H E A L I N G H O S P I T A L Upycling the OLD for a healthier Master Thesis Report by Maria Soledad...

8/19/2019 H E A L I N G H O S P I T A L Upycling the OLD for a healthier Master Thesis Report by Maria Soledad Larrain Salinas

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Master Thesis Report

by

Maria Soledad Larrain Salinas

H E A L I N G H O S P I T A LUpycling the OLD for a healthier NOW


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Master Thesis Proyct by Marìa Soledad Larraìn Salinas

Healing Hospital: Upcycling the old for a healthier now.

Examiner: Michael EdenProfessor: Walter UnterrainerExternal Supervisors: Juri Soolep and Peter Kjaer.

Umeå universitet _ UMA School of ArchitectureLSAP Laboratory for Sustainable Architectural Production Master Program 2010-2012

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 subject of health care and believin g in my proposal and the rel-evance of its outcome. And with her to all the staff of MalmöUniversity Hospital and Regionservice Malmö for letting me in-vade their premises and for their valuable time answering myquestions and showing everything, but above all their tremen-

dous disposition to help me.

To my teachers for their advice on assuming this subject andallowing 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 togo to all those places afterwards and visit.

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


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CONTENT

PART 1 : RESEARCHTHESIS 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 HOSPITALHISTORY AND CONTEXT 46

VISION 48

ANALYSIS AND MAPPING 50

STRATEGY AND MASTERPLAN 52

BUILDING 65 54

NEW PROPOSED BUILDING 62

CONCLUSIONS 76


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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 nd 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

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

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

MOTIVATION


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What is health?The World Health Organisation (WHO) dened health in

1948 as ‘a state of complete physical, mental and social well-

being and not merely the absence of disease or inrmity’.1 This

coincides closely with the holistic view seeing the patient rst as

a person within their family, community and workplace, and rec-

ognising the positive and negative inuences 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-fth edition, Supplement, October 2006.

H E A L T H C A R EUpycling the OLD for a healthier NOW


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If we take the matter in a simple way, hospitals are the

institutions that implement society’s health care, but we start

with a void: what is health care? Who are we caring for? And

what should they care about?

When people is asked about the role of a hospital, in the

majority of cases the concept: take care of the sick, comes up.

But when asked what is health and being healthy, more choices

come to mind. Health as a more general understanding is not

just a state, but also “a resource for everyday life, not the ob-

jective of living. Health is a positive concept emphasizing social

and personal resources, as well as physical capacities.” 1

As the early word comes from a less medical root, hospi-

tal per se comes from the sense of hosting, where there are two

actors in a dynamic relation: the host and the guest, each hav-

ing its role. The concept of hospitality is born as offering comfort

and guidance to strangers, which during time has been lost in

the hospital duty and responsibility. Is here where information,

but specially trust come into place, two concepts that are natu-

rally there but should be implemented and strengthened. As

was mentioned health is a double relationship, where we get

cared for when in sickness, but there is much more to do before.

Our health is bounded to external factors such as genetic and

environmental agents. From our transport system to our politic

1 World Health Organization. 1986. Ottawa Charter for Health Promotion,

adopted at the First International Conference on Health Promotion, Ottawa, 21 No-

vember 1986 - WHO/HPR/HEP/95.1.

mid-13c., “shelter for the

needy,” from O.Fr. hospital, ospital

“hostel” (Mod.Fr. hôpital), from L.L.

hospitale “guest-house, inn,” neuter of

Latin adjective hospitalis “of a guest or

host,” from hospes (gen. hospitis); see

host (1). Later “charitable institution to

house and maintain the needy” (early

15c.); sense of “institution for sick

people” is rst recorded 1540s.

http://www.etymonline.com/

index.php?term=hospital

Sjuk hus = Building of the

sick, comes from the middle High Ger-

man siecen-hûs, which was designated

a hospital for lepers.

(New Hospital Buildings in Ger-

many, page 12)

19%20%

51%

10%

B I O

- G E N E

TIC F A C

T O R S

C O M M U N

I T Y I N

F L U E

NCES AN D S O C I A

L S U P O R T

A C C E

S S T O

H EA L TH C AR E S E R V I C

E S

L I V I N G

A N D W

OR KING C O N D I T I O N S

S O C I O

- E C O

N O M

I C, C U

L T U R AL, ENV I R O N M E N T A L C O

N D I T

I O N S

+HEALTH

-HEALTH

ELEVATED

LEVEL OF

WELLBEING

AND PER-

FORMANCE

CAPACITY

PREMATURE

AND PRE-

VENTABLE

SICKNESS

AND DEATH

WE L L BE I N G

S

I C K N E S S

strategies and agricultural legislation, all actions impact on the

nal personal health.

Actually today some of the diseases that are affecting

a majority of the populations and collapsing our health system

come from unhealthy and uninformed behavioural choices in a

daily basis. According to WHO (World Health Organization) in

their 2009 Report, “Global health risks: mortality and burden

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

factors, such as water pollution and sanitation infrastructure.

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

are not seen as very inuential 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

future condition than treating the resulting disease afterwards.

Though many factors seem further than our personal

range, it’s important to realize how health is a joint cause and

every actor involved has it own role to play, from local gov-

ernment to social institutions. Health as we know is not just

about not being sick, but a whole range of other aspects, that

is why today health care is not seen just like a hospital, but a

dynamic network, wived into the urban fabric. The hospital till

now appeared as the safety net of the system, when nothing

else worked, but latest trends involve the hospital’s mission with

broader issues than just treatment.

In a broad look there is a clear process that guides

healthcare, and will in an end point guide the planning of a

hospital. We can identify ve very distinct stages where society,

or in this case the patient, move through. Its important to un-

derstand that though the different stages are always present in

2 McGinnis, J. M. and Foege, W.H. (1993). “Actual Causes of Death in the

United States,” Journal of the American Medical Association, Volume 270, Number

18: 2207-2212

HEALTHCARE:What it is and How to achieve it.


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PREVENTION DETECTION DIAGNOSE TREATMENT END OF LIFE

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 benets for the whole system. Simple actions like: physical tness, bed nets

against malaria, a good diet, clean drinking water, less use of tobacco, etc. Preventive action is

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

that is not sick”.

Detect: Nowadays the healthcare system helps who comes with a condition, and some-

times in that situation is already late, that is why proactive outreach on the part of the healthcare

system is important. Monitoring and detecting conditions in early times is not only efcient for the

system, but also benecial for the patient. This strategy must be impulsed by the health institu-tions and also governmental campaigns, focusing and spotting beh avioural and medical trends in

the community, so they can be addressed before a condition becomes a disease.

Diagnose: This is probably today’s one of the key processes in a hospital performance.

An on time and efcient diagnose is probably one of the most cost effective steps, where health

management can improve their performance. For the organization is a way to save resources

and time, which translates in the possibility of relocating those resources where they are really

needed. A miss diagnose can waste a lot of time and human workforce, but the most relevant is

also that the timeline of a diagnosis is critical for many disease paths.

