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Health-care design across Canada focuses on fun, form and function - raic.org “It’s a culmination of an accumulated 40 years of design objectives,” says Milton Gardner, FRAIC, a principal with Kasian Architecture Interior Design and Planning Ltd. “My philosophy is that to deliver a good hospital you need to do it fast, simple and robust. To be able to deal with changes; medicine changes and so does technology.” Experience has taught him that. Gardner explains that before the 37,000-square-metre diagnostic and treatment (D&T) centre opened at Victoria’s Royal Jubilee Hospital, he and his Kasian colleagues had to design the emergency department three times. “The hospital had to deal with an emerging tuberculosis issues, and at one point, the hospital became a cardiac centre of excellence for southern Vancouver Island, which changed the emergency-room focus from trauma to cardiac resuscitation – and required significant program changes, such as monitored beds and direct access to angiography,” says Gardner. “The chairman of the hospital board later told me what D&T stands for: determination and tenacity.” Gardner spent 12 years on the hospital’s design, re-design and construction. It has taken less time with a project that has received widespread praise, a result, Gardner says, of co-operation between the Calgary Health Region and Alberta Infrastructure, a provincial government agency. The $253-million, 74,000-square-metre Alberta Children’s Hospital in Calgary is “an architectural and medical marvel: a state-of-the–art health-care facility with a homey feeling,” gushed The Globe and Mail’s public health reporter, André Picard, over the summer. “It is the most beautiful place you could ever hope to never have the misfortune to visit.” Situated on a 35-acre site on the westerly tip of the University of Calgary campus, the grounds of the new Alberta Children’s Hospital include outdoor “healing” gardens, apple orchards and interactive playgrounds. The five-storey building itself looks like a big playground toy. Brightly coloured oversized window frames in red, green, yellow and blue help reduce the scale of the building that has a Lego-block look to it. A seven-metre-high penthouse, clad in a corrugated metal panel, is designed to refract sunlight in different shades of colour. The Globe’s Picard pointed out that the “centrepiece” of the new hospital is its main lobby – an open two-storey theatre-in-the round. It features a bronze sculpture, in the shape of a half-globe, through which water flows and upon which a stage can be placed. There are also several aquariums throughout the hospital, all of which were donated by the construction workers assigned to the project. In addition, there are play areas an a room where pediatric patients can be visited by their pets, as well as an auditorium where the children can watch movies, or see plays and puppet shows. Every patient room comes equipped with a bed for visiting parents. If it seems like the type of children’s hospital kids might design, it is. Gardner says that when the designing phase began in 2002 and it soon became obvious the professionals “weren’t getting it,” Kasian enlisted the help of four teams of chronically ill children and young people – between the ages of 8 and 22 – who had spent time at the old hospital. Everyone was given a sheet of paper with the outline of the building elevations, and each one of the young participants contributed their own design ideas – many of which figure in the final result. Explains Gardner: “We asked them about their experiences in going to a hospital and were expecting them to tell us about pain and anguish. Instead we heard comments like, ‘Ah man, it’s so dark and depressing and boring’.” “The kids gave us a lot of cues about variety, colour and scale.” They drew little people with big windows, and used a lot of colour – bright yellows and deep blues. And in the completed hospital, that’s what they got – on the inside and the outside. When children in the cancer unit are too ill to venture out, a sunroom provides them with a lot of daylight along with a spectacular view of the Rockies. Alberta’s new children’s hospital – which was completed in less than three years – also satisfies Gardner’s goad to create a flexible and nimble design. The hospital site has been master-planned to enable future expansion to occur laterally and not vertically, and thus avoid disruptions or shutdowns of existing areas during construction. The latest information system and technology have been incorporated into the hospital building to accommodate new wireless and fibre-optic technologies. (Stretched out, the 19 kilometres of fibre-optic cables for telephones and computers could reach the summit of Mount Everest and back down; the 