Cor Wagenaar. his article, Healing Words, J. William Thompson quotes experts
in the field of healing garden design:
Several theories have evolved to address the question of
Nature having a “healing” or restorative condition. In learning “Anything green makes patients feel better, any plant,
theories, the subscribers suggest that man has learned to pre- any tree,” and “…if they wish to create truly healing spaces,
fer nature. For example, people may have learned to associate landscape architects would do well to discover – or rediscov-
restorative experience with nature because of vacations spent er—the wonder of the plant kingdom”
in beautiful settings or long childhood summers spent on the Landscape Architecture,

beach, or near a lake or stream. Jan. 2000:54-75

Urban settings, on the other hand, bring back images


of traffic, congestion, work pressure, filth, or crime. Cultural
theories propose that we are taught by society to have positive
feelings towards certain types of environments. For example,
Native American and Asian cultures have taught their peoples
to respect nature.

36 37
SATISFACTION AND REDUCE TURNOVER
MIGHT INCREASE PRODUCTIVITY, STAFF

IN FEWER ERRORS
BRIGHT LIGHT MAY RESULT

ENERGY CONSUMPTION
DAYLIGHT REDUCES

NATURE IMPROVES RECOVERY PROCES


ACCESS TO DAYLIGHT AND VIEW TO
LIGHT
Probably one of the most abundant resources and with
high impact in patient recovery is daylight. Though daylight is
recommended, sunshine must be controlled, avoiding glare and
too much reflection on the patients bed. There are many factors
that will determine the light situation in a project and is needed DAYLIGHT AND HEALTH
to take them into account:
REDUCE LENGTH OF STAY MORTALITY RATE MEDICATION COST
(northern hemisphere guides)

Room without Room with North facing South facing More pain Less pain
direct sunlight direct sunlight room room

19.5% 16.9% 16.9% 16.9% 22% LESS

GUIDELINE 1 _Beauchemin, K.M. & Hays, P. (1996). Sunny hospital room expedite
recovery from severe and refractory depressions. Journal of Affective
Disorders, 40 (1-2), 49-51.
_Beauchemin, K.M. & Hays, P. (1996). Dying in the dark, Sunshine,
gender and otcomes in myocardial infarction. Journal of the Royal
Society of Medicine, 91(7), 352-354.
_Walch, J.M., Rabin, B.S., Day, R., Williams, J.N., Chai, K.,& Kang,
J.D. (2005). The effect of sunlight on post operative analgesic
medication usage: A prospective study of spinal surgery patients.
Psychosomatic Medicine, 67 (1), 156-163.

Orientation and Location DAYLIGHT AND ECO-EFFICIENT


GREENHOUSE GAS EMISSIONS. THE NEED OF REDUCING ENERGY CONSUMPTION:
Comparison between hospitals in HEALTHCARE ARCHITECTURE AND GLOBAL HEALTH
The direction of the building will determine solar gains in ra- U.S., Germany and Norway.
With appropriate control for HEAT GAIN and GLARE, daylighting has the potential
to reduce energy consumption needed for lighting
diation, though this must be determined also by the particular
climate zone, the specific site, an external factors present in ENERGY USE IN
HEALTHCARE FACILITIES
ELECTRICITY CONSUMPTION

the place. Is not possible to define a universal orientation for 13% of electricity
Space Heating

Cooling consumption is used


for lighting.
Ventilation

healthcare buildings because of functional and individual char- 280 KBtu/SF/year=


116 lb CO2/SF/year
104 KBtu/SF/year=
43 lb CO2/SF/year
127 KBtu/SF/year=
52 lb CO2/SF/year
Water Heating

Lighting

Cooking
60 % Fuel

acteristics, but is possible to define advantages and disadvan-


Average carbon dioxid emission of Average carbon dioxid emission of Average carbon dioxid emission of _Electricity Consumption
U.S. Hospitals. German Hospitals. Norwegian Hospitals. (Rikshospital and St. 40 % Electricity
Refrigeration (Total BTU) by End Use for
Olavs) Healthcare Buildings in the
Office Equipment
_Burpee, H., et al., 2009. High _Energy type used in Health U.S. in 2003. Released 2008
Computers (US Department of Energy

tages of different orientations:


_Data from U.S. National Database: _Arqum Gesellschaft für Arbeitssicher- Performance Hospital Partnerships: care buildings in the U.S.
The Commercial Buildings Energy heits/Qualitäts- und Umweltmanage- Reaching the 2030 Challenge and US Department of Energy. information Administration)
Other
Consumption Survey (CEBECS) ment mbH (2008).Abschulssbericht Improving the Health and Healing
zum durchgeführten Projekt BTU

40

60

80

100

120
Environment

Patients to an increased intensity of sun-


"Energieeffizienztisch" für Kranken-

NORTH-SOUTH: The negative is that minimizes the souther, and häuser in Rheinland-Pfalz

most preferred facade. But it avoids the northern faced rooms, light experienced less, perceived stress, less
giving all some light during the day. pain, took 22% less analgesic medication per SAFETY
EAST-WEST: Maximizes desired southern facades with simple hour and had 20% less pain medication costs.
DAYLIGHT CAN BE USED TO IMPROVE
and easy sun control strategies. Creates a clear distinction with Ulrich, 2004. ILLUMINATION LEVELS. HIGH
ILLUMINATION LEVELS MAY RESULT
IN FEWER ERRORS .
norther facades, that will not get any direct sunlight.
!! !!
!! !
GUIDELINE 2
3.8% 2.6%
error rate error rate

_Buchanan, T.L., Barker, K. N., Gibson, J.T., Jiang, B.V., &


Pearson, R.E. (1991). Illumination and errors in dispensing.
American Journal of Hospital Pharmacy, 48(10),2137-2145.