Treat: This is the core of health care’s mission today and through time, though this is a

very technical and specic process, it is the reason for why people resort to the health system.

Though curing is important, caring has become a side concept, expanding the technical trea tment

to a more complete view of recovery.

End life: Probably one of the most controversial stages in healthcare, has to do with giving

life quality to whom is about to die. In difference as the other processes, this does not require of

specialist of different areas, but a more holistic approach that give relief and a good end periodof life for people in that path. Is not about effective endless treatment trying to x something

broken, but to reect on the general state of the patient and what is better for their case. For ex-

ample there is no point to do a high risk operation to x one organ on an old patient who’s entire

system is shutting down, but to improve its environment.

THE DETERMINANTS OF HEALTH

Many factors combine together to affect the health of individuals and communities.Whether people are healthy or not, is determined by their circumstances and environment.To a large extent, factors such as where we live, the state of our environment, genetics, ourincome and education level, and our relationships with friends and family all have consider-able impacts on health, whereas the more commonly considered factors such as access anduse 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 individualcharacteristics and behaviours.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 unlikelyto be able to directly control many of the determinants of health. These determinants—orthings that make people healthy or not—include the above factors, and many others:

Income and social status - higher income and social status are linked to betterhealth. The greater the gap between the richest and poorest people, the greater the differ-ences in health.

Education – low education levels are linked with poor health, more stress and lowerself-condence.

Physical environment – safe water and clean air, healthy workplaces, safe houses,communities and roads all contribute to good health.

Employment and working conditions – people in employment are healthier, par-ticularly those who have more control over their working conditions

Social support networks – greater support from families, friends and communitiesis linked to better health. Culture - customs and traditions, and the beliefs of the family andcommunity all affect health.

Genetics - inheritance plays a part in determining life span, healthiness and the likeli-hood of developing certain illnesses.

Personal behaviour and coping skills – balanced eating, keeping active, smoking,

drinking, and how we deal with life’s stresses and challenges all affect health.Health services - access and use of services that prevent and treat disease inuenceshealth

Gender - Men and women suffer from different types of diseases at different ages.

World Health Organization _ Health Impact Assesment

http://www.who.int

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


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Hospitals have come a long way through history, not

only in a formal point of view, but most important in their

genesis. They have been a kind of reection on society

all along, because the denition of health and health care

goes deeply rooted to what is the concept of person and

society. To understand where is the debate now, and why

has it got here, we need rst to understand the journey of

this institution, that through the centuries has been evolv-

ing looking for the right way.

Some of the earliest documented institutions aiming

to provide cures were ancient Egyptian and Greek temples.

In ancient Greece, they were dedicated to the healer-god

Asclepius, known as Asclepieia. This temples presentedthemselves as centres of medical advice, prognosis, and

healing1. At these shrines, patients would enter a dream-

1 Risse, G.B. Mending bodies, saving souls: a his-

tory of hospitals. Oxford University Press, 1990. p. 56

like state of induced sleep, in which they either received

guidance from the deity in a dream or were cured by sur-

gery. The worship of this god and the treatment rituals

were kept by the Romans.

After Romans converted to Christianity, health cov-

erage expanded through the empire. Following First Coun-

cil of Nicaea in 325 A.D. construction of a hospital in every

cathedral town was begun. Among the earliest were those

built by the physician Saint Sampson in Constantinople and

by Basil, bishop of Caesarea in modern-day Turkey. Called

the “Basilias”, the latter resembled a city and included hous-

ing for doctors and nurses and separate buildings for vari-

ous classes of patients, with a separate section for lepers.2

Some hospitals maintained libraries and training programs,

and doctors compiled their medical and pharmacological

studies in manuscripts. Thus in-patient medical care in the

sense of what we today consider a hospital, was an inven-

tion driven by Christian mercy and Byzantine innovation.

Byzantine hospital staff included the Chief Physician (ar-

chiatroi), professional nurses (hypourgoi) and the orderlies

(hyperetai). It can be said, however, that the modern con-

cept of a hospital dates from AD 331 when Constantine ,

having been converted to Christianity , abolished all pagan

hospitals and thus created the opportunity for a new start.

Until that time disease had isolated the sufferer from the

community. By the twelfth century, Constantinople had two

2 Catholic Encyclopedia - [1] (2009) Accessed April

2011.

Temple of Asclepios, Greece-600

Temple of Asclepios, Rome-293

Medirigiriya Hospital, Sri Lanka-400

Valetudinarium Hospital, Rome-100

Saint Basil the Great, Cappadocia369

Gundishapur’s Academy, Persia271

Xenodochium of Mérida, Spain580

Abbey of Saint Gall, Switzerland612

Hôtel-Dieu, of Paris, France651

Santo Spirito in Saxia, Italy1204

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well-organized hospitals, staffed by doctors who were both

male and female. Facilities included systematic treatment

procedures and specialized wards for various diseases. The

Christian tradition emphasized the close relationship of the

sufferer to his fellow man, upon whom rested the obliga-

tion for care. Illness thus became a matter for the Christian

church.3

Medieval hospitals in Europe followed a similar pat-

tern. They were religious communities, with care provided

by monks and nuns. Some were attached to monasteries;

others were independent and had their own endowments,

usually of property, which provided income for their sup-

port. Some hospitals were multi-functional while others

were founded for specic purposes such as leper hospitals,

or as refuges for the poor, or for pilgrims: not all cared for

the sick.

In Europe the medieval concept of Christian care

evolved during the sixteenth and seventeenth centuries

into a secular one. It was in the eighteenth century that

the modern hospital began to appear, serving only medical

needs and staffed with physicians and surgeons. The bour-

geoisie started founding the new hospitals i n the fast grow-

ing cities. Now they were civic buildings, commissioned by

authorities , but usually managed by religious orders. Hos-

pital became the face of reason, of progress. Though the

world was still runned by aristocracy and the church, the

3 http://www.edwardtbabinski.us/history/hospital_

history.html

HEALTHCARE THROUGH TIME:The Hospital Journey.


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hospital became an island for the rational thinking and a

symbol of what was coming after, started by the french

revolution in 1789.

A stepping stone was in 1772 when a big re burned

the Hotel Dieu in Paris, in icon of healthcare of the times.

After this event, there was an opportunity to re-think and

propose new environments for the sick. Even though noth-

ing was built right away, it fuelled the discussion, shifting

the healthcare aims of the time. Now it wasn’t a place

where to accommodate poor and sick people, but to take

care of the “common man”. By 1859 Florence Nightingale,

an Italian nurse with high knowledge on health statistics,

noticed that the death rate in city hospitals was much

higher than the patients in a same state treated outside

this institutions. This became a turning point on the ob-

jectives of hospitals of th ose days. The urbanity of the

time was faced with a mayor issue: hygiene, and hospitals

turned in search of clean air. This quest became the rst

step towards natural environment, and relating nature to

the healing process.

