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9 July 2015

Hospitals are moving away from conventional institutional architecture to become patient-focused health facilities, according to Bruce Wolfe, Managing Director of Conrad Gargett and Adjunct Professor at the University of Queensland’s School of Architecture.

It’s part of a wider trend known as ‘Salutogenic Design’, which makes a connection between our health and the built environment (the human-made space in which people live, work, and recreate on a day-to-day basis). This is a belief Wolfe has brought to life in numerous large-scale hospital projects throughout Queensland.

“There is recognition globally, and very much in Australia, that the environment in which you are treated makes a big difference to how successful the outcomes are,” he says. “This isn’t about the kind of clinical environment, such as how sterile it is, or how sophisticated the machinery is, but about how attuned the patient is to getting well. If you can make the environment a positive one and decrease the stress levels in the patient you get a better outcome and there is plenty of research to support this. Part of it is an attitude about landscape and how fresh air, the sunshine and seeing the outdoors can have a positive influence on our health.”

Bringing the outside in

The Brisbane-based architectural firm picked up a slew of awards for the $1.4 billion redevelopment of the Lady Cilentro Children’s Hospital in Brisbane, a joint venture with Lyons. This includes the Future Health Project Award in the 2013 Design and Health International Academy Awards; the John Dalton Award for Building of the Year at the 2015 Brisbane Architecture Awards; and the 2015 Australian Institute of Landscape Architects award for Queensland in the Design category.

Kicking off in 2007, the redevelopment was prompted by the merger between the Royal Children’s Hospital and the Mater Children’s Hospital and was completed late 2014. The 359-bed tertiary/quaternary hospital was designed to ensure nature and the environment form part of the healing process. Based on the concept of a ‘living tree’ it doesn’t look like a typical hospital with a network of trunks and branches throughout, leading to outdoor gardens, terraces and viewing gardens. In total, there are 11 rooftop gardens, a green sloping roof of 23,000 plants and a community plaza featuring six transplanted fig trees. Natural ventilation and lighting were used where possible.

“We did a lot of research at the start of that project on how to use the environment as a healing element in hospitals,” says Wolfe. “Although it’s in a tight urban environment there are gardens on different levels that relate to activities within the hospital so you can get out of the hospital more. We are trying to make the hospital more connected to the community, so the division between the apparent sick and everyone else is broken down.

“You can see into the public spaces of the hospital, so it becomes a more normal environment rather than a sealed box. And from the inside, being able to see outside from everywhere that you’re walking makes you feel more connected to the outside world but also allows you to navigate a bit more intuitively,” he says. “These tertiary and quaternary hospitals are pretty big and with a big floor plan comes a complex circulation. If you can make some of that circulation quite simple it helps people navigate through the building.”

The impact of technology on hospital design

The average length of a hospital stay is also being reduced. Wolfe gives the example of a friend who recently spent two days in the hospital for knee surgery. In comparison, his father’s knee surgery years ago meant a two-week stay in the hospital and a longer recovery time.

“This is not only about saving the costs of people being in a hospital but about recognising that it is more therapeutic if patients are not bound up in a hospital environment,” says Wolfe. “There are also the interventionist aspects of hospitals; clinicians can target what is wrong with patients so much more effectively than they could 10 years ago. The drugs are so much better; the tactical interventions more directed through MRI and CT scans, but we must not believe it’s all about technology. It’s about the other aspects of what makes people healthy rather than what cures them.”

As robotics become more popular in surgery, they will also have an impact on the way hospitals are designed.

“The more you put into an operating theatre, the bigger they have to be, and the more connected to technology so the walls get filled up with cables,” says Wolfe. “The environment becomes more technology rich and the actual theatres become far more sophisticated as a result of all that equipment, something that is affecting hospital design.”

He gives the example of the $45 million redevelopment of St Stephen’s Hospital in Hervey Bay, Conrad Gargett worked on for Uniting Care Hospitals, which is Australia’s first fully digital hospital.

“It’s paperless, so there are no paper medical records, and you can find every bit of equipment just by looking at the screen,” says Wolfe. “Practitioners throughout the world are finding fewer mistakes are being made in that way because there’s no interpretation of what is written down.”

Australia’s standing in hospital design

Wolfe adds that Australia compares favourably with the best in the world when it comes to hospital design. The Australasian Health Facility Guidelines, an initiative of the Australasian Health Infrastructure Alliance, enables planners and designers of health facilities throughout Australasia to use a common set of guidelines and specifications for the base elements of health facilities. Providing a layout of nearly every room and department, the guidelines get updated periodically.

“That planning and room layout tool is modelled on the latest models of care, how patients should be treated, what gets done by whom and how circulation operates in a hospital and is as up-to-date as anything I have encountered in our studies around the world,” he says.

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