Sun Control
As paradoxical as it sound, the worst enemy of daylight is the
DAYLIGHT SOCIAL/ECONOMIC BENEFITS
sun itself, that is why efficient and thought strategies for shad- DAYLIGHT CAN BE USED TO IMPROVE
ILLUMINATION LEVELS. HIGH Environmental Nurses being exposed to daylight for more than 3
Daylight in a workplace
ILLUMINATION LEVELS MAY RESULT IN
ing must be implemented, to avoid heat gain and glare. This
satisfaction is high if is hours during their work showed less perceived
is the most preferred more likely that overall stress, higher job satisfaction and lower intention
FEWER ERRORS. source of lighting.
(Mrochzek et al.,2005)
satisfaction in hospitals to quit in comparison to nurses with a daylight
will be also high. exposure less that 3 hours per day.
(Harris et al., 2002) (Alimoglu,M.K.,& Donmez, I.,2005)

strategies will take effect mainly in the southern (all day) and Though building a highly perforated building may be more costly,
this investment will translate in several long term benefits and
savings for the institution such as energy savings. But on another
level there is a great potential to reduce the cost related to staff

western (afternoon) facade. The role of the system is to control


members by increased satisfaction, reduce stress levels and
increase productivity and concentration, which results in lower
medical errors rates.

thermal and visual comfort of its occupants and to support the


heating and cooling system loads. Since the sun is an always
moving source, not only throughout the day but during seasons,
is necessary not only to shade but to control and redirect the
given light in an efficient manner to the interior of the building.

38 39
CONTROL PATIENT ROOM
To reduce anxiety on the patient is necessary to reduce its sense The room must be one of the most important places in
of lack of control, by giving them the needed information an a hospital, is where the actual healing takes place. Small space
tools to make decisions and prepare themselves for following full of small decisions, like having a broader free space on the
tasks or procedures. Most of the times patients are carried entrance side of the bed for easier medical access. The role of
through the building with no clear explanation of where they distances play a huge role, specially the one toward the bath-
are or where they are going, creating an unclear an frightening room, not only should be short but also continuos surface from
scenario. Intuitive wayfinding, ceilings is what patients sees, so the bed, to avoid falls.
there must be effort in strengthening these aid and also creat-
ing a readable space, so is not necessary to explain everything Single room are in demand, because of infection but also
but the building becomes self explained. practical issues: reduce risk of infection, stress from noise and
transfer rates which is a high cause of medical errors. Also is
Helping patients effortlessly find their way through hospitals can
more comfortable to welcome the family.
improve patients’ overall care experience and increase satisfac-
tion by reducing feelings of stress, anxiety, and helplessness
for them and their families. Better navigation can be addressed
architecturally through useful signs and easily navigable cor-
ridors.6

6 Nelson C, West T, Goodman C. The Hospital Built Environment: What Role

Might Funders of Health Services Research Play? Rockville, MD: Agency for Health-

care Research and Quality; 2005 Aug. AHRQ Publication No. 06-0106-EF.

COLOUR
1,3%
3,0%
7,4%

32,2%
19,9%

Colour is a non built element that really impacts the space,


36,0%

most of the time is disregarded as a secondary and decora-


6,27% Patient Room
tive role, without weigh-in its possible effects. Is also one of
2,7
2%

the elements that is characteristic for a hospital, where people 6,0%


3,8
%

realtes to certain shades, evoking medical treatment. Nowa- 12,05%


12,4% 39,6%

days after many polls and interviews with user is known that 39,95% 15,2%

though white is prefered through out the different spaces, the 23,1%

use of colour is now recomended, avoiding huge planes of a Work Places

plane washed out colour for more intense but confined ones. 24,23% 8,2%
3,0
%

The colour is also a powerfull tool for orientation, information 8,8%


34,3%

and spatial clearnes.


14,78% 17,0%

28,8%

Corridors

7,9%
2,
8%

19,6%
53,7%

7,09%
Graphics of the ideal colours to use inside the Ward ac- 9,0%

cording to the personnel.


