ARCHITECTURE & DESIGN
recovery. The walled garden has been adopted by volunteer groups during the construction process, and includes staff, the local community, the design team, and contractor members, showing their support for this vital new facility.
Reducing staff stress
The building is designed to reduce stress through the zoning of staff spaces, which offer multidisciplinary work zones, teaching spaces, and rest areas, away from the hospital’s clinical zones. The staff are excited about working here, and are already volunteering to preserve and enhance the walled garden to become a community asset and food production space.
At Wexham Park patient pathways were developed ‘to make care more efficient, and allow patients to be cared for more quickly in the right place’.
Modelled emergency patient flow The diagnostic treatment area in Zone 1 is organised around our modelled emergency patient flow. The room layouts and relationship between them reflect the idealised patient journey. The design team has liaised continuously with the clinical teams to make sure that the arrangement for diagnostics helps to support the most efficient patient routes, thus ensuring rapid access to treatment. With diagnostic services brought together, the patient transfer times are minimised, and the clinical staff journeys reduced dramatically. Within Zone 1, patients can be assessed and moved through to diagnostics, treatment, and inpatient areas, much more quickly. Even the wayfinding has been designed to help patient flow, and to be intuitive for patients, which minimises staff interruption.
Using the natural landscape The Grange site sits along an axis which links the hospital and surrounding landscape to the listed Grange building and its walled garden. The hospital building sits on the brow of the hill facing east/west to maximise views. The hospital has been conceived as a ‘hospital in a garden’, with the landscape purposefully brought up to the building along the full western frontage to maximise connections to the countryside. The views and access to therapeutic spaces both help to promote healing and wellbeing. Similarly, the design has endeavoured to maximise natural daylight, and, where possible in inpatient areas, natural ventilation, all of which helps with patient mental health and
108 Health Estate Journal October 2019
Visualising the design During the briefing and design development of both projects, BDP consulted extensively with staff using ‘virtual reality’ imaging, and constructing physical mock-up rooms, so that they could ‘walk around’ the building during the design phase, as well as undertaking simulation of clinical activities. This has resulted in several innovations; for example, the GUH inpatient wards have been planned with ‘inboard’, en-suite bathrooms. In contrast to the bedrooms with interlocking en suites developed for the Health Board’s local general hospitals, the GUH model minimises corridor lengths in order to reduce travel distance for staff – a key consideration given the high levels of patient acuity and increased intensity of nursing.
The shape of the ward bedroom and en suite was the topic of much debate during the early stages of the GUH design, so, alongside the virtual reality, full-size mock-ups of the rooms were constructed, and tests undertaken by clinical teams to validate the size and shape of the room. A full cardiac arrest team exercise – simulating resuscitation – was conducted under the supervision of the Chief Nursing Officer for Wales. The outcome of the exercise provided clear evidence not only for the perfect room size and geometry, but also the ideal configuration of doors and adoption of clear lines of sight, all of which ensured that all aspects of patient safety were considered. In addition, open days to view the mock-ups were held, and the public, patient groups, staff, stakeholders, and national figures such
as the Chief Medical Officer, were all invited to comment.
A ‘3D’ environment
Alongside the use of virtual models, both projects’ departments and individual room types have been fully equipped in a 3D environment which can be accessed using an iPhone – a practice BDP has been refining over a number of years. The
Adrian Hitchcock
Adrian Hitchcock, Architect director at BDP, has specialised in healthcare facility design for 30 years, and works with BDP’s Health sector design group. He has provided design leadership and clinical planning for a number of large- scale acute hospital redevelopment projects, including Brighton ‘3Ts’, Queen Alexandra Redevelopment Portsmouth, and Great Western Hospital Swindon, as well as delivering a diverse range of smaller healthcare projects for UK NHS Trusts and Health Boards in Wales. His interest in hospital building design stems from secondment during the early days of his career to a then recently privatised NHS regional design practice, and involvement in one of the last Nucleus standardised hospital design projects. Current projects focus on delivering therapeutic patient environments through particular attention to daylight and views, acoustics, patient privacy, and design for integration of landscape and arts.
GUH also has a web-hosted model of the whole hospital, which all staff can visit to familiarise themselves with the layout and internal appearance, which has helped staff to visualise the 2D drawings in terms of space, observation, and scale. The extensive staff consultation using virtual reality has enabled the clinical team to have real input into the design process, and has brought a level of clinical expertise to the project not seen before. In addition, being able to work with our French counterparts has helped BDP to bring a new perspective on hospital design to these recent projects. The key insights gained throughout the design process for both hospitals will undoubtedly be used as best practice for future healthcare design.
hej
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