2,100 km of wire required amounts double the distance between Calgary and Vancouver.) Each of the pediatric intensive care and oncology patient rooms has its own air supply. To prevent the build-up of dangerous bacteria, such as legionella, not a single pipe is at a 90-degree angle. In addition, pre-manufactured headwalls to house medical gases, electrical outlets and nurse-call systems will facilitate future retrofits and changes to occur without the need to demolish walls or shut down patient rooms. Overall, the new Alberta Children’s Hospital is more than 60 per cent larger than the previous facility, and its emergency department is designed to server 60,000 patient visits annually compared to the 25,000 visits-per-year its predecessor was built to handle. However, the most distinguishing aspect of the new Alberta Children’s Hospital – the first freestanding pediatric facility built in Canada in 20 years and the only one between the Alberta-British Columbia border and Winnipeg – is that its youth friendly look and function reflects the needs and desires of its end users. As Picard wrote in the Globe, the hospital’s “form has a function” and supports the health-care-delivery notion that “place matters”. The same can be said of the Children’s Health Centre at Surrey Memorial Hospital in BC. “Delight in nature” is the theme threaded throughout the centre. For instance, the rainbow is a recurring motif, appearing in the blue-green-yellow-orange-red-purple sequence of frittered-glass sunscreen panels shielding the lobby windows. The rainbow is also embedded in the flooring pattern of the lobby at the main entrance. At the front, a wooden beamed “sleeping dragon’s tail” canopy provides rain shelter from the drop-off area to the lobby. The entrance also includes four sculptures of children at play – doing cartwheels, jumping and swinging – and each sculpture is a different colour of the rainbow to celebrate the “innate cultural and racial tolerance of children,” according to Vancouver-based Stantec Architecture Ltd, the firm that designed the Children’s Health Centre. “A lot of children’s hospitals follow the usual: Put up a bunch of Walt Disney pictures on the walls as something that children and parents are going to respond to,” says Bruce Raber, MRAIC, Stantec Architecture’s vice-president and practice area leader, who was involved in the project. “We deliberately took an approach that was going to appeal to people of all ages, and is more than just cartoons.” For example, he explains that there are 14 accessible roof decks and terraces throughout the building where families can go outside for a breath of fresh air or view the exterior courtyard that captures the look of a woodland forest. The 30,000-square-metre facility is also bright inside. Every patient room is equipped with bay windows, which Raber explains, reflects research that show access to natural light can hasten the healing process. “We also feel that the art and sculpture that relates to nature and whimsy makes people feel a little more comfortable during a bad period in their lives.” So, a brightly coloured frog, which comprises a 3-D display, greets people as they walk into the centre. When they look up at the ceiling, coloured “spring green,” they see a flock of swallows outlines cut into a large curving rainbow beam that holds up the lobby roof. Another flock flies up the banister panels along the main circular stairs to the maternity and surgical in-patient floors. The firm’s project description explains that the rainbow and springtime designs serve as “natural reminders that growth and renewal follow adversity.” Green tree branches shelter the nurses’ station. Pieces of rainbow lead into each patient room. There are also opportunities to play. The combined pediatrics in-patient and outpatient reception area, located off the lobby features a play space for small children overlooking the entry garden. The adolescent psychiatric unit has a secure outdoor courtyard with a basketball hoop. For its efforts, Stantec Architecture received the 2001 Award of Excellence for Built Projects from the American Institute of Architects’ Academy of Architecture for Health. Over in Prince Edward Island, Bergmark Guimond Hammarlund Jones in association with Stantec Architecture incorporated community consultation ad the use of bright colours and natural light, in leading the design of the new Prince County Hospital on a 27-acrea site in Summerside. “The area is rural and agricultural, therefore we wanted to keep it low-scale and connected to the landscape,” explains grant MacEachern, RMAIC, an associate with Stantec Architecture, who worked on the project as an intern architect. “We created a two-storey building that would spread horizontally on the land and suit the surrounding community better than a