Sanitary Facilities
(Source: Research Project Working-Place Hospital)

40 41
EVIDENCE BASED DESIGN
Guidekines and Method by Research PHYSIOLOGICAL PARAMETERS ELEMENTS FOR
IMPACTS DESIGN

Healing View Site

Pain Light Orientation

Healing Environment: Is the result on a EBD that has Infection Art Layout
demonstrated measurable improvements in the physical and/
or psychological state of patient and/or staff, physicians, and Cardiac Rhythm Colour Functionality
visitors.
Should make a therapeutic contribution to the process Exercise Sound Interiorism
of restoring someone’s health. For what it should be more than
just intuition (most practices) it has to be proven with on site Admition time Airflow Materials
field research and answer: Who was healed? How do we know?
EBPractice: designers make critical decisions together Medical Errors Privacy Equipment
with an informed client, on the basis of the best available infor-
mation from credible research and the evaluation of completed Accidents Social Rooms Envelope
projects.
Performance Based Building Design (PBBD): attempts PHYCHOLOGICAL Acces to nature Flows
to create clear and statistical relationships between design de- IMPACTS
cisions and requirements satisfaction levels evidenced by the Safety Connections
building systems.PBBD uses research evidence to predict per- Comfort
formance related to design decisions. however, the decision Wayfinding
making process is not a linear one: for the build environment is Orientation
a complex system. Choices cannot be based on simple cause- Hygiene
and-effect predictions; instead they depend on many variable Economical
components and on the mutual relations established one each
other. Control

Four Levels of Evidence-Based Practice Satisfied Staff


Level 1:analysing the literature in the field in order to fol-
low the related environmental researches reading the meaning
of the evidence in the relationships to the project
Level 2: foreshadowing the expected outcomes of de-
sign decisions upon the general readings measuring the results Current Hospital design is These parameter summa- Though the architectural el-
through the analysis of the implications, the construction of a focused on analysing the dif- rise the quest for a better and ements don’t change much
chain of logic connection from decision and future outcome, in ferent impacts that their ac- healthier environment. Creat- from a traditional project, the
order to reduce arbitrary decisions tions can improve or create. ing a strong set of guide lines relations change. Is important
Level 3: reporting the results publicly, writing or speak- EBD bases all its knowledge for the design process, that to bring to surface the hidden
ing about results, and moving in this way information beyond in the analyse and research comes as a result of system- links and be aware of the end
design team subjecting methods and results to others who may of this mostly quantitative ef- atic research, revealing hard results that a single decision
or may not agree with the findings fects, because of its scientific data and trustworthy param- can achieve. Many practical is-
Level 4:publishing the findings in reviewed journals col- approach, for the rest environ- eters meant to be addressed sues are mostly regarded, but
laborating with academic or social scientists mental psychology plays an at the project. the relation to more soft val-
important role, backing up the ues show an important role on
knowledge. their impact.

42 43
H

MALMÖ HOSPITAL
Maximize the OPPORTUNITIES within
an EXISTING building

“... built catastrophes, anonymous institutional complex-


es run by vast bureaucracies, and totally unfit for the purpose
they have been designed for ... They are hardly ever function-
al, and instead of making patients feel at home, they produce
stress and anxiety.”1

1 a b Healing by design – Ode Magazine, July/August 2006 issue. Accessed


2008-02-10.
MALMÖ UNIVERSITY HOSPITAL
History and Context Rigshospitalet
Copenhagen University Hospital
46,5 km 43 minutes

The Hospital was founded in the outskirts of the city, as


a green complex almost as a continuation of Pildmmsparken.
The Pavillion arrangement followed that premise, as an open
arrangement standing in a park like site.
Nowadays the hospital stands where the city has been
growing and expanding.
It is split by a former urban limit , as is the road that

1812 conects the airport and the city. As a response, the complex
was densified in the same “free standing building” scheme, but
Lund Hospital
without following any urban logic.
Lund University Hospital
20,5 km 18 minutes

1912
N

NNW NNE

NW NE

WNW ENE

W 10 15 20 E

WSW ESE

1939
SW SE

N SSW SSE

NNW NNE S

NW NE Average wind direction, (km/h)

Temperature RH, Precipitation


(percentage,cm)
(Celsius, C)

January January
WNW ENE December December
20 February 80 February

15 70

10 60
November November
5 50
March March
W 10 15 20 E -5
40

30
-10

-15

October April October April


WSW ESE

2
September September
SW SE 5
May May
9

SSW SSE August August

2010
June June

S July July

Average wind direction, (km/h) Temperature, (Celcius) Rh, Precipitation, (percentage/cm)

Temperature RH, Precipitation

46 47
(percentage,cm)
(Celsius, C)

January January
39
December December
20 February 80 February

15 70

10 60
November November
5 50
MALMÖ UNIVERSITY HOSPITAL
Vision

The mission is to develop a sustainable plan for the hospital in others fate of this hub for public transport ken and the hospital
Malmö. The hospital’s physical environment and structural en- should have an obvious and clear design.
gineering status have been investigated. Existing buildings can
not meet future requirements for high-tech care, such as surgi- A new service terminal proposed in the southeast corner of the
cal and intensive care. Current health care buildings have little hospital campus with entrance from John Ericsson path. Where
opportunity be converted into units of one-patient rooms, but f NNS also able to place certain technical services and other
should be in less term to serve as day care and reception. Ma- operational functions. The block is strategically in relation to
ture where buildings need to be supplemented in order to serve transportation and an extensive culvert system.
as administrative premises. Some Hospital Activities today are
rented premises on the South area and Sege park will eventu- The proposed coherent block structure of the hospital campus
ally move in and be assured a place in the area. occur as a result of the concentration of the medical care activi-
ties, more perifical area that can be utilized by other functions.
Hospital district of Malmö, the region’s largest employer, cen- The extent of these surfaces is dependent on strategic decisions
trally located in Malmö and with close links to the City Tunnel. regarding Hospital maximum size in the long term.
A well-developed City of integration synergies and development
opportunities for both Region Skåne and Malmö City. Ongoing By allowing an area to be undeveloped, the hospital has the
planning work with this starting point and a common mission facility to incorporate an elasticity in the range especially at op-
statement has been established in cooperation between the City erations and for future reference. It is therefore important that
and Region Skåne. Region Skåne Ongoing planning activities the hospital’s control This “reserved” zone.
are primarily designed to establish a robust development struc-
ture for the hospital area and to study a number of areas or The proposed planning will be characterized by: an integral and
development scenarios, which can form the basis for detailed natural part of the city, organized in a concentrated develop-
planning of future expansion phases. Proposal for overall plan- ment of a coherent block structure. The communication struc-
ning and design details of this Property Development Plan have ture for traffic, cycling and walking should be clear. A compre-
been addressed in a number of working meetings between the hensive green structure will characterize the area.
project team and City Planning