Though the popularity of the pavilion type grew, the

importance of nature took a step to the side and medical

advances took over. Now the pavilion model was a repre-

sentation of medical specialization, a series of small hospi-

tals inside the original one.

Everything changes by 1895, when Röntgen, a

German physicist discovered and shared the X-Rays. Now

health care was not so much about the care, but instead,

technology took its place. With this turnaround now hos-

Hospital San Pau, Barcelona '

Hospital leeuwenberghkerk, Royal Hospital Chelsea, UK Hospital Charite, Berlin Hotel Dieu, Paris. .

Hospital of Jesús Nazareno, Mexico

Vienna General Hospital, Austria7 4

Selimiye Barracks, Turkey

Lariboisière Hospital, Paris

St Thomas Hospital, London, UK.

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l a g u e

pitals became full of new equipment, and with that the

services provided became out of reach for the poorest and

needy, which till now was its objective crowd. Hospitals

came from almshouses to top medical institutions, chang-

ing the aim from helping the ones in need to developing

technology. The pavilion system showed to be inefcient

with the long distances and communication issues, and the

expensive machinery forced to go back to concentration

of resources. Now doctors, machines and the elite where

the inhabitants of the new hospital: the Block Hospital.

Highly concentrated and big scale representative build-

ing conquered the city. This monumental creature lost the

feature and ambition to create healing environments that

would emulate nature. This machine like buildings accom-

modated technology and resources in a efcient and cost

effective way. Nature and small scale movement became

an artistic ideal.

This shift lead to over organized, technology ridden,

anti-human establishment, mostly blamed to the modern-

ist architecture. Though during the 20’s and 30’s avant-

garde modern movement shared the nature-oriented view

of the beginning of the century, but didn’t got the chance

of taking those ideals to reality.

“No art is more widely misunderstood than the art

of achitecture, and no buildingd illustrates teh misunder-

standing more clearly than the hospital. The hospital has

become completely a product of the technologies of medi-

cine and of manufacture, so precisely adapted to the uses

of sciences, as to become in effect a scientic instrument

not escentially different from the X-ray machine or the op-

erating table which it encloses. It is hard for people to

imagine any relationship between such a building and taht

great tradition whose owers are the Parthenon and the

Cathedral of Chartres. It is hard to think of a hospital as a

work of art”

J. Hudnut, ‘Architecture and the Art of Medicine’, in Journal of the

American Institute of Architects, 1947, n°4, 147.

After the Second World War, and due to the social

revolution that came with it, the “welfare state” concept,

shook things for hospitals again. The late examples of

technological sanctuaries had to open way back to the “

common man” and safeguard its health. The hospital re-

gained its role as a social institution, and became a monu-

ment for welfare, and entering a new age of science pro-

gress as social justice.

This new capitalistic oriented welfare found its face

in the international style, which introduces back the refer-

ence to nature, taking this urban institution to the outsides

of cities in the search of spacious locations. The architec-

ture became synthetic, a combination of three parts and

characters: Patient ward, Medical Treatment, Daycare.

This became a grouping exercise and a typology test for

architects, resulting in during the 50’ and 60’ in several

types named after the letter they resembled: T, K, L, H.

During this time medical technology and science


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where moving faster than the have ever done it before,

and it was precisely this that became the biggest challenge

for architects and hospitals. Adaptability became an essen-

tial design aspect to keep up with the dynamic scene of

technology. As a result of building experience during 50’s

and 60’ American Military Hospitals came with a strategy

for this changes. Most of the technological changes would

occur in the treatment and outpatients area, so for this

they would have a low horizontal building, easier to retrot

and redesign, and the patient wards that was the area with

less change could be concentrated in a high rise building.

This was a building boom for hospitals, especially in Eu-

rope and the United States, where this new slick and high

tech building took place, again an example of rationality,

but this time was seen in another way.

A counter culture, instead dened it as a bureau-

cratic creature that represented the political and economi-

cal establishment. The hospital became a bureaucratic

sphere, governed by politics or big companies, and this

inuenced the inner life of it. Patients were not treated like

a person anymore but like a “disease case”, and it could

say that the patient concept almost disappeared from the

hospitals concerns. The modern life was blamed to be the

source of illness, society as a whole was seen as sick and

the ‘medical fortress’ was an accomplice. This views turned

the scene around, where society had to shift from institu-

tional power to citizen power, and this had a huge impact

inside the hospital, where patients became the main actor

in the new system: patient-centered care.

This new shift pointed to a more natural society,

giving the importance of the physical and social environ-

ment for the well-being of people. So the challenge of the

new hospitals now was quite different: it was a balance

play between the individual and the collective; the per-

sonal experience of the patient and the medical needs of

the staff. The answer for this new approach was the instal-

lation of basic, industrially built structure that would work

as a neutral framework where more individualized com-

ponents could be inserted, tackling the core of the hos-

pital’s problematics. This “style” also had other concerns,

beyond only the hospital building itself, but its urban role.

Stepping away from the monumental big scale building,

there’s mostly low rise buildings. This new projects try to

read the large scale grid, and integrate to the urban tis-

sue. The hospital grid tries to follow the surrounding city,

becoming unrecognizable as a single building or institu-

tion. The strategy is to develop really exible structure,

for the same reason they must be neutral and inexpres-

sive, the function of today won’t be the same as tomorrow,

so the frame shouldn’t express neither. Another turn was

the differentiation of the medical machine and the ows

of visitors and patients, during the 80’ and 90’ hospitals

where recognized by large halls and passageways, cov-

ered street and squares. This is the time where shops and

urbanity jump inside the hospital structure, accompanied

by change in the management vision, the hospital became

more a social place than a medical one. But this attempt

to take part of city urban life, wasn’t completely accom-

Hospital San Pau, BarcelonaLluis Domenech i Montaner1902

Paimio Sanatorium, FinlandAlvar Aalto1929

Beaujon Hospital, FrancePlousey, Cassan, Walter1933

Maimonide Hospital, Sn Fco, USAErich Mendelsohn1946

Princess Margaret Hospital, UKPowell, Moya

1957

Vienna General Hospital, Austria1784

Univ. Medical Center, Groningen, NLUMCG1997

St. Mary’s Hospital, Newport UKAhrends, Burton, Koralek1982

Erasmus Hospital, Rotterdam, NLMedicine Faculty Rotterdam1972

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plished, though shopping and social activities where under

the same frame, this were very different from the medi-

cal side, now the border was inside the hospital ground,

instead of actually blurring the limits it was just a matter

of disguise.


