Sumit Singhal loves modern architecture. He comes from a family of builders who have built more than 20 projects in the last ten years near Delhi in India. He has recently started writing about the architectural projects that catch his imagination.
New University hospital in Aarhus, Denmark by C. F. Møller Architects in collaboration with Cubo Arkitekter A/S
August 23rd, 2011 by Sumit Singhal
Article source: C. F. Møller Architects in collaboration with Cubo Arkitekter A/S
The largest hospital construction project in the history of Denmark, the New University Hospital in Aarhus, will be built onto the existing Aarhus University Hospital, Skejby, to form a single hospital complex. The resulting New University Hospital will be the size of a Danish provincial town.
The giant hospital complex is also organised like a town, with a hierarchy of neighbourhoods, streets and squares which provide a foundation for a diverse and dynamic ‘green’ urban area. The complex is not merely a construction project, but also a cultural project, involving many different branches of science and art.
The hospital is intended to function both as a university hospital, a regional centre and a basic treatment hospital for citizens of the region, and has been designed to flexibly accommodate future developments in technology, treatment and working practices. The programme for the New University Hospital in Aarhus takes its starting-point in Evidence-Based Design.
Functionality and ARCHITECTURE
In an urban image
The New University Hospital in Aarhus will represent a physical model of the hospital of the future: a patient-centred hospital founded on concepts of the healing environment, technological innovation and health-promoting surroundings, and which points the way to future hospital architecture.
What is it that makes a hospital patient-centred? What kind of demands must the interior and exterior environment live up to, if it can claim to be healing architecture? How can we secure high quality, when the New University Hospital will grow to the size of a small market town and become the largest workplace in the city of Aarhus?
First and foremost, we must take our point of departure in the human being. We must use the human scale as our measuring rod, so that individual patients and visitors will not only be able to find their way around, but will also feel comfortable and secure in the new hospital complex. The hospital will require a clear and comprehensible spatial organisation, in a readable building structure which will lead patients and visitors to their destinations in a natural manner.
Traditional towns have a recognisable structure and a functional diversity which produces identity-creating qualities, being based on the human scale. They thus offer a means of organising large units by creating and emphasising experiential differences. It is precisely this image of the town that provides the conceptual starting-point and structure for the project.
The hospital complex must not, however, have a traditional appearance – on the contrary. The unique character of the hospital must arise out of the broad spectrum of activities which take place there. Health and healing are the primary goals, but research and training, as well as cultural and commercial activities, should also influence and shape important elements in the new ’town’.
The human hierarchy
From a distance, the skyline of the hospital complex will be perceived as a homogenous structure increasing in height towards the centre – a stylised picture of the traditional town. Above a base of red buildings, taller ward buildings will cluster around the hospital’s large interior landscape spaces, where some very tall tower blocks will mark the hospital’s central thoroughfare.
Three primary elements – to promote freedom and flexibility
The New University Hospital in Aarhus consists of three primary elements:
These three elements are linked, activated and shaped by an intricate network of functions and circulation routes, providing an urban hierarchy of spatial qualities which complements the functional organisation of the professional communities.
This basic composition provides a number of advantages. The three elements form an extremely flexible framework which enables the base to be adapted to the existing hospital, and allows phased extensions of the hospital to take place in accordance with the relevant political and economic conditions.
The hospital’s compact character is thus carefully balanced against decentralised aspects which favour local environments and help to break down the large scale.
From public areas to an – almost – private atmosphere
The hospital complex is organised in an urban hierarchy of neighbourhoods, streets and squares which provide the foundation for a dynamic urban district. This hierarchy is activated and presented all the way from the general level of the Forum down to the local decentralised squares. The urban designations refer to classic spatial sequences, thereby giving visitors an immediately comprehensible physical frame of reference for the individual places.
The user progresses gradually from the most active and public urban spaces through more decentralised units, and out to areas like the ward buildings, which offer an intimate and almost private character. The variation and diversity of the hospital complex thereby creates appropriate spaces for both joyful occasions and sad events. The hospital must be able to mirror all aspects of life – from children playing in the many gardens and the play areas of the Forum, to more emotional moments which demand spaces that offer dignity and calm.