To develop a modern hospital with high demands on functional


relationships at all levels in the surrounding urban environment
is a major task. The buildings must be integrated into the sur-
rounding neighborhood structure, creating attractive human
environments and enhance the architectural values​​. City Tunnel
up from Triangeln way is on blocks just north the hospital and

42 TRUST

48 49
MALMÖ UNIVERSITY HOSPITAL
Analysis and Mapping

The hospital is a machine that works The site is conformed by singular The Hospital was founded in the
in a closed circuit, having nothing to do buildings connected during time. The outskirts of the city, as a green pavil-
with it’s surroundings. Today, the con- configuration is different from the urban ion complex almost as a continuation of
cept of hospitals as islands, separated block, but it continues the floor density Pildmmsparken. Nowadays the hospital
from context it’s blurring and becoming as the surroundings, becoming a part stands where the city has been growing
more permeable to the city. The idea of the city, with is own neighbourhoods and expanding.
is to discover this connections, present and streets. Split by a former urban limit, now
and hidden. Once knowing this, it’s Buildings are all arround the plot. the airport road. As a response, the
possible to propose new links and im- The highest density is on the center- complex was densified in the same “free
prove the existing ones, with a series north part of the hospital, where the standing building” scheme, but without
of measures. patients and the treatment and diag- following any urban logic.
nostics are.

50 51
MALMÖ UNIVERSITY HOSPITAL
Strategy and Masterplan

As a general strategy to connect the parts and ares of branches. The idea is to strengthen the network by creat-
the hospital, we decided to revitalize the existing under- ing a “main line” that connects the supply-service area
ground system, that lacks of spatial qualities but performs with the treatment-patient area.
an essential role in the hospital’s logistic system. Today
is only a one level and two direction corridor, with many

UNITE CORE

Children’s hospital is sepa- Important part of our master


rated from the main part of plan is a central core. At the mo-
the hospital by a loaded road ment a vast amount of functions
which is the main city road are put together. We suggest to
from airport to city centre. concentrate all patient rooms and
Due to necessity for future treatment in that part. This will
growth of hospital we offer enclose wards from city and give
to unite main hospital’s block them their own courtyard.
with a kid hospital’s block,
thus to have a possibility for
densification.

DEFRAGMENT CONNECT
SUS contains many func-
Although hospital is sur-
tions: day treatment, research,
rounded by city, it’s not as well
emergency, etc. At the moment
connected with it as it could be. Since the hospital is so close to one There is a clear centre area where Creating the link with the Children’s
they are mixed with each other
By clarifying main access ways of Malmö’s most breathtaking parks, the most of the facilities converge, having to- hospital is a prevailing action for the de-
so there is no a particular order
and making more distinct facade connection to this place is prevailing. A day already the face of a main street. The velopment of the Hospital. Efficient con-
in it. Part of the proposal is a
we try to improve visual and main city road stands in the way on both, intention is to create a pedestrian walk nections and perceived link between them
spatial defragmentation. We di-
physical connection between so to get a fluid and non interrupted flow with urban qualities that flows trough the influences the users view, responding to
vide into different areas depend-
hospital and city. towards and from the park, we decided to faces and entrances of the units. To avoid the department as part of the complex,
ing on functions they contain.
create an underground passage. To avoid a dull walk, the street will be accompa- instead of being a segregated island, dis-
doing a dark anonymous tunnel, a slop- nied by courtyards that will bring a fluent connected from context. This is made by
ing plaza is proposed as a promenade to- rhythm and will provide a prelude for the creating a double south entrance that
wards the tunnel, giving light and public entrances, giving quality and green out- creates an underground link to the chil-
space also to the neighbour buildings. door space to users. dren’s hospital.

52 53
BUILDING 65
The existing Building

THE SITE_
Locate in the heart of the Hospital,
but hidden away immersed in an internal
park, the building now denies its surround-
ings. Turning around becomes a logical step,
facing the existing nature and landscape.
The new axis looks to harvest the benefits
of what is existing already on the site and
also becoming a strategic point of further
developments planed for the hospital, like
strengthening the centre block, now built by
old houses that fail to comply to the necessi-
ties of the hospital program.