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24 25

After studying the journey of this emblematic institution

the only thing that can be seen as permanent has been the

continual change, not only in shape and strategies, but in its

core. Because of this continuous shifts it feels sometimes that

hospitals are, one step behind or are just a bit too late to meet

current needs of society. That maybe is because a hospital pro-

ject is planned to be long term, taking into account that the life

cycle of one of this structures is of 50 years. Lately, as most

technical areas, has been growing and changing at much higher

rates than ever, leaving us with a complex scenario.

The hospital as a building has been adapti ng to time, but

without a complete solution. We can go back to the beginnings

of the modern hospital in the enlightenment, where rationality

ruled the guidelines and nature had an important healing role,

but the patient was not the focus, but its illness. After, moder-

nity creates the most efcient hospitals, but falling into the trap

of giving life to a machine, more focused on its functioning that

what this engine was producing. Then we come to today, due

to high regulation and the current bureaucratic apparatus, hos-

pitals have been victims of lack of planning and power games,

becoming complex messy buildings instead of better buildings.

The System itself is portrait in this kind of patchwork inside

the institution, building from different times without any main

guide, just stacked together as the needs appear. Creating in-

timidating fortresses lled with a riddle of corridor mazes runby bureaucracy. This anonymous institutional complexes are

hardly ever functional, and most of the time are unt for its

purpose, resulting in high factors of stress and anxiety, which

undermines the patient’s recovery. This scenario is the result of

an reactionary attitude toward health and well being, leaving

the big pictured blurred for anyone to see, guiding blind throw

contingency.

“Hospital mirror and project the consciousness and

acceptance of responsibility of its society” The Zitgeist

EDUCATIONAL

CAMPAIGN

NATIONAL

POLICIES

COMMUNAL

PROGRAMS

SOCIAL

INICIATIVES

REGIONAL

POLICIES

WELLNESS

INFRASTRUCTURE

FOOD

INDUSTRY

TRANSPORT

SYSTEM

W H A T

TO DO?

HIGH TECHHOSPITAL

GREEN

HOSPITAL

HOLISTIC

HOSPITAL

CLIMATE

FRIENDLY

HOSPITAL

FREE MARKET

HOSPITAL

WELLNESS

HOSPITAL

ENERGY

EFFICIENT

HOSPITAL

COMMUNITY

HOSPITAL

WHER E

TO NOW?

OUTSIDE THE CITY LOWNING THE CITY L ALIEN IN THE CITYL BECOME THE CITY

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

Hospital and the City

Today Hospitals face again a turning point, where not

only the building is being questioned but the system at large.

More and more, the view of the hospital as a city has come

through, and the will to integrate to the urban tissue is dominat-

ing, but what does this aim to? Is not about systems and repli-

cating a model, it goes beyond that. The ultimate characteristic

that comes out from a good design city and what is lacking in

the healthcare area is integration that is a direct result from a

living and active community. Which will translate in to a social

engine that will create a true platform for social, economic and

cultural integration, because health has never been an individual

matter but a social one, and for that it has to be understood aspart of a bigger picture. Is mistakenly believed that if a hospital

is located in an urban setting, this will be a guarantee for its

integration, but this is a complete error, consequence of the lack

of understanding of the complexity of the health landscape. The

aim of re-urbanizing hospitals is not only so they t in the ci ty

on a functional way, but also to has to overcome built obstacles

and nally connect physically to the city. One example of this

is the University Medical Center Groningen, where even though

is on a urban location its surrounded by built barriers and the

only place that opens up, is in a monumental entrance hall with

a “public plaza” towards a highway instead than the city itself.

Industrialized Hospital

One criticism often voiced is the ‘industrialised’ nature

of care, heritage of the machine hospital of the modernists stillalive to this times. The high working pressures often put on the

staff can sometimes exacerbate such rushed and impersonal

treatment. The architecture and setup of modern hospitals of-

ten is voiced as a contributing factor to the feelings of face-

less treatment many people complain about. The high stress in

health workers, not only affects their work and health but also

contributes to the already stressful experience of the patient.

According to a report about Work life and Health in Sweden

done by the National Institute for Working Life almost 40% of

the health workforce is under an “unhealthy” work situation. In

addition to that, most of budget cut in health are solve by per-

sonnel reduction, that not only puts more work and responsibil-

ity onto one person, but also creates the ghost of uncertainty

of work. All that comes to the most serious matter how it is

mental health.

In Sweden from the 90’ sickness absence and disability

retirement caused by mental problems and disorders have risen

markedly. Concepts such as burnout, depression and chronic

fatigue syndrome have been used increasingly in the media and

are now part of everyday language.

These phenomena are probably the result of prolonged

stress processes, and the biological and medical risks of pro-

longed stress have been highlighted recently (Lundberg & Wen-

tz 2004). Signs of reduced mental well being therefore deserve

attention, since they may develop into serious health risks inthe long term.1

Green Hospital

As time goes “Green” approaches have appear in every

area and hospitals are no exception. Though is very true that

certication and regulation helps keeping matters in order, and

is a visible way for institutions to show their investments and

standards to the community their serving, and in that way gain

its trust.

Until the mid 90’s hospitals and health care facilities en-

joyed a deceiving reputation the cleanest buildings, where peo-

ple didn’t question their neatness, but after an eye opener re-

port issued by the US Environmental Protection Agency, where

medical waste incinerator, over 5.000 in North America, turned

the red alarm becoming the single biggest source of dioxin emis-sions into the atmosphere. With this all heath institutions where

put on the spotlight, and their attitude towards environmental

policies and strategies had to change from a quite passive one,

to a more active one, giving the industry the chance to lead the

needed change.

Hospital are not only expensive, but also high ly polluting

and stress producers.

Today the Healthcare sector is growing fast, and many

eyes are on it for its big impact, not only social, but also eco-

nomical, political and ecological. Now is the time where we

1 Worklife and Health in Sweden 2004. Rolf Å Gustafsson,Ingvar Lundberg

(eds.)


14/39

26 27

Hospitals in the US have “enormous carbon

footprints”, being the second most energy intensive

building type behind that of the food service indus-

try and twice that of commercial buildings.

They are “extraordinarily water intensive”,

averaging about 300 gallons per patient per bed per

day when there is a desperate need to reduce the

water footprint.

The National Health Service (NHS) in Eng-

land has calculated its carbon footprint at more

than 18 million tons of CO2 each year — 25% oftotal public sector emissions.

Brazilian hospitals use huge amounts of en-

ergy, accounting for more than 10 % of the coun-

try’s total commercial energy consumption.

Towards a Green Hospital

Speech held by Dr. Wolfgang Sittel at the Asia Pacic-

Weeks in Berlin.

September 8ht 2011.

GOVERNMENT MANAGMENT

DOCTORS

NURSESPATIENTS

INSURANCE

COMPANY

CURRENT PURPOSESFOLLOWED BY HEALTH CARESECTOR:

Enhance communica-tion between referring phy-sicians and the hospital, im-prove team communications,streamline patient ow, anddecrease waiting time andoverall length of stay.