vertical scheme, which would be out of context with the surrounding rural landscape.” Opened in 2004, the 18,000-squre-metre, 102-bed hospital is closely connected to its surroundings, through window glazing, the use of natural and local materials (landscape stone, brick and wood detailing) and the inclusions of the work of PEI artists throughout its corridors and public spaces. Its horizontal orientation also promotes accessibility. Diagnostic and treatment services are centralized and located near the main entrance facing north, while the in-patient units are located in pods on the south side of the building away from high-traffic public areas. “The pods are configured in a cruciform plan to ensure that staff have minimal walking distances to get to patients when they need immediate access,” says MacEachern. The in-patient area is also adjacent to two large courtyards: one is a healing garden, the other a place for meditation And the hospital – about 30 percent larger than its half-century-old predecessor facility – features skylights and large windows throughout the building so staff and patients “aren’t stuck in a rabbit warren all day,” says MacEachern. He explains that the $38.5 million project relied heavily on the input of hospital staff. “We held user-group sessions where we sat down with representatives form each medical department at every design stage and had a dialogue with the,” says MacEachern. “We went back and forth until we worked out the final plan, because we believed we wouldn’t be successful unless we combined out best practices with their specific needs.” While the Prince County Hospital project in PEI focused on blending the hospital into its pastoral environment, the Quebec firm, Les architectes d’Anjou, Lefebvre et Gagnon, has been focused on the urban challenge of linking an emergency department expansion (a trauma centre that serves eastern Quebec) to a more than 80-year old hospital in the provincial capital. In the 1970s, Hopital de l’enfant-Jésus, which is affiliated with Université Laval, underwent an expansion of the surgical and emergency departments that resulted in massive grey concrete erected at the front of the hospital, explains Pierre d’Anjou, FIRAC, a partner in the firm, d’Anjou, Lefebvre et Gagnon. “At the time concrete paneling was considered de rigueur.” In 1990, his colleague Jacques Gagnon led another, $40-million expansion that was more integrated with the yellow masonry of the original building. The latest expansion, at $13.7 million and scheduled to be completed by the spring of 2008, will build on top and in front of the concrete work from the 1970s, says d’Anjou. He explains that by expanding the existing space of the emergency department, the drab space of the emergency department, the drab concrete that overwhelmed that part of the hospital will be replaced by more of the original masonry and give “homogeneity” to the whole building. “When finished, the hospital may not look exactly like it did in the 1950s, but it will have a uniform, contemporary design.” Montreal architect Paul-André Tétreault, AP/FRAIC, is also designing a hospital emergency department. But his challenge lies indoors. Tétreault, who serves as the RAIC College of Fellow Chancellor and has the distinction of having designed more than one million square metres of hospital space throughout Quebec, is a leading team consisting of architects from the firm Aedifica, and from ABCP Architects on a $34-million project to build a new, 5,000-squre-metre emergency ward at Hopital Maisonneuve-Rosemont in Montreal’s east end. Scheduled to open in the summer of 2007, Maisonneuve-Rosemont’s emergency ward – the largest such hospital ward in the country – has required much attention to detail. Says Tétreault: “usually in emergency departments, medical personnel work on patients in the same room with curtains dividing the stretchers. But the hospital wanted closed cubicles with bathrooms in each of the 55 cubicles.” He says it’s important to have the separation between patients and staff – particularly for the doctors and nurses in a hospital in a section of Montreal known for having “some tough guys.” In the new emergency ward, space for medical personnel will be situated in the centre and surrounded by examining rooms and cubicles. Tétreault, who was also involved in the design of the Maisonneuve-Rosemont’s new $70-million ambulance centre that opened in 2004, says when approaching health-care-related projects, architects need to keep an open mind. “Since all of us may end up going to a hospital at one point in our lives, the tendency might be to only consider the patient in our designs.” “But you always have to consider the big picture and think about the medical staff and their needs too.”
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