54 55
56 57
B U I L D I N G P O R P O U S E S:
FAN
ROOM

FAN
ROOM TECHNICAL
ROOM

SIXTH FLOOR SIXTH FLOOR

TECHNICAL
ROOM
_Enhance team communication
SIXTH FLOOR
STAFF TECHNICAL
AREA ROOM
FIFTH FLOOR FIFTH FLOOR

DERMATOLOGY
CONSULT
AREA
_Organize and clrify circulations.
DERMATOLOGY OFFICES
TREATMENT
AREA

FOURTH FLOOR FOURTH FLOOR

_Streamline patient flow

_Improve waiting time and overall stay condition THIRD FLOOR THIRD FLOOR

FIFTH FLOOR
STAFF
AREA

_Bring daylight inside the ward


OFFICES

CONNECTION VENTILATION
OPERATION OPERATION
FLOOR ROOM
STAFF SECOND FLOOR SECOND FLOOR
PRE AREA
OPERATION
WAITING OPERATION STAFF
AREA ROOMS AREA

_Offer quality social space


FIRST FLOOR FIRST FLOOR

_Provide a flexible comfortable room.


GROUNDFLOOR GROUNDFLOOR
FOURTH FLOOR
POST SERVICE
OPERATION AREA STORAGE
UNIT
OPERATION
ROOMS

STAFF
AREA SINGLE MULTIPLE
PATIENT PATIENT
OFFICES
ROOM ROOM
AXONOMETRIC ANALYSIS OF PATIENT FLOWS UNDERGROUND AXONOMETRIC ANALYSIS OF VERTICAL CONNECTIONS UNDERGROUND

R O O M P U R P O U S E S: PATIENT VERTICAL
THIRD FLOOR
With only one main access point lowered from In the building structure we find a central and public con-
_Increase daylight levels and frame view
street level, makes it hard to find the place to enter the nection that works as a distribution node for all three wings.
MULTIPLE MULTIPLE
PATIENT PATIENT
ROOM OFFICES ROOM OFFICES

STAFF
AREA

buildings. Once inside the space the elevators are the though facing the same space, the volumes for elevators and
STAFF OFFICES

_Private but flexible rooms


OFFICES
AREA

DOCTORS
ROOM

most important element. From a “distribution” space the stairs are separated. Inside the building there is a service eleva-
_Assign space for digital open medical information, creating and entrances of the three buildings are labelled. In case of tor and an emergency stair that connects all the floors.
information section in the room. Visible for the patient.
RECEPTION
ADMINISTRATION
transfer patients the underground corridor is used.
SINGLE SECOND FLOOR
PATIENT STAFF

_Improve family Zone, giving the possibility for longer accom-


ROOM AREA

modation and over stay.


RECEPTION
ADMINISTRATION

OFFICES LECTURE
ROOM

_Design an obstacle free path for the patient.


SIXTH FLOOR SIXTH FLOOR

FIRST FLOOR
FIFTH FLOOR FIFTH FLOOR
CONSULT STAFF OFFICES
AREA
TREATMENT

THE ROOM _The views to the outside, that becomes


ROOMS

ADMINISTRATION

AMBULATORY FOURTH FLOOR FOURTH FLOOR


CONSULT SERVICE

obstructed by the irregular shape of the room, are far from


AREA

ideal. The fact of the small outside balcony, that becomes more
THIRD FLOOR THIRD FLOOR

an obstacle for light and a clear view, it also adds elements that
GROUNDFLOOR

CONSULT AUDIOLOGY LABORATORIES


ruin the view even more. Its clear from the pictures that the
MEASSURING
ROOMS SECOND FLOOR SECOND FLOOR

inner bed doesn’t get much view or light, and none when the
RECEPTION OFFICES
ADMINISTRATION

other patient’s curtain is closed.


ARCHIVE

The multiplicity of elements, cables, rails, volumes cre-


FIRST FLOOR FIRST FLOOR

ate a perceptual chaos inside the room, tried to be fixed by an


uniform colour, but not accomplishing the task. Colour use is
GROUNDFLOOR GROUNDFLOOR
UNDERGROUND

UNDERGROUND TECHNICAL

not used in its potential, clarifying the areas or informing the


PASSAGE WAY ROOM

patient. Even though there is an area for reading and visitors is AXONOMETRIC ANALYSIS OF SERVICE FLOWS UNDERGROUND AXONOMETRIC ANALYSIS OF STAFF FLOWS UNDERGROUND

the best light an improvable view and becomes small for both
patients.
SERVICE STAFF
Service flow is a general underground corridor Staff members are probably the ones with more flex-
that connects all the buildings, through nº 65 is the en- ibility in flows, starting from various access points in different
trance for the adjacent buildings also. It has one vertical levels, using mainly the public/main vertical connection Since
point inside the unit and one loading area outside the their service area is spread through the different units and de-
same, making use of the public vertical circulation, which partments, there is no main circulation pattern today.
creates a superposition of uses.

58 59
FAMILY AREA
Though there is a defined
space for visitor, it lacks of flex-
CLINICAL SUPPORT ibility in use, without giving the
patient a real opportunity of use.
Because of the high rates of up- The area becomes a well light
dating and changes that the medical niche but fails to provide a qual-
equipment requires it becomes a ity space for use.
sort of collage of different typologies
of elements, that enhance the confu-
sion an disorientation of the patient
and also making the medical staff’s
work less clear, having to recognize
between the elements before taking
action, which translates in time loss.