HEALTHY

PERSON

HEALTHY

HOSPITAL

HEALTHY

CITY

HEALTHY

HOUSEHOLD

EDUCATION

+

have to realize that they are part of an ecosystem, and so are all

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 bein g, 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 pointwere healing the individual is directly connected to healing our

planet. I might sound a bit to general or heroic, but no society

will ever have healthy individuals, healthy families or healthy

communities if there is no clean air, clean water and healthy

soil.

Health care institutions should not build to meet a label,

since they will change with time, but use the existing resources

and make it efcient. The existing health infrastructure is there

and is huge, the impact on the overall system, if they would be

used, upgraded and renovated with a long term vision, it would

be more efcient that burying them and build new. The value of

the existing structures is great, not only for its cost and mate-

rial, but for its location and existing relation with the city.

Hospital as a Social entity

Hospitals are today barely alive and serving its purpose:

healing sick people, though the purpose also has to change. Is

being sick wasn’t bad enough, patients are obliged to go to this

intimidating place where they are stripped of any privacy, suffer

of long waiting times, are exposed to uncontrollable noise and

get separated from family, taking into account that from the

start people in a hospital are already l ow in spirit hospitals today

only manages to get that spirit even lower, not only for patient

but also for the a lready overwhelmed staff.

Hospital staff is mostly disregarded in the discussions

and are seen as a pressure group, difcult to negotiate with,

but they are the direct link between the “machine” and the pa-

tient, they are the face of the system and the change starts

with them. Nurses and doctors have the opportunity to touch

peoples life, making them important agents for changing think-

ing, behaviour, communities and patterns. The importance is to

not forget that Health care is health+care and that show be the

guide line for every decision and action.

Now they are work as Medial Health Centres for the In-

dividual, but they must take the leading step towards the para-

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.


15/39

H

Heal:

‘To restore to health’

‘To cause an undesirable condition to be

overcome’

T H E H E A L I N GE N V I R O N M E N T

Upycling the OLD for a healthier NOW


16/39

30 31

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.

But how do we know that? For that a method is needed.

Healing environment: describes a physical setting

and organisational culture that supports patients and families

through the stresses imposed by illness, hospitalization, medi-cal visits, the process of healing, and sometimes, bereavement.

During the second half of the last centu ry, medicine took

a scientic turn, in hand with evidence based medicine, the

whole eld moved towards research, which is by the way today,

one of the biggest areas in the medical community not only

for it reputation but also because is highly nanced, from that

hospitals couldn’t function without a research branch in their

system.

After World War II not only medicine was advancing in

the research eld, but from the contingency of the time envi -

ronmental psychology stepped up, raising new discoveries but

also new questions. Is during the 80’ when the architect and

researcher Roger Ulrich saw in this investigation a rich source

of data, through a report exposing that surgery patients witha view of nature suffered fewer complications, used less pain

medication, and were discharged sooner than those with a

brick-wall view, and with this the effects on people of a certain

environment started to be measured.

Rooting from this scientic approach the hospital’s critics

had something to work from, and now evidence could support

decisions not only in the eld of architecture, but also designers

and managers. Everything started to be measured: clinical out-

comes, staff efciency and patients impression; since this was

an empirical approach, replacing philosophical matters, opin-

ions and suggestions weren’t regarded because of their lack of

objectivity, instead only “rst reactions” were used as rm data,

PATIENT:-Need of privacy

-Need to socialize with

others

-Healing Environment;

Indoor+Outdoor

STAFF:-Need accessibility tocorridors and rooms-Comfortable Workingenvironment-View to outside/ Relation to timeand space

“John gets home at 6 am. Takes the grocery list from his

wife who’s leaving for work. He has to dress his son that also

got a cold thanks to the germs he brings home, he hates night

shifts. He drops his son off, does his groceries and tries to catch

a few hours of sleep. Even after all the years he hasn’t managed

to adjust to the shift. Wakes up in time to make dinner and fetch

his son from school. He waits for his wife and hopes she comes

in time or he will have to leave his son at the neighbours. She

comes. They exchange a few words and off he goes. He will

be going straight to the hospital from her elderly home for yet

another night shift.

VISITOR:

-Smell of hospital -Walking through the

corridors -Comfortable place to

relate to the patient

“Bob can meet his mother from 10 to 1 o’clock, then

his mother goes to lunch. Then he’s able to see her from 3

to 7 in the evening. After work goes to the shop to buy some

things for his mother and goes to the hospital, already being

around 5. He can meet a lot of visitors, cause most of them

can only make it after work.

He feels very unpleasant smells and sees very sick

patients. He’s afraid of that and of the possibility of getting

something himself. After passing several oors and corridors,

he reaches the ward where his mother is. There are other

people in the ward, so they can’t have a normal chat. They

can go to the yard and talk more privately and have a walk.

“ As a patient, I want a private and comfortable room which has supportive

environment but exible and have lots of function such as sit, stand, low-down and

look outside. Outdoor environment must be quite good, the I can have a good view.

A exible space that could change quite easily and I can get all the things quite easy

and cured. A private room should be good but sometimes I want to communicate

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.

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.”

HEALING ENVIRONMENT:What to take into account.

HEALTHY

SPACE

STAFF

PATIENT

VISITOR


17/39

32 33

though with time this has been also questioned.

After building data and analysis of results, by publica-

tion on different matters, Evidence based Design (EBD) could

be implemented in new projects and renovations through out

the globe. This as a tool was perfect for architects to convince

their clients, Institutional managers to guide their boards and

medical staff to demand changes. The body of research and in-

formation is building day by day and not only that, it is getting

updated, which present a new challenge: what was efcient or

preferable yesterday, might not be today.

As every architectural approach EBD has to respond to

a multi-sensorial demand, in its core regards the health impact

of a particular environment on patients, staff and visitors as aguiding principle of design. So from Ulrich’s connection between

view and pain, many studies and researches were made for dif-

ferent factors as light, colour, sound, control and distance. After

many actions were implemented in different settings the main

factors for comparing results and weight its validity are: patient

clinical outcome, staff recruitment and retention and facility op-

erational efciency.

Though many factors are in play at the time of recovery

one that showed to be one of the most inuential in all three

NATURE

The view or perception ofnature brings the patienta sense of calm, reducingstress levels.

POSITIVE D I S -

TRACTIONElements like art and activi-ties help to scape from thehospital environment, creat-ing a break in the routine.

LIGHTThe view or perception ofnature brings the patienta sense of calm, reducingstress levels.

SAFETYSecure environment reduc-es stress, but in a higherdegree avoids unnecessaryinjuries and complications.

SOCIAL SUPPORTIs an important factor forpatients to feel at ease in anew environment.

CONTROLIs an important factor forpatients to feel at ease in anew environment.

NOISEIts reduction affects notonly in the patient but alsothe staff, translating in lessstress and medical errors.

