From Healthcare to Health-caring
A new paradigm for healthcare design in a dense city
Vivien W L Mak 麥詠倫
The design of healthcare facilities has never been a matter of the building hardware alone. Over time, healthcare solutions evolve in response to the advancement of medical science, patient care models, technological development and, to a great extent, social needs. Social factors such as population growth, demographic changes and urbanisation determine the scale and form of hospital architecture. Cultural characters such as filial piety and religious beliefs may define priorities and performance criteria of healthcare design. Social behaviour also informs the performance of a healthcare facility in parameters such as patients’ experience, visitors’ satisfaction, clinical safety and staff efficiency.
Among the design trends guiding today’s healthcare architecture are lean and sustainable design principles, zonal approaches to infection control strategies, modular construction and future-proofing solutions. Hospital architects and medical planners around the world of course also agree that healthcare architecture design should be humanistic and people-centreed.
Hospitals in Hong Kong
What makes hospital design in Hong Kong challenging is the scarcity of land. Hong Kong is a hilly city of about 1,100 square kilometers with a population of more than 7 million people. While some hospitals are fortunate enough to be situated on relatively flat and agreeable sites, others face the challenges of being built on slopes, development restrictions and irregular boundaries. As a result, hospitals in Hong Kong are well known for their height and high density.
Major public hospitals often give the impression of having generous sites. However, many of them under pressure from tremendous growth in demand, phased expansion, outdated infrastructures and limited expansion capacity. About one-third of Hong Kong’s 42 public hospitals are situated on sloping sites, with various degrees of topographical and geotechnical complexity. Private hospital developments tend to face particular difficulties. Most of them were established by foreign missionaries, independent groups, and individuals in the late nineteenth and early twentieth centuries. Some started as nursing homes and sanatoriums, others were small hospitals with as few as 20 beds. Due to this, many were built on hills commanding fascinating views but bound by limited land plots.
With the development of town planning for new urban districts, hospitals founded after the mid-twentieth century tend to be situated on relatively flat sites. Major public hospitals such as the Queen Elizabeth Hospital (1963) and Prince of Wales Hospital (1984) have fewer problems with topography. However, the shortage of land and pressing demands for healthcare remain major challenges. It is against this background that Hong Kong has come to be home to two of the tallest hospital buildings in Asia.
The design of tall hospitals is challenging. In addition to medical planning of the clinical, operational and maintenance requirements, other matters require special attention. To allow for the evacuation of patients, for example, inpatient floors are compartmentalized to allow horizontal escape routes to a safe holding area where hospital staff can conduct transfers via designated evacuation lifts. Centralised air-conditioning system, likewise, may have to be adopted to house plants at designated floors for efficient ducting and maintenance access.
The vertical circulation system for human and healthcare supplies also has to be planned well. For people to move around, the hospital design should plan for adequate and strategically allocated passenger lifts that segregate staff, patients-in-beds and the public. Hospitals may arrange shuttle lifts to transfer lobbies between inpatient and outpatient facilities if there are many visitors and outpatients, as is typical in public hospitals in Hong Kong.
Hospital design must all allow for the circulation of clean and dirty materials. While dumbwaiters and pneumatic tube systems are common in the transport of healthcare supplies, recent innovations such as robotic delivery machines and vertical conveyors are now used to handle medication, laboratory samples, medical records and the like. St. Paul’s Hospital during its redevelopment project replaced a pneumatic tube system with the Boxveyor system.
Despite their heavy technical demands, tall hospitals can also be an opportunity to demonstrate the desirable architectural qualities involved in humanistic, health-promoting and future-proofing design. As the Case Study on the St. Paul’s Redevelopment and Gleneagles Hospital Hong Kong accompanying this article shows, care needs to be taken to incorporate local history, greenery, appropriate décor and other features that that prioritise users’ physical and psychological needs and the expectations of the local community.
Post-Pandemic paradigm shift
The rigour hospital design has for infection control could be modelled by other buildings. As the coronavirus pandemic has shown, social behaviour plays a crucial role in fortifying health. In 2020, we witnessed an unprecedented collective drive to practise hygiene. From social distancing and body temperature monitoring to hand washing and gearing up with personal protection equipment, this drive covered both individuals and communities. Hygienic practices manifested themselves in tangible ways in our physical environment, such as floor lines delineating the appropriate distance people should keep between each other, hand sanitisers at building entrances and partitioned dining tables. It is foreseeable that this new awareness of hygienic practice will be seamlessly integrated into the next generation of architectural design in various ways.
