Table Of ContentHospitals — A Design Manual
A Design Manual
Hospitals
Cor Wagenaar
Noor Mens
Guru Manja
Colette Niemeijer
Tom Guthknecht
Contributions by
Giuseppe Lacanna
Peter Luscuere
Birkhäuser
Basel
We would like to thank the organizers of the
‘Building the Future of Health’ conference,
www.btfoh.eu, for their kind support of this
publication.
Layout and cover design Jenna Gesse, Berlin
Graphic design concept of ‘Design Manual’ series
Oliver Kleinschmidt, Berlin
Cover Akershus University Hospital, Oslo,
C. F. Møller Architects; photo: Torben Ekserod
Frontispiece Surgical Clinic La Croix-Rousse, Lyon,
Atelier Christian de Portzamparc; photo: Erick Saillet
Concept Cor Wagenaar, Noor Mens
Project texts Noor Mens, Cor Wagenaar
Copy-editor Harvey L. Mendelsohn, Cambridge,
Massachusetts
Editorial supervision Ria Stein, Berlin
Production Katja Jaeger, Amelie Solbrig, Berlin
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Principles of the Hospital Building
8
Preface
Cor Wagenaar, Noor Mens
9
Introduction
Cor Wagenaar, Noor Mens
DEFINING THE HOSPITAL DESIGNING HOSPITALS PUBLIC SPACES TREATMENT AREAS
OF TOMORROW
12 23 52 67
Paradigm Change? Distribution of Healthcare Zoning and Traffic System Planning: an Integral
The Perspective of the Patient Facilities: Centralization, Tom Guthknecht, Peter Approach
Cor Wagenaar, Noor Mens Decentralization and the Luscuere, Guru Manja, Colette Tom Guthknecht
Network Hospital Niemeijer, Cor Wagenaar
15 Guru Manja, Colette Niemeijer, 69
Healthcare as a Public Service Cor Wagenaar 58 Outpatient Department
Cor Wagenaar, Noor Mens Arrival and Entrance Tom Guthknecht, Guru
27 Noor Mens Manja, Colette Niemeijer,
19 The Design of Hospitals: Cor Wagenaar
The Business Case Care Pathways 61
for Hospitals Guru Manja, Colette Niemeijer, Public Spaces in and Around 75
Guru Manja, Colette Niemeijer Cor Wagenaar the Hospital: Streets, Inpatient Wards
Squares, Patios, Waiting Tom Guthknecht, Guru
22 32 Areas, Healing Gardens Manja, Colette Niemeijer,
Changing Healthcare Needs Processes and Spaces: Giuseppe Lacanna, Cor Wagenaar
Cor Wagenaar, Noor Mens the Example of the Maternity Cor Wagenaar
Department 83
Guru Manja, Colette Niemeijer, 65 Diagnostic Imaging
Cor Wagenaar Wayfinding: Signage and Tom Guthknecht, Guru Manja,
Orientation Systems Cor Wagenaar
37 Noor Mens
Evidence-Based Design for 85
Healing Environments Operating Theater and
Cor Wagenaar Recovery Area
Tom Guthknecht, Guru
42 Manja, Colette Niemeijer,
The Building Type and Cor Wagenaar
its Emergence
Noor Mens 100
Intensive Care Unit
Tom Guthknecht, Guru
Manja, Colette Niemeijer,
Cor Wagenaar
108
Emergency Department
Tom Guthknecht, Guru
Manja, Colette Niemeijer,
Cor Wagenaar
111
Laboratory Department
Tom Guthknecht
Selection of Projects
GENERAL HOSPITALS CHILDREN’S HOSPITALS UNIVERSITY HOSPITALS
118 140 160 188
Circle Bath Hôpital Riviera-Chablais Nemours Children’s Hospital Center for Surgical Medicine
Bath, UK Rennaz, Switzerland Orlando, Florida, USA University Hospital
Foster + Partners Groupe-6; GD architectes Stanley Beaman & Sears Düsseldorf
Düsseldorf, Germany
122 142 164 Heinle, Wischer und Partner
Butaro District Hospital Medisch Spectrum Twente Randall Children’s Hospital
Butaro, Rwanda Enschede, the Netherlands at Legacy Emanuel 192
MASS Design Group IAA Architecten Portland, Oregon, USA St. Olav’s Hospital
ZGF Architects Trondheim, Norway
124 148 Nordic – Office of Architecture;
Private Hospital Rey Juan Carlos Hospital 168 Ratio Arkitekter
Villeneuve d’Ascq Madrid, Spain Juliana Children’s Hospital
Lille, France Rafael de La-Hoz The Hague, the Netherlands 196
Jean-Philippe Pargade MVSA Architects Akershus University Hospital
Architectes 152 Oslo, Norway
Meander Medisch Centrum 172 C. F. Møller Architects
128 Amersfoort, the Netherlands Mother-Child and
Extension Kolding Hospital Atelier PRO architekten Surgical Center 200
Kolding, Denmark Kaiser-Franz-Josef-Spital Reconstruction of the Johann
Schmidt Hammer Lassen 156 Vienna, Austria Wolfgang Goethe University