PATIENT UTILITIES
Placed in a movable unit, it
blends with the clinical equipment
creating confusion in use and
in approach. The patient doesn’t
make it his and that is translated
in a sence of being out of place.

PATIENT FACILITIES PATIENT ZONE


Not only the shower but also the rest
of the hygienic facilities are placed out- The Patient doesn’t have a defined
side the room, striping the patient from area, blending with the public and tech-
any level of privacy. Exposing the sick in nical zones, creating a sensation of root-
their most vulnerable state, and request- lessness. In the end nor the whole room
ing commonly aid for the path since it is “owned” nor a defined space really be-
requires to go out the personal sector. longs to the patient.

60 61
NEW BUILDING 65
1
CONNECT_
Strategies to Upcycle the structure
Create a link to the
sorroundings through
strengthening ties with the
existing landscape. Lever-
aging the existing park as
an extension of the build-
By re organizing and extending outside the circulation ing in a visual and physical
spaces, the total area grows but most important it shifts its role sphere.
from an administrative building to a care unit. Housing enough
wards makes it coherent and underlines its character, leaving
more administrative functions on a more secondary position.

2
LIGHT_

By breaking the mas-


sive volume through light
chambers that run across
the existing structure, al-
lowing light and more gen-
erous spaces to flow in-
side the layout. Open the
facade in strategic places
to ensure day perception
within the building.

3
TURN_
PLAN 07 STAFF
Create a new en-
PLAN 06 TECHNICAL
trance toward the rich-

PLAN 05 STAFF est park in the hospital,


projecting the circulation
spaces to the green oasis.
PLAN 04 OPERATION
Extend the axis towards
PLAN 03 WARD the courtyard giving clarity
to the building structure
PLAN 02 WARD and functions, and allow-
ing more generous organ-
PLAN 01 WARD
izing spaces.
PLAN 00 ACCESS _ DAY CARE
PLAN -1 UNDERGROUND SYSTEM
62 63
64 65
SECTION AA’ SECTION BB’

B
radio therapy
enaL GVA

daycare 81

71
Consult Consult
daycare technical
61

51

41

31

21

11

01 Room Room Room Room Room Room Room Room


Operation Operation Rinsing Operation Operation Rinsing Operation Operation
9

TECHNICAL FLOOR
7
6

Room
Technical
A A A A A A A A
Area
W.C.
Supply
Storage Room Storage Room Room Room Room
Corridor Room Room Room Room Room Room Technology Room Room
Sterile Sterile Sterile Storage Storage Storage Lab Office Office Office W.C
Lab Lab Lab Storage Lab Storage Operating Storage Cleaners
Office Desk Room Room Room Cafeteria
Kontor Reception Conference Desk Conference Conference Staff
Reception
81

71

61

51

41

31

21

81

71

61

51

41

31

21

81

71

61

51

41

31

21
Room R.W.C W.C.
11 11 11
W.C. W.C.
01
Data 01 01

9 9 9

i i i
1

8
1
91

81
2
Office
3
71

4 Waste Room
61

5
Room Room Room Lockers Room
51
Consult Pre-Post Operation
41
6
Workshop Storage Operation Storage Operation
1 1 1 1
7
Office 91 Consult 91 91 91
31 2 2 2 2
81 81 81 81
Room Room Room Room Room
8

3
Office Office Office Office Office Office Office Office 3 3 3
71
Lab Lab Lab Lab Lab 71 71 71

4 4 4 4
61 61 61 61

5 5 5 5
51 51 51 51
21

01
11

daycare daycare technical


9

6 6 6 6
41 41 41 41

7 7 7 7
31 31 31 31

8 8 8 8

21

01

21

01

21

01

21

01
11

11

11

11
9

9
B

B
PLAN -1 PLAN 04 PLAN 05 PLAN 06 PLAN 07

83,97

4,75 28,55 7,60 20,90 14,16 8,02

4,00 4,00 4,00 4,00 4,00 4,00 4,00 8,00 4,00 4,00 4,00 4,00 4,70 8,58 5,48 8,07

daycare

11
12

10

9
5,29

13
7

14
6

15
5

16
4

17
3

i
18
2

19
1

Head
Nurse

8
W.C.
14,14

Team Team
Diagnose
Station Station
9
26,14

Room
3 File Nurse Rinsing 1
10

Kiosk-Cafe Storage Reception


11,11

11

Room Station Room Team W.C. Team Team


Room Desk Diagnose
Team Station Station Station
Staff Rinsing Testing Room

18

17

16

15

14

13

12
Station 2 3 File Nurse Patient Testing Rinsing 1
Kitchen Room Room Storage Reception
4 Supply Room Station Kitchen Room Room Team
W.C. Room Desk
Area Team Station
Staff Rinsing Testing 2
Station
Kitchen Room Room
4 Supply
W.C.
Area

