Over the past couple of years, new children’s healthcare schemes have emerged that demonstrate how very seriously healthcare providers now take this patient group – and their carers – as well as how far design has come in the engineering of healthcare spaces which reassure and support their occupants.
Daylight, uplifting and strategic use of colour and materials, clear wayfinding, ample garden spaces and greenery are deployed in bold and generous measure. But there are clearly many ways to calm a stressed-out family.
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For the traumatised parents at Bath’s Dyson Centre for Neonatal Care, being given a space – even a window ledge – to take ‘time out’ from the intense activity surrounding their child is as important as providing a clear sense of progress via layout and signage to show that a child’s treatment is progressing well.
When a child is sick, the whole family gets involved – siblings included. One of the most impressive schemes for maximising family engagement has to be Melbourne’s Royal Children’s Hospital, designed by Billard Leece Partnership (BLP), with Bates Smart and HKS. Its art-filled public spaces feature not just a museum-quality aquarium in the reception foyer but also a meerkat enclosure, managed and maintained by staff from nearby Melbourne Zoo. Ron Billard, director of BLP says: ‘We were very aware of the importance of distraction and attractions to make the hospital a more appealing place to come to. These features have had an enormous impact. I keep coming across parents who just rave about it all – their kids actually enjoy going to the hospital now.’
Not every design team can forge links with a zoo. This scheme, and its unique animal features, were very much inspired by the logic of BLP’s initial master plan, which proposed moving the children’s hospital to within the Royal Park (which the existing hospital was adjacent to but had been separated from), where the zoo is also located. As a result, says Billard, the client had time and reason to look at all the most compelling research into the role of nature and daylight as restorative and healing agents, while visiting benchmark projects around the world, as the international design competition progressed. Says Billard: ‘By the time the competition was decided, the client was very focused on best practice. That gave us an enormous boost. We had a client that was completely switched on.’
While aquaria and meerkats are guaranteed to delight the under 12s, placement is crucial. Billard explains: ‘The meerkat enclosure is right at the end of the outpatient clinic courtyard, behind glass so that the kids can look at them all they like without touching them (the enclosure itself is open to the sky, though protected from the elements). We put it where the maximum number of kids would benefit from it – there are 350,000 presentations a year in that group of clinics.’
But a few show-stopping features aren’t enough to make a healthcare building work. According to Billard, one of the most successful design elements is the way the central atrium ‘Main Street’ unites and clarifies wayfinding on every level through its network of bridges and walkways. Says Billard: ‘The research staff are on the top two floors but every day they have to interact with the children’s hospital below, as they are walking around the building. When we visited with a team from Perth, where we’re designing another children’s hospital, the research team thought that was fantastic. It reminds them why they’re there.’
Feilden Clegg Bradley’s solution for its client, the Dyson Centre for Neonatal Care, is at the opposite end of the spectrum in terms of bells and whistles, and solves a different set of emotional and logistical issues for its occupants. One of the clearest findings from the stakeholder workshops that the practice attended was the degree of stress typically experienced in a neonatal unit, and the need to alleviate it by any means possible. Says FCB partner Matt Vaudin: ‘For the parents, being in the neo-natal unit is one of the most stressful things they could ever endure. We wanted to use lots of natural light and a very calm interior that didn’t have all the usual trappings of a clinical environment.’ FCB’s building is constructed of cross-laminated timber panels, with timber visible inside and out. Says Vaudin: ‘Using timber makes the whole place feel completely different. Putting pictures of Mickey Mouse on the walls and bright colours just wasn’t appropriate – particularly because babies are only just about aware of night and day. It doesn’t need to look like a day nursery.’
Equally effective, says Vaudin, is the psychological sense of progress that the unit affords, by placing rooms in a clear hierarchy of care (colour coded to highlight each shift), progressing from intensive to high dependency, then special care, then parents’ rooms, then home.
The building has been garlanded with several awards, including two RIBA awards (one for the building, one for its client), and ‘Best Inpatient Facility Design’ at the Building Better Healthcare Awards 2012.
In both cases, the inspirational and holistic solutions to specific client and occupant issues have been achieved in no small part thanks to the architects getting involved early on.