Architects Cleveland Clinic Abu Dhabi Nickl & Partner Architekten Hospital
Abu Dhabi, Frankfurt am Main, Germany
130 United Arab Emirates 176 Nickl & Partner Architekten
AZ Groeninge HDR Ann & Robert H. Lurie
Kortrijk, Belgium Children’s Hospital 204
Baumschlager Eberle Chicago, Illinois, USA Erasmus MC Hospital and
Architekten ZGF Architects Education Center
Rotterdam, the Netherlands
134 182 EGM architects; KAAN
Zaans Medisch Centrum Royal Children’s Hospital Architecten
Zaandam, the Netherlands Melbourne, Australia
Mecanoo Billard Leece Partnership;
Bates Smart
SPECIALIZED HOSPITALS OUTPATIENT CLINICS REHABILITATION APPENDIX
AND HEALTH CENTERS AND SUPPORT CLINICS
210 232 248 268
Cleveland Clinic Lou Ruvo Ruukki Health Clinic Maggie’s Centre West London The Authors
Center for Brain Health Ruukki, Finland London, UK
Las Vegas, Nevada, USA alt Arkkitehdit; Architecture Rogers Stirk Harbour + Partners 268
Frank Gehry Office Karsikas Index of Places
250
212 234 Maggie’s Centre Gartnavel 270
Surgical Clinic Municipal Healthcare Glasgow, UK Index of Names
La Croix-Rousse Centers San Blas, OMA
Lyon, France Usera, Villaverde 271
Atelier Christian de Madrid, Spain 252 Illustration Credits
Portzamparc Estudio Entresitio Gheskio Cholera
Treatment Center
216 238 Port-au-Prince, Haiti
Milstein Family Heart Center UCLA Outpatient Surgery MASS Design Group
NewYork-Presbyterian and Medical Office Building
Hospital Santa Monica, California, USA 254
New York, New York, USA Michael W. Folonis Architects Cancer Counseling Center
Pei Cobb Freed & Partners Livsrum, Denmark
240 EFFEKT Arkitekter
220 New QEII Hospital
National Center for Welwyn Garden City, UK 258
Tumor Diseases Penoyre & Prasad Healthcare Center
Heidelberg, Germany for Cancer Patients
Behnisch Architekten 242 Copenhagen, Denmark
Outpatient Clinic Nord Architects
224 Hospital-Asilo of Granollers
Institut Imagine Granollers, Spain 262
Paris, France Pinearq Rehabilitation Center
Ateliers Jean Nouvel; Groot Klimmendaal
Valero Gadan Architectes Arnhem, the Netherlands
Koen van Velsen Architects
228
Cancer Centre at Guy’s 266
London, UK Anti-Aging Life
Rogers Stirk Harbour + Partners Center Chaum
Seoul, South Korea
KMD Architects
Preface
Hospitals — A Design Manual is a book for architects, hospital administrators and plan-
ners, medical specialists and policy makers about the latest trends in hospital architecture
and it aspires to be a tool for change. As used in this manual, the term ‘design’ encompass-
es more than spatial configuration, the use of materials, color, windows, doors and furni-
ture. The authors present the hospital as a composition of components, each of which can
be designed in various ways. We offer a range of choices, many of which are determined
by programming decisions. Weighing various options is an essential part of the architect’s
task in designing a hospital. The publication’s focus is on people and processes rather than
on medicine and technology. Caring for people and optimizing the processes they undergo
are constant concerns in hospitals, no matter how quickly and fundamentally medicine and
technology change. In hospital design, there are no standard solutions. Each hospital rep-
resents a unique combination of design decisions that is determined by its specific context,
including the characteristics of the population it serves, demographic trends, healthcare
systems, economic realities, etc. If the reader comes away with a heightened awareness of
the many questions architects and decision makers have to consider, then this book will
have served its purpose.
The projects documented here have been selected because they represent fundamental
trends. Revolutions in healthcare architecture are always slow – paradigm changes take time
to materialize. Some of the trends illustrated by the case studies have been underway for
quite some time, others are more recent, but both testify to the gradual emergence of new
hospital landscapes.