Consult
6,71

Room

daycare
1 Patient
Bedroom

4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00 4,00

PLAN 00 PLAN 01-03


66 67
SOUTHERN FACADE _ MAIN ENTRANCE
SCALE 1:250

+ OLD
PATIENT
541,6 M2
MEDICAL
350,2 M2
SOCIAL
84 M2

+
NEW
STATISTICS
PATIENT MEDICAL SOCIAL
544,8 M2 290,2 M2 155,1 M2

OLD
PATIENT +
MEDICAL SOCIAL
541,6 M2 350,2 M2 84 M2
67%
BEDS

NEW
PATIENT MEDICAL SOCIAL
STATISTICS
544,8 M2 290,2 M2 155,1 M2

+ +
22,7
M2 55,4% 57,1%
14,6
M2 0,7 WC
M2
X PATIENT X PATIENT

+
67%
BEDS

EXISTING ENVELOPE
22,7
M2
+ +
55,4% 0,7 57,1%
14,6
M2
M2 WC
X PATIENT X PATIENT

EXISTING ST
RUCTURE
BALCONY
EXTENSIO
N

68 69
MALMÖ SUS _PROPOSED WARD MALMÖ SUS _PROPOSED WARD
HOW CAN THE EXISTING LAYOUT BE IMPROVED? WHAT ARE THE FEATURE TO UPGRADE THE WARD?
READING ROOM_
Though social spac-
es are needed, va-
riety is also needed.
For creating a wider
range of options a
CONNECT_
more remote space 1 Create a link to the surroundings through
gives the chance of a
strengthening ties with the existing land-
quieter and isolated
scape. Leveraging the existing park as an
instance for practic-
1 es like reading.
extension of the building in a visual and
physical sphere.

NURSE STATION_
Placed in the heart of
2
the ward, the main
station has not only 3
direct control over
the social spaces, but
also gets view and
light from the exte-
rior. Besides it sits in
front of the kitchen
2 for close control.
WARD FLOOR
PERSPECTIVE PLAN

SOCIAL SPACE_
Commonly referred 4
as the “day room”
the space now opens
up completely, both
CORRIDOR SPACE_ INTERNAL FLOW_ CONTROL VIEW_ inside and outside
By opening up the core in wide flow ex- Replace the unique centered control point to create a more
Though repetition exits due to the room
changers the circulation avoids the rigid with multiple cross facing check points connected and fluid
module, the core is the one that creates
loop and is replace by multiple choice for a more efficient performance. The space. Also gives the
and defines the opposing space. By fluc-
paths that differ in lengths and spatial areas allow to create functional teams chance of the use of
tuation in depth and interruptions in the
characteristics. to overlook and care smaller groups of
3 a protected balcony.
front the space becomes more fluid and
patients.
give possibility for more.
RECEPTION DESK_
With a more adminis-
trative role, this acts
as a control point for
the access and cir-
culation to and in-
before side the ward. Also
before before
the existing of and
information element
4 gives guidance for WARD FLOOR
visitors and patients. PERSPECTIVE PLAN

after after
after

01 04 07
ROOM SIZE _ Though the PERSONAL SPACE_ By means HYGIENIC SUPPORT_ In
structural grid is kept, the of single rooms the patient many research studies the
shared bed becomes a sin- doesn’t only gets his needed hand washing for part of the
gle patient room, giving the privacy, but also contributes staff, becomes one of the
patient more personal space to host medical interaction in most relevant factors to re-
and also guaranteed. the environment. duce contact infections.

02 05 08
VIEW _ Through a deep win- FAMILY ZONE_ Creating a safe VISIBILITY_ The chance to
dow, the view is framed, be- environment benefits the pa- check from the corridor gives
coming clear and clean. The tient’s recovery and for that the nurses control over the
view becomes a understand- family support is essential. patient and also gives com-
able and strong element in- To promote this practice, a fort to patient with high anxi-
side the room’s layout. welcoming space is needed. ety levels, without disturbing.

03 06 09
NATURE_ Plus the direct view HYGIENIC INDEPENDENCY_ LIGHTING_ Unique lighting
from bed, the patient has the Individual bathrooms become settings should be provid-
possibility of multiple spaces a necessity on a modern hos- ed to accommodate various
with different levels of rela- pital, giving the advantage of tasks that might take place
tion to the exterior, beside of liberated use and reducing in a patient room and give
nature inspired graphics. patient stress. control.

12 H 13 H
Master Thesis Project _ Healing Hospital _ Malmö SUS Master Thesis Project _ Healing Hospital _ Malmö SUS
70 Student _ María Soledad Larraín Salinas Student _ María Soledad Larraín Salinas 71
Tutors _ Walter Unterrainer _ Juri Soolep Tutors _ Walter Unterrainer _ Juri Soolep
LSAP _ UMA LSAP _ UMA
MALMÖ SUS _PROPOSED ROOM MALMÖ SUS _PROPOSED ROOM
DEFINING THE NEW ROOM HOW WILL THE NEW ROOM WORK?
3,28 1,38

Existing
Structure
Coloured ceramics on the sink wall, to cre-
Service
ate a lively environment and break with the 3,28
Shaft
1,38

sterile character of the space. It also contains View and Control


point of Patients Existing
the water spill from the sink and frames the Structure

patient’s mirror. Handicaped


Service Accesible with 80

3,08
Shaft cm to the wall
and 1 meter to Unique Assisted
View and Control the shower
point of Patients translucent door