The same is true of Medical Architecture (MAAP)’s new child and adolescent mental healthcare centre in England’s North. For this project, completed in October 2011, consultations kicked off as far back as 2005, when a choice of sites presented themselves. What has resulted, according to architect David Davies, is ‘a completely new service model. It involves a reworking from the Trust side about how it was delivering its services as well as creating a new building typology and new accommodations.’
Davies and interior designer Scott Stewart spent a lot of time listening to what the young occupants wanted. The facility houses a very vulnerable group of inpatients – children ranging in age from four to 18, with moderate to severe learning difficulties and some with severe psychological illnesses. Working closely with a committed and passionate client team – steered by clinical lead Jane Gibson – and with energy and motivation maintained thanks to a high standard of teamwork and communication between architects, designers, contractors and clinicians, the children’s demands were usually accommodated, even when they contradicted the initial instructions. For example, says Davies: ‘The initial brief hadn’t allocated much space to the multipurpose hall, but when the kids saw it they said they wanted to play five-a- side football. So it was expanded.’
As designs evolved, MAAP even made a full-sized mock-up of a bedroom, allowing patients’ comments to impact on final designs – if they felt wardrobes should be bigger, they were made bigger. Says Stewart: ‘Making mock-ups was invaluable because by the time you come to the final thing, you know it’s right.’ The team also brought in a poet and an artist to work with the young people in evolving a delightfully counterintuitive wayfinding scheme.
Inspired by the building’s tranquil, wooded setting, each ward is identified by a particular two-tone colour palette and animal. Poems and symbols evoking these animals and colours weave their way from the wards along the route until they collide in the main social spaces. So wayfinding is oriented towards the child inpatients, rather than the visitor.
Stewart adds: ‘The quality and finishes are also so much better than people expect – the lead clinician was key in driving this. She wanted the place to feel more like a hotel than an institution – even down to the duvet covers in the bedrooms being reversible, in the same two-tone scheme that each ward is identified by, so the kids can choose what colour they want uppermost. She wanted mattresses that were better than standard too. There are also big areas with pinboards so they can make it theirs.’
High-quality and durable furniture was sourced from the leisure industry rather than use typical institutional items. Says Stewart: ‘We involved ourselves with those reps – the sports hall floor is the same quality as the gymnasium in the Olympics. It’s just a case of haggling. Ironmongery is massively important to get right. Developing bespoke products together (at an early enough stage) doesn’t make them more expensive.’
It is this kind of attention to detail – driven by the passion and engagement of design and client teams – that makes all the difference to child healthcare spaces; not just the way they look but they way they work.
As anyone with young children knows, waiting is its own form of torture, inducing high levels of stress in both child and carer. Global practice HKS has developed a new clinic design that aims to minimise it. Pioneered at Children’s Hospital Dallas, this system entails providing a standardised module of 12 examination rooms arranged in a way that allows rooms to be assigned to a specific clinic as needed. Each module has its own small waiting area to serve the daily clinics, tied in to an electronic patient tracking system. All the essential support elements for the medical staff to run the clinics are in place.
Ron Dennis, principal and director of children’s health facilities at HKS, says: ‘The efficiency happens because when the patient comes in, they are assigned to one of the physician’s two or three exam rooms and then they are expedited. It’s like air-traffic control. There’s a tracking system that knows where the patients and clinicians are as they move through the facility. In the past, many clinics would say come in at 7am and we’ll get to you when we get to you. This way they can tell them to come in at 10am, and they’ll be seen by 10.30am.’
HKS has now rolled this out to several other facilities, including Melbourne. After 30 years in the field, Dennis knows what he’s talking about when he says children’s hospitals are more challenging than adult ones. ‘But,’ he concludes, ‘they are so much more exciting, because they have to take into account not just the medical but the emotional and psychological experience.’