The manual is the result of teamwork. Tom Guthknecht, an internationally renowned
healthcare architect, theoretician and consultant, helped define the main principles of hos-
pital planning as well as identify current trends and challenges in designing specific func-
tional components. Kirk Hamilton, a prominent healthcare architect, is also an expert on
evidence-based design; his input focused on the use of science in architecture. Peter Lus-
cuere, a leading professional in hospital construction, general layout models and clean air
technology, contributed to the parts of the book dealing with these issues. Guru Manja and
Colette Niemeijer, who specialize in the reconceptualization of the hospital from the pa-
tient’s perspective and in hospital programming, were responsible for describing the close
link between patients’ needs, the program, logistics and business matters, on the one hand,
and architecture and distribution models, on the other. Laura Bulau, Marien Kleizen and
Kees de Wit at CEANconsulting produced all the graphs and diagrams. Many people have
helped in making this book happen — we mention only two of them. We thank Ria Stein for
staying with us when for a number of reasons the project came to a complete standstill —
this manual is the result of its renaissance in the spring of 2014. We are particularly grate-
ful to Harvey Mendelsohn with whom we have worked on many projects for many years;
his editorial skills were indispensable.
Cor Wagenaar and Noor Mens
8
Introduction
COR WAGENAAR, NOOR MENS
Only a decade ago, architects and critics considered hospital architecture to be a field
‘lagging behind the most inventive and progressive developments in the art and science
of architecture, and indeed losing the commitment and skill required in the making of
places that mean something to people’.1 Since then the situation has changed complete-
ly. Hospitals are back in the frontlines of architecture. The world’s leading designers have
discovered that this building type offers fundamental, indeed unique design challenges.
Absorbing the latest findings in science, psychology, medical technology and the digital
revolution, exploring the urban surroundings as a framework for integration and reflect-
ing major economic trends and, most notably, the transfer of responsibility to the end user,
hospitals address fundamental aspects of human life in ways no other buildings do. Few
other institutions have such a direct impact on the quality of life of the people who rely on
their services. Sometimes the stakes are even higher: whether a patient lives or dies may
depend on the way a hospital performs. This book outlines how architecture can help hos-
pitals increase the efficiency of the medical processes they house, while simultaneously im-
proving financial performance and, most importantly, providing patients with better care.
Since their architecture directly affects how hospitals function, we believe that the
architect’s role goes beyond the realm of design in the strict sense. Architects involved in
planning a hospital must address a host of issues: accommodating the flows of staff, pa-
tients and their visitors, balancing efficient use of facilities with the need to meet unpre-
dictable peaks in demand and ensuring sufficient flexibility in the design to accommodate
constantly evolving technology, to name but a few. They should be capable of assessing
the impact of design solutions on the efficiency of medical processes and, therefore, of ex-
panding the scope of their work to include the functional program: logistics, public spaces,
wayfinding, patient transfers, the balance between single- and multiple-patient rooms, er-
gonomics, etc. As the CEO of an American hospital stated, architects ‘…should want more
control and be a more integral part of the medical team’.2 If they accept the reduction
of their role to that of aesthetic and technical advisors responsible for a building’s form,
appearance and representative qualities, they abandon what we see as a large area of their
profession’s responsibilities, leaving behind a void that cannot be easily filled. Good hospi-
tal design can only flourish when its organization and processes, as well as its spatial logis-
tics, infrastructure and programming are addressed in an integral manner.3 Ideally, this
should culminate in a perfect fit between program and design.
Hospitals are key elements in the healthcare system, which we view as a public ser-
vice; they are obviously meant to enhance public health, which, ultimately, is measured by
statistical data: life expectancy and the various other parameters used to define the quality
of life. Often, the latter aspects are related to social and economic factors and lifestyle in-
dicators. While medicine clearly has an impact on public health, its effects should be seen
in a wider perspective. It is clear that city planning (by providing decent sewage and water
supply systems and stimulating walking and physical exercise, for instance) and architec-
ture (notably in the field of public housing) have been very important factors in improving
life expectancy and quality of life.4 Investment of public money in medicine and medical
facilities, it has been argued, should be proportional to their contribution to improved pub-
lic health. In principle, the financial interests of hospitals do not always coincide with the
objectives of public health. If a thorough upgrade of post-war housing projects yields bet-
ter results in that regard than building new hospitals, then this is where the money should
go. In many countries, only a small percentage of healthcare expenditure is allocated to
prevention, while the cost of medical treatment continues to rise to unsustainable levels.
Faced with the prospects of financial disaster, many public health systems need to improve
their cost-effectiveness. If prevention of disease develops into the new frontier of public
health, hospitals will be forced to reconsider their role and try to define their place in a con-
tinuum of prevention, health promotion and medical intervention (care and cure).
Franz Labryga uses the term ‘health houses’ to describe facilities that ‘(…) will primar-
ily be places that provide information, support, surveillance and prevention. Diagnosis
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