Clinical Support
Handicaped
Natural and durable product. One important

1,28
Unit located in
Accesible with 80
main staff path

3,08
factor is that is easy to clean and maintain; cm to the wall
and 1 meter to Unique Assisted
and provides a safe walking surface. The the shower translucent door

same material will flow from the room to the Clinical Support
Patien Area

1,28
Unit located in
bathroom to break the rooms limits. 8.41m2
main staff path

Patien Area

TV and entertainmet
8.41m2
To create a more comfortable family area.
Patien Bed
Also the reflectance of the material works as 110cmx210cm
an amplifier of daylight, filling the room with
it. It also becomes a viewing element from

TVSet
and entertainmet Set
the bedside, giving a sense of extra quality. Patien Bed
Family Support Zone 110cmx210cm Wooden floor
Patient’s
Closet

The volume of the wards is configured by a Foldable bed hidden in

2,40
wooden facade that searches to break the Family Support Zone the wall Wooden floor
Sitting/ Bed for visitors Patient’s
hardness of the typical hospital block exist- Closet
ing. The material sends a message of comfort Frame also used for sitting
and warmth before the aptient even steps Floor to Ceiling Foldable bed hidden in

2,40
Window
into the building. Sitting/ Bed for visitors
the wall

0,15 0,15 0,15


1,66 2,05 0,60 3,39
Frame also used for sitting 0,15
By creating a frame the patient is aware of 0,62 Floor to 1,19
Ceiling
0,15
2,17 0,36 3,51
the view to the outside, and also the window Window
4,00 4,00
becomes an extra feature in the room. The
0,15 0,15 0,15
possibility of using the space by the openings
ROOM PLAN
1,66 2,05 0,60 3,39
0,15 0,15
give the patient and incentive to move and 0,62 1,19 2,17 0,36 3,51
SCALE 1:50
get out of the bed. 4,00 4,00

Openable window

FIxed _ framed
Window

Openable window

FIxed _ framed
Window
FIxed _ no frame
Window

FIxed _ no frame
Window

ROOM FACADE STUDY


SCALE 1:50

R VE
U
CYC PU
B LIC
IVA TASK ANALYSIS_
PR Flow Diagrams

PATIENT FACILITIES_
PRIVATE

CLINICAL SUPPORT ZONE_

PATIENT ZONE_ TASK ANALYSIS_ TASK ANALYSIS_


Nursing Care Bathroom Use
SEMI PROVATE

PATIENT UTILITIES_ Summer


Sun

FAMILY SUPPORT ZONE_


Service Shaft
Winter
Sun

Sitting
Window
Frame

H: 260cm H: 230cm Corridor


Existing structure

New Previous
Building Building
Envelope Envelope

SUN ANALYSIS_
Room Proposal _ Thesis Proyect _ Malmö Retrofitting Proyect
TASK ANALYSIS_ TASK ANALYSIS_
Summer and Winter Visitors Patient Code
Maria Soledad Larrain Salinas
LASP _ UMA

14 H 15
Master Thesis Project _ Healing Hospital _ Malmö SUS

H
72 Student _ María Soledad Larraín Salinas
Master Thesis Project _ Healing Hospital _ Malmö SUS
Student _ María Soledad Larraín Salinas
73
Tutors _ Walter Unterrainer _ Juri Soolep
Tutors _ Walter Unterrainer _ Juri Soolep
LSAP _ UMA LSAP _ UMA
MALMÖ SUS _PROPOSED ROOM
DEFINING THE NEW ROOM

EXISTING ROOM P R O P O S E D P R O P O S E D
ROOM TYPE 1 ROOM TYPE 2

88,7 lux 230,3 lux 210,6 lux


(At bed space) (At bed space) (At bed space)

16 H
Master Thesis Project _ Healing Hospital _ Malmö SUS
74 Student _ María Soledad Larraín Salinas 75
Tutors _ Walter Unterrainer _ Juri Soolep
LSAP _ UMA
CONCLUSIONS
Lessons and reflections

The project started as an exercise to test the possibilities of


existing structure. Under used buildings are everywhere and
are affecting the city density, and what is more troubling they
are pushing towards new construction, that as we have already
seen in not always needed.

From the lessons towards re-using occupied frames is possible


to extract the necessity of clear planing and explicit strategies.
Committing to a goal is essential, specially in a project like a
hospital, that tends to branch out, being really easy to loose the
north, or in this case: the south.

This strategies are not given from above, but involvement of the
parts is crucial. Interdisciplinary and user oriented work, that
was a corner stone of this work, appears to be an obligatory
element for successful endeavours. The tendency as architects
to fall into wishful thinking and then “landing” projects, is only
translated in an awkward marriage between the original concept
and more pragmatic requirements from the actors that will ac-
tually occupy the space. This thesis only reassures my thought
that we must not forget that we create space for others, and we
should have them in mind and involve them in the process for a
more fruitful result.

The hospital is a very complex structure, and probably I just


managed to scratch the surface and expose son of the issues at
hand. But highly wived projects as this with more reason need
to have a leading idea, a principle to which the parts fall to.

Small changes are useful sometimes, but in examples like this


one, a mayor renovation is needed, where the building rises
up to its potential, housing more room and decompressing the
need in the overall hospital.

Functional and modular rooms are needed, but is important not


to fall into repetition and create the spaces to walk away from
the “machine” . This exercise as it was show, doesn’t take so
radical solutions, but a more strong guidelines.

76 77

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