AIR Air transmitted infection is aserious issue, since is a highfactor for extending staysdue to new complications.

factors is stress reduction. It was discovered that over the exist-

ing stress experimented by medical procedures, many features

of the same hospital actually help increase the environmental

level of stress for the patient.

The reduction of stress is not important just for reducing

stress itself, but for the side effects that come with it, not only

for the patient but also for the staff and physicians .Shorter

outcomes, less medical errors and fewer prescribed medication

are some of the benets that addressing stress can mean for a

health care facility, so it’s not only a better service but a more

economic one also.

Research has proven that the actual design can inuencemedical outcomes by mitigating stress or increasing safety,

that is why the focus today for most facilities are : reduction

of stress, patient and staff safety, and energy and resource ef-

cient building.

So what does a healing environment consist of? The

main considerations that are mostly agreed in the overall com-

munity are:

_Connection to nature, Option and Choices, Positive Dis-

tractions, Access to social support, Environmental stresses


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34 35

NoiseFrequent overhead announcements, pagers, alarms, and noisy

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

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-

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

2 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.

StressThough is a very normal condition, today’s levels of stress are

not only higher but also present in a larger group. The known

risks, that everyone has experienced at least once, are only the

supercial signs of more relevant effects in the body. On top of

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. Independen t from the procedure

stress produces a hormone that also lowers the threshold of

pain, giving the patient a higher pain sensation.

But this condition actually not only affects the patient but in

great measure affects the medical staff. By overloads of re-

sponsibility, lack on material and staff, and inadequate facilities

for the required tasks, health workers become a highly stress

group, which is directly transferred to the patient, creating a

vicious circle.

BRAIN AND NERVES

Headaches, feeling of despair, lack of energy,

sadness, nervousness, anger, irritability,

increased or decreased eating, troubleconcentrating, memory problems, trouble

sleeping, mental health conditions, such as :

panic attacks, anxiety disorders and depres-sion.

SKIN

Acne , irritation other skin problems.

MUSCLES AND JOINTS

Muscle aches and tesion, especially in the

neck, shoulders and back. Increased risk of

reduced bone density.

HEART

Faster heartbeat, rise in blood preassure,

increased risk of high cholesterol and heart

attack.

STOMACH

Nausea, stomach pain, heartburn, weight gain.

PANCREAS

Increased risk of diabetes

INTESTINES

Diarrhea, contipation and other digestive

problems.

REPRODUCTIVE SYSTEM

For women: irregular or more painful periods,

reduced sexual desire. For men: impotence,

lower sperm production, reduced sexualdesire.

INMUNE SYSTEM

Lowered ability to fight or recover from illness.

HEALING ENVIRONMENT:Factors and Effects.

Errors & Safety

Medical Errors: Poor lighting, frequent interruptions

and distractions, and inadequate private space can complicate

lling prescriptions. Well-illuminated, quiet, private spaces al-

low pharmacists to ll prescriptions without the distractions that

may lead to medication errors.

Patient rooms that can be adapted for the acuity of a

patient can also reduce errors. Acuity-adaptable rooms reduce

the need to transfer patients around the hospital and lessen the

burden on the staff to communicate information to caregivers in

the patient’s new location.3

Patient falls: Patient falls, which are common in hospi-

tals, can result in serious injuries, extend a patient’s stay, and

drive up the cost of care signicantly. By 2020 the estimated

annual cost of fall injuries for older people will exceed $30 bil-

lion.7,8 Now that the Centers for Medicare and Medicaid Ser-

vices no longer reimburse hospitals for the cost of patient falls

that occur in their facilities, and insurers are likely to follow its

lead, hospitals will bear a greater portion of this cost.

Poor placement of handrails and small door openings are




28%of health care workers report

a higher than average degree of

stress compared to 18% of the

general population.

bmj.com

two primary causes of patient falls. Many falls can be reduced

through providing well-designed patient rooms and bathrooms

and creating decentralized nurses’ stations that allow nurses

easier access to at-risk patients.4

4 Transforming Hospitals:Designing for safety and Quality. Agency for

Healthcare and Quality, US. 2007


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36 37

INFECTIONSingle-bed rooms and improved air ltration 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.




NATUREOn a rst aproach we can all agree the looking at nature

has a traquilising effect and that it provokes a positive outcome

in our current condition, for patient it has been proven that this

is more than just a personal impresion but a fact:

“a view nature on a screen or view can reduce stress

and pain”

“Indoor Plants lift people’s mood and reduces self-re-

ported symptoms of physical discomfort”

Healing By Architecture,

Agnes Van den Berg and Cor Wagenaar.

Several theories have evolved to address the question ofNature having a “healing” or restorative condition. In learning

theories, the subscribers suggest that man has learned to pre-

fer nature. For example, people may have learned to associate

restorative experience with nature because of vacations spent

in beautiful settings or long childhood summers spent on the

beach, or near a lake or stream.

Urban settings, on the other hand, bring back images

of trafc, congestion, work pressure, lth, 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.

Environmental preference studies have shown that a

natural setting is the view of choice. Charles A. Lewis refers

to it as “green nature”(Spriggs et al., 1998). Gordon Orians

and Judith Heerwagen, in their studies on landscape aesthetics,

have shown that people prefer open, distant views with scat-

tered trees, water, and refuges and paths that suggest ease of

movement. In studies of users of some urban parks, properties

such as vegetation, water, and savanna- like qualities, such as

scattered trees, grass, and spatial openness, seemed to cor-

relate with ratings of restoration (Ulrich and Addoms, 1981). In

his article, Healing Words, J. William Thompson quotes experts

in the eld of healing garden design:

“Anything green makes patients feel better, any plant,

any tree,” and “…if they wish to create truly healing spaces,

landscape architects would do well to discover – or rediscov-

er—the wonder of the plant kingdom”

Landscape Architecture,

Jan. 2000:54-75


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38 39

LIGHTProbably 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 reection on the patients bed. There are many factors

that will determine the light situation in a project and is needed

to take them into account:

(northern hemisphere guides)

GUIDELINE 1

Orientation and Location

The direction of the building will determine solar gains in ra-

diation, though this must be determined also by the particular

climate zone, the specic site, an external factors present in

the place. Is not possible to dene a universal orientation for

healthcare buildings because of functional and individual char-

acteristics, but is possible to dene advantages and disadvan -

tages of different orientations:NORTH-SOUTH: The negative is that minimizes the souther, and

most preferred facade. But it avoids th e northern faced rooms,

giving all some light during the day.

EAST-WEST: Maximizes desired southern facades with simple

and easy sun control strategies. Creates a clear distinction with

norther facades, that will not get any direct sunlight.

GUIDELINE 2

Sun Control

As paradoxical as it sound, the worst enemy of daylight is the

sun itself, that is why efcient and thought strategies for shad-

ing must be implemented, to avoid heat gain and glare. Thisstrategies will take effect mainly in the southern (all day) and

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

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 efcient manner to the interior of the building.