The Royal Children’s Hospital, Melbourne
Inspired by the hospital’s setting, in Melbourne’s Royal Park, The Royal Children’s Hospital is filled with light and nature – real and imagined. Designed by architects at Billard Leece Partnership, along with Bates Smart and HKS, the six-storey building features a museum-quality aquarium by the reception desk, and a meerkat enclosure in the children’s waiting area. A six-storey ‘Main Street’ at the heart of the building leaves ample space for performance, large-scale artworks, and – through its intersecting walkways and bridges at each level – a constant view on to patient activity for clinicians and researchers who occupy the upper floors. A star-shaped inpatient building is sited to the north, set into the actual parkland. Medical procedures are conducted away from calm, soft-toned bedrooms, to ensure that these spaces are a haven for both patient and families. Separation of clinical and support areas allows those areas not used 24/7 to be shut down, reducing energy consumption. Bio-mass heating and solar thermal panels reduce the building’s carbon footprint, along with blackwater treatment and rainwater recovery programmes. The building is filled with art, as well as animals, including a 14m-high ‘creature’ in the atrium, by Melbourne artist Alexander Knox, and Jane Reiseger’s charming wall illustrations that aid wayfinding.
Client: State Government of Victoria
Architects: Billard Leece Partnership/Bates Smart/HKS (USA)
Size: 165,000 sq m
Cost: $1bn (Aus)
Completed: 2011
Art consultant: Bronwen Colman
Dyson Centre for Neo Natal Care, Bath
The new Neo Natal Intensive Care Unit at Bath’s Royal United Hospital (RUH) is intended to be at the forefront of sustainable and patient-family-friendly intensive care. The RUH specifically commissioned a non-healthcare architecture practice, Feilden Clegg Bradley (FCB), to approach the project afresh.
The single-storey new-build extension is constructed of large, cross-laminated timber panels, which form part of a breathable wall of wood, fibre insulation and timber cladding. Exposed timber internal panels are coated with white translucent paint for ease of cleaning, adding a quasi-domestic interior feel. Feature-wall colours are coded to aid wayfinding, ranging from green for intensive care through to pinks and oranges for the less critical areas. Care rooms are grouped around a central staff base to ensure visibility.
A landscaped courtyard between the neonatal and delivery units provides a ‘decompression’ zone for parents, overlooked by three comfortable parent rooms. In the critical care rooms, generously proportioned window ledges become seats for parents. Brothers and sisters have their own brightly coloured, highly interactive sibling room, featuring bespoke play equipment.
A walk-in duct along the spine of building accommodates all air-handling equipment so that maintenance staff can access and adjust equipment without entering the NICU unit – thereby helping with infection control. Sustainability initiatives include a sedum roof, low-flow water fittings, rainwater harvesting and a combined heat and power unit providing low-carbon electricity and heat.
Client: Royal United Hospital, Bath NHS Trust
Architects: Feilden Clegg Bradley
Construction value: £3m
Opened: February 2012
Healthcare researcher: Desireland
Sibling space design: Boex
Randall Children’s Hospital, Portland, Oregon
Zimmer Gunsul Frasca (ZGF) was asked to consolidate the previously dispersed pediatric care facilities at Legacy Emmanuel Medical Center in Portland and create a new identity for the children’s hospital on its campus. The resulting building and uplifting interiors were inspired by values established between ZGF and the hospital’s leadership team: to create a building that was comfortable for all ages, full of inspiration, with a sense of unexpected discovery and thoughtful distractions.
ZGF took its inspiration from the natural world, with local geographic colourings used to distinguish departments, and local fauna appearing in uplifting art works. Public areas feature soft, curving forms as well as patterning inspired by games and objects familiar to children. Most importantly, the facilities, design and layout place family-centred care at its heart.
The new nine-storey building is filled with non-institutional textures, materials and facilities, such as bamboo doors on patient rooms, sculptural wood pendant lights. Patients and families can spend quality time together in a range of spaces, including two-storey family lounges in the patient floors, a wellness centre for families to work out in, a 20-seater theatre for movie viewings, and games rooms. A teen lounge offers foosball table, gaming software and casual, flexible seating. The 165 inpatient bedrooms feature high ceilings, ample storage, pull-out beds for parent sleepovers, entertainment centres and views on to the city or mountains. The facility also houses the Children’s Cancer and Blood Disorder Unit; a new pediatric emergency department and a day-surgery unit with direct access to surgery in the main hospital. A tunnel connection, a first-floor gallery connection and second-floor bridge provide convenient links to the existing hospital’s support services. A separate staff work room and lounge has been provided on each floor, with lounges on the south side of the building overlooking gardens and views.