The heart of the University Hospital
The Forum is the most important thoroughfare: a distinctive, capacious public space which occupies a central position as the complex’s natural heart. From here, circulation routes will branch out towards the professional communities via open arcades. The arcades to the north-east lead all the way to the existing main entrances, which have naturally been incorporated into the complex’s new traffic system, while to the south they provide a transition zone to galleries which form decentralised nodes in comprehensible neighbourhood sizes, giving each professional area its own physical character.
The overall style of the New University Hospital in Aarhus thus favours the decentralised over a more compact building character, partly in order to retain and enhance the humane character and identity of the existing building, and partly to build upon the idea of the town as a model of spatial organisation. Precisely because the patient typically remains within the same area, it is important to focus on creating spatial identities in the local physical environment.
THE HEALING WHEEL OF THE ENVIRONMENT
”The effect in sickness of beautiful objects, of variety of objects, and especially of brilliancy of colours is hardly at all appreciated. People say the effect is only on the mind. It is no such thing. The effect is on the body too. Little as we know about the way in which we are affected by form, by colour and light, we do know this, that they have an actual physical effect. Variety of form and brilliancy of colour in the objects presented to patients is an actual means of recovery.” Florence Nightingale, 1885.
Internationally, there is an increasing focus on Healing Architecture and Evidence-Based Design (EBD). EBD is seen as a parallel to evidence-based medicine, and is defined as ”the deliberate attempt to base design decisions on the best available research evidence… Evidence-based healthcare designs are used to create environments that are therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress. An evidence-based designer, together with an informed client, makes decisions based on the best information available from research and project evaluations.” Hamilton DK (2003) The Four Levels of Evidence-Based Practice. Healthcare Design, Nov 2003. EBD is the basis of the programme for the New University Hospital in Aarhus.
Evidence-Based Design and the Healing Wheel of the Environment
On the basis of EBD, the DNU consultant group has developed “The Healing Wheel of the Environment”, which forms the planning foundation for the entire project. As EBD is a relatively new discipline, and limited in many respects in its scientific foundation, the logical consequence is that only “evident” areas are included in the wheel, which can be extended at any time.
The twelve components of the Healing Wheel of the Environment are:
Empowerment and ergonomics
The patient must as far as possible be able to regulate the light, heating and music in the patient room. Via bedside PCs, patients will have access to their own journals and will be able to see the times of planned examinations, test results, etc. Improved ergonomic design will help to ensure less fatigue and stress.
Daylight is not just important for our sense of well-being, but also for our health. Daylight helps to ensure that our circadian rhythms are correctly adjusted; it also lifts the general atmosphere, and has an antidepressant effect. Patients in rooms with windows, particularly windows with green landscapes outside, have shorter periods of convalescence and fewer complications, and require less pain-relieving medicine.
Careful and early planning of natural light can reinforce the positive effect of daylight and help to prevent the problems that natural light can also cause, such as overheating and dazzling.
Besides improving personal comfort, the conscious use of daylight also helps to save power consumption on artificial light. The optimum use of daylight thus has both an environmental and an economic dimension.
Research shows that single-bed rooms confer a number of benefits, including fewer hospital-acquired infections, fewer medication errors and a lower noise level. Single-bed rooms also mobilise the patients when they get up to eat, or meet other patients. They also provide privacy for conversations with hospital staff, and thereby a basis for better treatment.
The arguments in favour of multiple-bed rooms are usually that they are less expensive (to build and operate), but in fact the shorter periods of admission to hospital indicate that single-bed rooms are more economic from the point of view of society.
A room’s acoustic properties determine how sounds are disseminated there. The noise level of hospitals is notoriously high, with many simultaneous and different noise sources, such as people walking, talking or working, beep-sounds from equipment, and transportation noises – all in spaces with hard surfaces, due to cleaning requirements.
A lower noise level can reduce stress for both patients and staff and help to give patients the peace and quiet they need. Good acoustic qualities contribute significantly towards a good indoor climate, and are best secured by selecting the right construction principles, an appropriate internal organisation and good surface materials.
Artificial light must fulfil both functional and aesthetic needs. It must be flexible and variable and provide a sense of well-being, but must also be capable of being switched to diagnostic lighting, for example to examine changes in skin colouration. The choice of fittings and light sources must comply with both functional and atmospheric needs. Artificial light will be used in combination with daylight, and will take over the illumination function when daylight alone is insufficient.