DAYLIGHT SOCIAL/ECONOMIC BENEFITS

Though buildinga highly perforatedbuilding may be more costly,this investmentwill translate in severallong term benefits and

savings for the institution such as energy savings. But on anotherlevelthere is a greatpotentialto reduce the costrelatedto staffmembers by increased satisfaction, reduce stress levels andincrease productivity andconcentration, which results in lower

medicalerrors rates.

DAYLIGHTCANBE USED TO IMPROVEILLUMINATION LEVELS. HIGHILLUMINATIONLEVELS MAY RESULTIN

FEWERERRORS.

Daylightin a workplaceis the mostpreferred

source of lighting.(Mrochzek etal.,2005)

Nurses being exposed to daylight for more than 3hours during their work showed l ess perceivedstress, higher job satisfaction and lower intention

to quit in comparison to nurses with a daylightexposure less that 3 hours per day.(Alimoglu,M.K.,& Donmez, I.,2005)

Environmentalsatisfaction is high if ismore likely thatoverall

satisfaction in hospitalswillbe also high.(Harris etal., 2002)

DAYLIGHT AND ECO-EFFICIENT

GREENHOUSEGAS EMISSIONS.Comparison between hospitals inU.S., Germany andNorway.

THENEED OF REDUCINGENERGYCONSUMPTION:HEALTHCAREARCHITECTUREAND GLOBAL HEALTH

With appropriate controlfor HEATGAINand GLARE, daylightinghas the potentialto reduce energy consumption neededfor lighting

ENERGYUSEINHEALTHCAREFACILITIES

ELECTRICITYCONSUMPTION

_Data from U.S. NationalDatabase:The CommercialBuildings EnergyConsumption Survey (CEBECS)

_Arqum Gesellschaftfür Arbeitssicher-heits/Qualitäts-und Umweltmanage-mentmbH (2008).Abschulssberichtzum durchgeführten Projekt

"Energieeffizienztisch" für Kranken-häuser in Rheinland-Pfalz

_Burpee, H., etal., 2009. High

Performance HospitalPartnerships:Reachingthe 2030 Challenge and

Improvingthe Health andHealingEnvironment

_Burpee, H., etal., 2009. High

Performance HospitalPartnerships:Reachingthe 2030 Challenge and

Improvingthe Health andHealingEnvironment

280 KBtu/SF/year=

116 lbCO2/SF/year

Average carbon dioxidemission of U.S. Hospitals.

104 KBtu/SF/year=

43 lbCO2/SF/year

Average carbon dioxidemission of German Hospitals.

127 KBtu/SF/year=

52 lbCO2/SF/year

Average carbon dioxidemission of Norwegian Hospitals. (Rikshospitaland St.

Olavs)

60 %Fuel

40 %Electricity

13%of electricity

consumption is usedfor lighting.

_Energy type usedin Health

care buildings in the U.S.USDepartmentof Energy.

_Electricity Consumption(TotalBTU)by EndUse forHealthcare Buildings in theU.S. in 2003. Released2008

(US Departmentof Energyinformation Administration)

0 4 0 6 0 8 0 1 0 0

1 2 0 BTU

Space Heating

Cooling

Ventilation

Water Heating

Lighting

Cooking

Refrigeration

Office Equipment

Computers

OtherOther

SAFETY

DAYLIGHTCANBE USEDTO IMPROVEILLUMINATIONLEVELS. HIGHILLUMINATIONLEVELS MAYRESULTINFEWER ERRORS .

_Buchanan, T.L., Barker, K. N., Gibson, J.T., Jiang, B.V., & Pearson, R.E. (1991). Illumination anderrors in dispensing.American Journalof HospitalPharmacy, 48(10),2137-2145.

! !

! !

! !

!

3.8%error rate

2.6%error rate

DAYLIGHT AND HEALTH

REDUCE LENGTH OF STAY MORTALITY RATE

Room withoutdirectsunlight

16.9% 16.9%

Room withdirectsunlight

North facingroom

South facingroom

19.5% 16.9%

_Beauchemin, K.M. & Hays, P. (1996). Sunny hospitalroom expediterecovery from severe andrefractory depressions. JournalofAffectiveDisorders, 40 (1-2), 49-51.

_Beauchemin, K.M. &Hays, P. (1996). Dyingin the dark, Sunshine,gender andotcomes in myocardialinfarction. Journalof the RoyalSociety of Medicine, 91(7), 352-354.

MEDICATIONCOST

Less painMore pain

_Walch, J.M., Rabin, B.S., Day, R., Williams, J.N., Chai, K.,&Kang,J.D. (2005). The effectof sunlighton postoperative analgesicmedication usage:A prospective study of spinalsurgery patients.

Psychosomatic Medicine, 67 (1), 156-163.

22%LESS

A C C E S S T O D A Y L I G H T A N D V I E W T O

N A T U R E I MP R O V E S R E C O V E R Y P R O C E S

D A Y L I G H T R E D U C E S

E N E R G Y C O N S U MP T I O N

B R I G H T L I G H T MA Y R E S U L T

I N F E WE R E R R O R S

MI G H T I N C R E A S E P R O D U C T I V I T Y , S T A F F

S A T I S F A C T I O N A N D R E D U C E T U R N O V E R

Patients to an increased intensity of sun-

light experienced less, perceived stress, less

pain, took 22% less analgesic medication per

hour and had 20% less pain medication costs.

Ulrich, 2004.


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40 41

CONTROLTo reduce anxiety on the patient is necessary to reduce its sense

of lack of control, by giving them the needed information an

tools to make decisions and prepare themselves for following

tasks or procedures. Most of the times patients are carried

through the building with no clear explanation of where they

are or where they are going, creating an unclear an frightening

scenario. Intuitive waynding, ceilings is what patients sees, so

there must be effort in strengthening these aid and also creat-

ing a readable space, so is not necessary to explain everything

but the building becomes self explained.

Helping patients effortlessly nd their way through hospitals can

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.

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

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

tive role, without weigh-in its possible effects. Is also one of

the elements that is characteristic for a hospital, where people

realtes to certain shades, evoking medical treatment. Nowa-

days after many polls and interviews with user is known that

though white is prefered through out the different spaces, the

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

plane washed out colour for more intense but conned ones.

The colour is also a powerfull tool for orientation, information

and spatial clearnes.

2 , 7 2 %

39,95%

12,05%

24,23%

14,78%

6,27%

1 , 3

%

32,2%

7,4%

19,9%

36,0%

3 , 0

%

Patient Room

3 , 8

%

39,6%12,4%

15,2%

23,1%

6,0%

Work Places

53,7%

2 , 8 %

19,6%

9,0%

7,9%

7,09%

Sanitary Facilities

3 , 0

%

34,3%8,8%

17,0%

28,8%

8,2%

Corridors

Graphics of the ideal colours to use inside the Ward ac-cording to the personnel.