Client: Legacy Health
Architecture and interior /Design: Zimmer Gunsul Frasca
Size: 31,000 sq m
Cost: $115m
Schedule: completed January 2012
Bayt Abdullah Children’s Hospice, Kuwait
Bayt Abdullah provides a state-of-the-art facility for children and their families as they deal with the traumatic final months of the children’s lives. Developed by the Kuwait Association for the Care of Children charity (KACCH) under its president Dr Hilal Al Sayer and his wife, founder and director, Margaret Al Sayer, it is the largest inpatient healthcare facility in the world dedicated to terminally ill children. The three-storey building includes a mixture of family accommodation, day-care facilities, auditorium, library, hydrotherapy and gym, school and pottery studio. Sensory rooms are used for counselling and therapy, and there are outdoor and indoor sensory gardens. There are also 11 private chalets, overlooking a nature reserve and Kuwait bay. London Eye creator Marks Barfield Architects was brought on board to design several fantastical but fully accessible playground features, including a kaleidoscopic observation wheel, a ‘magic carpet’ and an arial walkway that proceeds above the rooftops to an observation platform overlooking a flamingo feeding ground and nature reserve. The 15m-high wheel features eight ‘pods’ that can accommodate up to five children each, including wheelchair users. Naturally ventilated, they are shaded by a perforated canopy of rainbow colours reflecting the tones of the wheel. The scheme itself was inspired by architect Alia Al Ghunaim’s graduate thesis on pediatric facilities. NBBJ worked closely with her to develop sympathetic interiors, graphics and signage. Interiors are vibrant, playful and child-scaled, from the low-level seating in all areas to the fantasy fibre-optic light-fittings and wall alcoves provided for play or storage. Materials are high quality, cost effective and long lasting: flooring is tough, commercial-standard rubber sheeting, Corian is used for counter tops, walls are Armourcoat, and there is maple cabinetry and millwork.
Project: Bayt Abdullah Children’s hospice, Kuwait
Client: Kuwait Association for the Care of Children (KACCH)
Architect: Alia Al Ghunaim, with Gulf Consult
Interior architecture and design: NBBJ
Playground architecture: Marks Barfield Architects
Landscape architect and engineer: Gulf Consult
Cost: $30m US
Area: 14,400 sq m
Opened: 2012
Ferndene, Prudhoe, Northumberland
Surrounded by forests and greenery, Medical Architecture’s 40-bedroom residential centre is designed for inpatient assessment and treatment for young people with complex health, behavioural and emotional needs, including learning disabilities. Children aged four to 18 are housed in four single-storey ward blocks which extend out to the rear of a two-storey, central shared-activity and ‘school’ building, like fingers from a hand, with a clear progression from public to private spaces. The main block’s facilities include a cafe, sports hall and a conference room that doubles as a cinema. Open-plan offices on the first floor provide superior staff accommodation together with excellent passive supervision via rear glazing overlooking wards, courtyards and play areas.
All stakeholder groups were involved in consultations. An attempt to marry both security and dignity is evident in the final design. Each inpatient has their own bedroom – most with en-suite bathrooms – arranged around three sides of a central courtyard also overlooked from the ward lounge area. Furnishings throughout are non-institutional for a more homely or hotel-like feel. A flat is provided for visiting parents to use.
Naturally ventilated and daylit, the central building is designed in zones to eliminate corridors and also facilitate localised use of areas, thereby minimising energy consumption during winter months. Cool greens, referencing the natural setting, are used inside and outside the building, with random-patterned louvres and exterior tiling contrasting with the simple geometry of the white rendered buildings.
Client: Northumberland, Tyne and Wear NHS Foundation Trust
Architecture, interiors and landscape: Medical Architecture (MAAP)
Cost: £27m
Area: 5,347 sq m
Opened: October 2011
Structural engineer: Arup
Artist: Artstop Studios
This article was first published in fx Magazine.
