RESTRUCTURING
‘The prize will be to future-proof our healthcare systems to enable effective economic delivery for future generations of patients.’
the existing estate to maximise its potential. This makes the model ideal for re- calculating floor area requirements and building adjacencies for a newly formed estate that fits with the new clinical requirements and reflects the inevitable shrinking of the healthcare estate. The opportunities are significant. As
the estate shrinks, so the maintenance and energy costs reduce. At the same time, land becomes available that can be used for other healthcare building developments or used to provide green spaces, healing gardens, or sold off to free up capital for investment. The model also tells us a lot about the
potential for maximising legacy and new healthcare estates. If we take the NHS in the UK, for example, we know that the healthcare estate has developed over many years into a number of distinctive types. Figure 5 illustrates typical building
arrangements and relationships that have been used over the years to develop campus sites. These forms are expressed in more detail in Changing Hospital Architecture, (a Royal Institute of British Architects publication). The structural frame, floor slab details, wall construction, façade composition and building services requirements are different for each form. Some of these forms and specific building types lend themselves to a reasonable level of flexibility for the adoption of new clinical functions while others do not. A further component of the ‘construction form’ is the effectiveness of the floor plate to accommodate a radical change of use. Specific building types need to be
analysed to ensure that cost-effective upgrading can be carried out. The extent of the refurbishment can be as simple as a redecoration or as complex as multiple floor extensions utilising new structural frame, façade and building services systems: integrating multi-bed wards into single bed accommodation or creating outpatient clinics from existing in-patient facilities. Whatever the project, it is essential that any upgrading review is considered with the potential to introduce therapeutic or healing environments. Any revamped facility or healthcare
environment should be developed to enhance the patient experience and allow
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1. Linked pavilion or finger plan The oldest typology and still in common use. The pavilions would often have clinical spaces on lower levels with wards above.
Examples Woolwich Hospital and St Thomas’s Hospital, London;
Hotel Dieu, Paris; many others worldwide.
2. Low-rise multi-courtyard or checkerboard This typology can offer a human scale in contrast to the institutional character that tends to overwhelm most hospital design. However it will tend to apply to the larger, non-urban sites or smaller hospitals.
Examples Wexham Park Hospital, Slough; Venice Hospital (unrealised
design by Le Corbusier); Homerton Hospital, London.
3. Monoblock The classic compact and circulation efficient type. The small atria/lightwells can take many forms and the lower floors may have fewer, with deep planning for non-patient areas or operating theatres. There is a need for artificial ventilation and the opportunity to incorporate interstitial service floors.
Examples Greenwich Hospital, London (demolished); Boston City Hospital;
McMaster University Hospital, Ontario.
4a. Podium and slab/tower (also ‘Bundles’ or ‘Stacked’ in US) The wards are generally in the tower with the clinical and technical area in the slab. This typology can be effective on urban sites with small footprinting but the upper floors can be problematic in terms of travelling distance.
Examples Bridgeport Hospital, Connecticut; Prince of Wales Hospital,
Sydney; Royal Free Hospital, London; UCL Hospital (PFI), London.
4b. Podium with two or more towers/blocks over This typology avoids some of the potential travel distance and scale problems of no 4a above but will require a larger site.
Examples Birmingham Hospitals (PFI)
5. Street The attraction of this type has lain in its flexibility and extendibility as well as the legibility that the street itself offers to patients.
Examples Wythenshawe Hospital, Manchester; Northwick Park Hospital,
London; Westmead Hospital, Sydney; Rikshospitalet, Oslo.
6. Atrium/galleria Atria have become extremely common in open plan office buildings where daylight can penetrate working floors from both sides. The cellular character of hospital buildings make atria a less obvious solution but there are a number of successful uses of this typology.
Examples New Children’s Hospital, Sydney; Chelsea and Westminster
Hospital, London; Hospital for Sick Children, Toronto; University of Maryland Homer Gudelsky Building.
7. Unbundled Unbundled is a pattern of segregation of the diagnostic and treatment functions on the one hard, and on the other the nursing functions along a shared circulation/support spine. ‘Unbundled’ is a North American term and the typology is dominant in current design there; but it is also used worldwide.
Examples Norfolk and Norwich Hospital; many US examples.
8. Campus Individual buildings disposed around the site with or without enclosed circulation network.
Examples Hospital sites that have been built up over the years with
successive additions. Figure 5: Different configurations of the acute healthcare estate. IFHE DIGEST 2013
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