(Source: Research Project Working-Place Hospital)

PATIENT ROOMThe room must be one of the most important places in

a hospital, is where the actual healing takes place. Small space

full of small decisions, like having a broader free space on the

entrance side of the bed for easier medical access. The role of

distances play a huge role, specially the one toward the bath-

room, not only should be short but also continuos surface from

the bed, to avoid falls.

Single room are in demand, because of infection but also

practical issues: reduce risk of infection, stress from noise and

transfer rates which is a high cause of medical errors. Also is

more comfortable to welcome the family.


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42 43

Healing Environment: Is the result on a EBD that has

demonstrated measurable improvements in the physical and/

or psychological state of patient and/or staff, physicians, and

visitors.

Should make a therapeutic contribution to the process

of restoring someone’s health. For what it should be more than

just intuition (most practices) it has to be proven with on site

eld research and answer: Who was healed? How do we know?

EBPractice: designers make critical decisions together

with an informed client, on the basis of the best available infor-

mation from credible research and the evaluation of completed

projects.

Performance Based Building Design (PBBD): attemptsto create clear and statistical relationships between design de-

cisions and requirements satisfaction levels evidenced by the

building systems.PBBD uses research evidence to predict per-

formance related to design decisions. however, the decision

making process is not a linear one: for the build environment is

a complex system. Choices cannot be based on simple cause-

and-effect predictions; instead they depend on many variable

components and on the mutual relations established one each

other.

Four Levels of Evidence-Based Practice

Level 1:analysing the literature in the eld 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

through the analysis of the implications, the construction of a

chain of logic connection from decision and future outcome, in

order to reduce arbitrary decisions

Level 3: reporting the results publicly, writing or speak-

ing about results, and moving in this way information beyond

design team subjecting methods and results to others who may

or may not agree with the ndings

Level 4:publishing the ndings in reviewed journals col-

laborating with academic or social scientists

PHYSIOLOGICAL

IMPACTS

Healing

Pain

Infection

Cardiac Rhythm

Exercise

Admition time

Medical Errors

Accidents

PHYCHOLOGICALIMPACTS

Comfort

Orientation

Economical

Control

Satisfied Staff

ELEMENTS FOR

DESIGN

Site

Orientation

Layout

Functionality

Interiorism

Materials

Equipment

Envelope

Flows

Connections

PARAMETERS

View

Light

Art

Colour

Sound

Airflow

Privacy

Social Rooms

Acces to nature

Safety

Wayfinding

Hygiene

Current Hospital design is

focused on analysing the dif-

ferent impacts that their ac-

tions can improve or create.

EBD bases all its knowledge

in the analyse and research

of this mostly quantitative ef-

fects, because of its scientic

approach, for the rest environ-

mental psychology plays an

important role, backing up the

knowledge.

Though the architectural el-

ements don’t change much

from a traditional project, the

relations change. Is important

to bring to surface the hidden

links and be aware of the end

results that a single decision

can achieve. Many practical is-

sues are mostly regarded, but

the relation to more soft val-

ues show an important role on

their impact.

These parameter summa-

rise the quest for a better and

healthier environment. Creat-

ing a strong set of guide lines

for the design process, that

comes as a result of system-

atic research, revealing hard

data and trustworthy param-

eters meant to be addressed

at the project.

EVIDENCE BASED DESIGNGuidekines and Method by Research


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H

“... built catastrophes, anonymous institutional complex-es run by vast bureaucracies, and totally unt for the purposethey have been designed for ... They are hardly ever function-al, and instead of making patients feel at home, they producestress and anxiety.” 1

1 a b Healing by design – Ode Magazine, July/August 2006 issue. Accessed2008-02-10.

M A L M Ö H O S P I T A LMaximize the OPPORTUNITIES within

an EXISTING building


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46 47

1812

1912

1939

2010

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

conects the airport and the city. As a response, the complex

was densied in the same “free standing building” scheme, but

without following any urban logic.

MALMÖ UNIVERSITY HOSPITALHistory and Context Rigshospitalet

Copenhagen University Hospital

46,5 km 43 minutes

Lund Hospital

Lund University Hospital

20,5 km 18 minutes

i i i ,

Temperature,(Celcius)

January

February

March

April

May

June

July

August

September

October

November

December

m r tur( l si u s, )

20

15

10

5

-5

-10

-15

Rh,Precipitation,(percentage/cm)

January

February

March

April

May

June

July

August

September

October

November

December

, r i i t t i n( r n t , m )

80

70

60

50

40

30

2

0

5

9

Averagewind direction,(km/h)

N

NNE

NE

ENE

ESE

SE

SSESSW

SW

WSW

WNW

NW

NNW

W E

S

201510

J nu r

F r u r

m r

m r

m r tur( l si u s, )

2

1

1

J nu r

F r u r

m r

m r

, r i i t t i n( r n t , m )


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48 49

MALMÖ UNIVERSITY HOSPITAL Vision

The mission is to develop a sustainable plan for the hospital inMalmö. The hospital’s physical environment and structural en-gineering status have been investigated. Existing buildings cannot meet future requirements for high-tech care, such as surgi-cal and intensive care. Current health care buildings have littleopportunity be converted into units of one-patient rooms, butshould be in less term to serve as day care and reception. Ma-ture where buildings need to be supplemented in order to serveas administrative premises. Some Hospital Activities today arerented premises on the South area and Sege park will eventu-ally move in and be assured a place in the area.

Hospital district of Malmö, the region’s largest employer, cen-trally located in Malmö and with close links to the City Tunnel.A well-developed City of integration synergies and developmentopportunities for both Region Skåne and Malmö City. Ongoingplanning work with this starting point and a common missionstatement has been established in cooperation between the City

and Region Skåne. Region Skåne Ongoing planning activitiesare primarily designed to establish a robust development struc-ture for the hospital area and to study a number of areas ordevelopment scenarios, which can form the basis for detailedplanning of future expansion phases. Proposal for overall plan-ning and design details of this Property Development Plan havebeen addressed in a number of working meetings between theproject team and City Planning

To develop a modern hospital with high demands on functionalrelationships at all levels in the surrounding urban environmentis a major task. The buildings must be integrated into the sur-rounding neighborhood structure, creating attractive humanenvironments and enhance the architectural values. City Tunnelup from Triangeln way is on blocks just north the hospital and

others fate of this hub for public transport ken and the hospitalshould have an obvious and clear design.

A new service terminal proposed in th e southeast corner of thehospital campus with entrance from John Ericsson pa th. Wheref NNS also able to place certain technical services and otheroperational functions. The block is strategically in relation totransportation and an extensive culvert system.

The proposed coherent block structure of the hospital campusoccur as a result of the concentration of the medical care activi-ties, more perical area that can be utilized by other functions.The extent of these surfaces is dependent on strategic

H E A L I N G H O S P I T A L Upycling the OLD for a healthier Master Thesis Report by Maria Soledad...

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