Access to the landscape
Patients must have access to gardens and landscaped areas. Nature has a positive effect on stress and fatigue, and its promotion of health and healing is well documented. Randomised studies have shown that a view of and access to natural surroundings can have a pain-relieving effect in itself.
Gardens also cause patients to move around more, which has a positive effect on their healing, e.g. by encouraging the release of endorphins through exercise. They also provide suitable places to meet and talk with other people.
Communication and logistics
The New University hospital in Aarhus is in dialogue with its surroundings: the existing hospital, the future new buildings and the landscaped environment. The hospital’s flow is clear, comprehensible and physically convenient for all user groups and staff. The hospital is built up around the large landscape garden, the Park, which is its most important physical landmark. The squares and arcades of the various blocks each have their own individual form and decor, and thereby their own identity.
The building information will be supported by “speaking signs” – hand-held receivers which can read out signs and information boards in Danish, English, German or Spanish.
Textures / surfaces
Surfaces influence and involve all of the senses. If we are to realise the vision of a clean, sensually rich, aesthetic, healthy and comfortable workplace, all of us – both the hospital, the occupational health services, organisations, researchers, advisers and public authorities – must work to promote a healthy working environment. All kinds of environmental factors should be given consideration in the project, and products with a positive effect on the indoor climate, including natural materials, should have preference. Efforts must be made to ensure that a large amount of the materials used can be recycled, and that the building materials are themselves based as far as possible on recycled materials. Partial or complete wood cladding should be used in some of the public areas, such as the Forum, arcades and squares.
The indoor climate of a building can influence a person’s health, well-being, quality of life and productivity. In a hospital building the patients are in a vulnerable health condition, and high productivity is expected of the staff. Accordingly, the indoor climate is of considerable importance to all who spend time there.
The basic principle behind the maintenance of an optimum indoor climate is that the building and its physical qualities should enhance the indoor climate as far as possible. This is primarily done through the use of heavy, well-insulated constructions and a combination of appropriate window areas, glass quality and sun screening to guard against over-heating or insufficient cooling.
The building is then supplemented with technical installations such as heating and air conditioning equipment, which support the building’s physical qualities. This minimises dependence on the technical installations, which, besides conferring benefits in terms of energy use, also ensures an optimum indoor thermal climate.
In atmospheric terms, the ideal indoor climate is achieved by utilising materials which release no gases, or only release gases in tiny quantities, and via the use of filtered and conditioned air from outside.
The other components in the Wheel are “rational and evident”. The rational and the irrational are inseparable; they define each other and are thereby interwoven. To meet art is to encounter something else. The appropriate relationship between the visual arts and architecture, and their modes of integration, is a perennial question.
Art in the public arena offers free and enriching experiences. The construction of the New University Hospital Aarhus presents an exceptional opportunity to create original works in special places. By integrating art at as early a stage as possible, the patients, staff and visitors can be presented with larger and more complex works.
The hospital of the future is a digital hospital. Wireless IT infrastructure is the natural starting-point to enable both staff and patients to easily send and receive information in digital form. Pervasive computing can make health care independent of time and place, and can improve communication and co-ordination between the various levels of the health sector.
Design / decor
In this context, design should primarily be understood as a combination of the traditional view of design and the modern perspective on design as a rational process of problem-solving. At the New University Hospital Design must contribute to improved solutions for staff, patients and relatives.
The conscious use of well-designed, well-functioning products, furniture or fixtures brings benefits which extend beyond the immediate target group. Equipment design which combines advanced technology and attractive appearance with user-friendliness and good ergonomics will contribute to an improved working environment for the staff, with a reduced risk of operational errors and work-related injuries. A beautiful and friendly design without an overly mechanical appearance will also help to instil confidence and reassure nervous patients.
In the same way, a well-designed patient room with a good decor and choice of materials will satisfy both the staff’s need for an efficient environment with the patient’s need for a friendly and confidence-inspiring space, in which elements from the domestic sphere help to call forth desirable associations and atmospheres, and in the final analysis contribute to more rapid healing and a shorter stay in hospital.
The interior project, which encompasses both furniture and fixtures, must support and complement the overall vision of a modern, IT-based and efficient hospital which focuses on the individual.