Spaces That Care

Nursing homes that seem like hotels, open hospitals closely connected to the urban context, places for patients that encourage relations between them, the medical staff and visitors. A new model of the care facility, which has to do with the passage from an idea of care as medical effectiveness to a concept of care in a wider sense of the term, embracing the theme of personal wellbeing.
We talked about it in relation to the experiences of the studios B2Ai, Barreca & La Varra, Ab Rogers and Dutch Hospital Design, also to preview upcoming scenarios in which IoMT (Internet of Medical Things) technology will play an increasingly decisive role.

AZ Zeno Hospital, Knokke-Heist (Belgium), project AAPROG, Boeckx, B2Ai; photo: Valerie ClarysseAZ Zeno Hospital, Knokke-Heist (Belgio), progetto AAPROG, Boeckx, B2Ai; ph: Valerie Clarysse

AZ Zeno Hospital in Knokke-Heist, by B2Ai: a healthcare structure with a focus on human beings

The Belgian studio B2Ai, in collaboration with AAPROG and Boeckx for the architecture, has created a large healthcare facility in Knokke-Heist, on the Belgian coast, including a hospital, a rehab center, a nursing home, an outpatient clinic, university classrooms, spaces for public events and a heliport, in an area of 52,000 square meters. In spite of its vast size and performance requirements for the various functions, the project remains on a human scale, seeking a calm atmosphere of continuing contact with the surrounding rural landscape, because it is based on the assumption that a warm, humane environment, close to nature, can offer patients the opportunity for a quicker recovery. “The correlation between design (space) and health has been demonstrated in various studies, like those of Prof. Alan Dilani of the International Academy for Design & Health,” says Pieterjan Vermoortel, CEO of B2Ai. “Inspired by the work of the Belgian painter René Magritte, the building seems to levitate over the landscape, and is dominated by nature and light, even in the spaces below ground level.
The transition between outside and inside, between the care facilities and the public spaces is almost seamless, resulting in an inviting and inspiring context of care. We want to get away from the idea of the hospital, and focus instead on the concept of a care-giving environment.”

AZ Zeno Hospital, Knokke-Heist (Belgium), project AAPROG, Boeckx, B2Ai; photo: Valerie ClarysseAZ Zeno Hospital, Knokke-Heist (Belgium), project AAPROG, Boeckx, B2Ai; photo: Valerie Clarysse

Hence the architecture seeks an ongoing indoor-outdoor relationship, in contact with climate conditions (wind, sun and rain) which are not screened off, but controlled by means of a double skin of the building and internal patios. Natural light floods into the spaces. In general, the project avoids the standard furnishings and materials of hospitals – though of course it complies with EC regulations. “We have made a breakthrough from the tradition of hospitals as functional boxes with sterile spaces, to an approach that harmonizes medical functions, personal relief and comfort, and social interaction. A ‘human-centered’ approach.” In a certain sense, B2Ai has taken the process of medical care into a more artistic, creative sphere. And the hospital, instead of being a structure on its own, with the addition of functions connected with culture and education, becomes a place of spaces open to the public, part of the community and the territory.

Nuovo Policlinico, Milan, project: Barreca La Varra.Nuovo Policlinico, Milan, project: Boeri Studio (S. Boeri, G. Barreca, G. La Varra).

The new Policlinico in Milan by Boeri Studio (S. Boeri, G. Barreca, G. La Varra): a big machine in the heart of the city

The new building of the Policlinico di Milano – now under construction, with design by Boeri Studio (S. Boeri, G. Barreca, G. La Varra) – comes after the demolition of eleven abandoned hospital pavilions, replaced by a single building that will be the largest structure built in the last 100 years in the center of Milan, measuring over 100,000 square meters. “The logic of the passage from care divided into pavilions to a single large building is based on the evolution of contemporary forms of healthcare,” says Giovanni La Varra. “Today the patient is no longer identified only in terms of pathology, but has a complex medical identity inside which the pathology is not such an important aspect as to justify a direct correlation between ailment and department (pavilion), an approach that made hospitals in the past become collections of buildings.” So the hospital of the 21st century returns to being a big machine, rather than a campus of autonomous clinical specializations.

“In the past, the architectural theme,” Gianandrea Barreca explains, “was to create a clear division between the parts of this larger dimension.” The building is composed of two wings of 7 above-ground levels, containing the inpatient rooms. Between the wings, a lower, introverted volume contains the operating rooms, outpatient clinics and delivery room, in a dialectic based on alternation of inpatient rooms (towards the top, and the light) and the “machine room” (the central block). On the roof of the central volume, at a height of 15 m, a therapeutic garden of 6000 sqm contains a pavilion for music and reading, play areas for children, vegetable and herb gardens, spaces for pet therapy, etc. This will be the largest therapeutic garden in the world, faced by the inpatient rooms.

Nuovo Policlinico, Milan, project: Barreca La Varra.Nuovo Policlinico, Milan, project: Boeri Studio (S. Boeri, G. Barreca, G. La Varra).

The hospital is designed to be a public space, open to the territory. “The roof garden is offered to the city as a potentially public green space,” La Varra says, emphasizing that it represents both the tradition of the herb gardens of Milan, and its insertion into the city. “This permeability was an important characteristic to preserve: the new galleria on the ground floor will make it possible to cross the city from Via Commenda to Via F. Sforza, where in a few years there will be a new station of the M4 metro line,” Barreca explains.

The insertion in the city also has to do with the technological development that will create an even closer bond with the life of residents. Besides the aspects of healthcare software, “the concrete future scenario will be that of a sensitive city, focusing on the theme of care and crossed by countless flows of information, also in relation to healthcare issues. The city itself, over and above the hospital, becomes a place of care, in a perspective of prevention. Air quality, clean water, physical wellbeing, urban temperature control with integrated systems of greenery and construction, will all be elements that contribute to create a healthy, safe environment.”

Maggie's, the Royal Marsden Hospital, Surrey (UK), project by Ab Rogers Design; © Ab Rogers DesignMaggie's, The Royal Marsden Hospital, Surrey (UK), project by Ab Rogers Design; © Ab Rogers Design

Maggie's inside Royal Marsden Hospital in Surrey, by Ab Rogers Design: a space that brings people together

The Maggie's centers are spaces for oncological care inside hospitals in the United Kingdom, created by internationally renowned designers with the aim of experimenting with spaces in relation to the psychophysical wellbeing of patients. Maggie’s at The Royal Marsden is based on a project by the London-based firm Ab Rogers Design. “The great thing about Maggie’s is that it is designed for all. There is no formality – no reception, no need for an appointment – and it is not just for those suffering from cancer but also for friends and family members,” Ab Rogers specifies. “The design acts as a caregiver, for the space to nurture through its tactile nature, delivering support, care and connectivity above all else. This informality makes visitors comfortable from the moment they arrive. The setting goes beyond domesticity, giving it a sensational quality that engages you on every level. The environment is constantly working to reassure, stimulate and welcome – offering natural light, views out to the garden, a range of room sizes and considered, crafted details such as hand-glazed terracotta lights and wooden door handles carved by an artist. The kitchen table at the center may act to draw people together, but there are also spaces where you can hide away or stare out the window.”

With respect to other hospital facilities, the Maggie’s centers are subject to less restrictive building regulations. “So often in our experience, it has seemed to be about what is perceived to be easiest to clean rather than what actually is easiest that sets the standard, but we will never stop challenging the norm where we feel it has value to the user’s experience of a space.”

Maggie's, the Royal Marsden Hospital, Surrey (UK), project by Ab Rogers Design; © Ab Rogers DesignMaggie's, The Royal Marsden Hospital, Surrey (UK), project by Ab Rogers Design; © Ab Rogers Design

The future of healthcare spaces also depends on technological development. “The brilliant thing about this new technology is the connectivity it allows, putting healthcare professionals in touch with each other and their patients, as well giving power back to patients, allowing them to spend less time in hospital and move more freely around outside their homes. I can see the potential for it to support localized networks of healthcare, smaller frameworks replacing the centralization of care in hospitals, which has become the norm. In our work with Maggie’s we experienced firsthand the value of smaller scale, personalized care, undoing the negative experience patients have of giant, institutional buildings where people feel faceless, nameless and uncared for.
In this perspective, I can see the incredible value IoMT [Internet of Medical Things] will have in increasing patient safety and optimizing processes, what it could do to fix the systemic problems in hospitals; to return healthcare to the community and make patients feel supported is perhaps most exciting aspect of all.”

Il progetto per la casa di cura a Mosca di Dutch Hospital Design

The project by Dutch Hospital Design for a nursing home in Moscow: spaces with a HoReCa look

Dutch Hospital Design is a multidisciplinary team of specialists in the integrated design of hospitals of the next generation, covering projects in all their aspects, from physical plant and technologies to interior design.
Though it was not selected in the competition for which it was made, their project for a nursing home in Moscow represents a step forward in the conception of the hotel as a resort, where time spent in residence is conceived in terms of patient wellbeing, getting away from the design stereotypes in healthcare facilities. “The project seeks contact with nature and landscape,” says Dick van de Merwe, in charge of architecture at Dutch Hospital Design. “All the rooms face outward and the façade acts as a brise soleil that screens without blocking the view.
The quality and the materials used in the interiors suggest spaces of hospitality, like hotels, rather than those of hospitals, in an unusual choice for a medical center.”

The project also addresses the aspect of scale, making it more human not just in terms of sizing but also in the management of flows and the attention to details, such as the wayfinding system and the sequence of the spaces. “The design of the entrance is important on a functional level, but also for its psychological impact. The waiting rooms should be 'domestic,' welcoming, quiet in terms of sound, connected with natural light. Today they are often leftover spaces in the corridors of buildings,” Van de Merwe points out.

Il progetto per la casa di cura a Mosca di Dutch Hospital Design

If a distinction is made between pathways and areas for patients and visitors and the more functional zones utilized by the staff, the regulations limiting the use of certain materials can be less restrictive for the former.
And the interior design can become more flexible. “The hard part in our work is to find greater variation inside a type of project that has been very standardized. Wood and similar materials can ‘warm up’ architectural finishes; glass and steel in the structure can boost relations with the outside world – these are some of the ideas.
We also propose plastic films for surfaces, which are easy to sterilize, and can make use of the quality of today’s digital printing, bringing an idea of nature into the spaces. The use of color is also important, since it has been scientifically proven to influence moods and the healing process in patients.”

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