First, buildings used by the public should be designed with disaster conversion in mind. That means thinking how large spaces that can be expanded or converted to become temporary emergency facilities or shelters. Atriums of shopping malls, school halls and indoors playground, for example, could play such roles.
Second, buildings and built-in features should be designed to facilitate the segregation and control of circulation flows. As in hospitals, clean and dirty zones and the separate channels for pedestrians and goods may need to be considered. During public health alerts, people’s incoming and outgoing circulation could be controlled with the use of designated paths for security checks, body temperature monitoring, and so on.
Third, isolation and personal hygiene facilities should be installed where necessary. Venues may have to be adaptable to accommodate social distancing and isolation needs. As well as allowing for the isolation and quarantine of people in individual units or rooms, pocket spaces to separate one person from another may need to be provided in common areas and outdoor spaces. Hygiene stations for hand-washing and the supply of personal protection equipment should be highly visible, easily accessible and constantly available. The visibility and availability of these stations will help make personal hygiene a habit.
Building entrances, public lifts, entry to lavatories and sanitary fitments will all need to be equipped with smart or touchless fittings. Wireless connections and online remote-control can also provide ways for people to avoid physical contact with shared surfaces such as buttons and door handles so to avoid cross contamination.
Infection control protocols can be facilitated with the provision of soft cues. A coloured rug in a classroom, a shoe rack and a hand basin put together may make a perfect setting for children to take off and store their shoes, wash their hands and have something to sit on. Such simple gestures as this could make a huge difference.
Ongoing research and studies are identifying anti-virus materials and surfaces that for use in both public and private spaces. Copper, for example, appears to shorten the lifespan of viruses more than most other commonly used building materials such as wood and stainless steel. Seamless detailing can lessen the collection of dirt and bacteria and make cleaning easy. Such common strategies and specifications commonly found in hospital and clinic design can be easily adopted for other building types.
Indoor air filters, adequate air exchange and an enhanced awareness of air flow directions should improve the provision of clean air environments. Monitoring devices can be deployed by building managements to track air quality, body temperatures and other important hygiene metrics.
In future, health-care design principles will have to be adopted in all types of building. Such ‘health-caring’ design will in time lead to architects embracing wellness and healthier lifestyles as part of their design thinking. In the long term, an accumulation of positive effects from such an approach should lessen the burden on the public healthcare system.
Case Study: Redevelopment of St. Paul’s Hospital and Gleneagles Hospital Hong Kong
In 2016, St. Paul’s Hospital redeveloped a part of its facilities into a new general hospital compound with 555 beds. The hospital stands within a tranquil convent campus in Causeway Bay, abutting the King of Christ Chapel and the three schools operated by the Sisters of Saint Paul de Chartres. Visited by hundreds of believers and students regularly, the chapel had been hidden behind various building blocks for decades. A new master plan was developed that revealed the historic and social significance of the chapel by allowing it once again to become visible and so be appreciated by the local community. With a central landscaped garden, the master plan changed an enclosed campus to one that is marked by two 22-storey towers housing hospital facilities and green open spaces that patients, staff, students and teachers can enjoy.
The design aimed at creating a stress-relieving experience for hospital users. Clear orientation for visitors’ wayfinding is given at the welcoming double- height main lobby. Medical zoning is achieved with radiology department and oncology bunkers in the basement, outpatient services in the lower floors, inpatient wards higher in the tower and a ‘hot zone’ with 20 main operating theaters and day surgery theatres sandwiched in the middle. Both buildings have lift cores separately serve their front and back areas. A regular structural frame that universally fits vertically stacked clinical functions has been adopted. Floor plates and clear heights are designed to allow future programmatic changes in new generations of medical care. On the patient ward floors, a spacious corridor wraps around a centrally located nurse station to provide efficient travel routes and visuals connections to patient rooms.
Modern hospitals are designed to avoid the cold, institutional and at times, intimidating image medical facilities have often had in the past. Gleneagles Hong Kong Hospital is a good example of this new approach. Its twin low-rise towers and curtain-wall design offers the hint of a resort environment. Internally, its wards and clinics are aimed at both being functional and comfortable. Greenery is widespread on its terraces, balconies and roofs, and its mental health unit has a private garden screened off with trees and purposely designed anti-ligature fences.
Vivien Mak is a director of P&T Group, specialises in the design and execution of medical, healthcare, aged care, community and institutional buildings.
Fig.1 Outdoor as well as indoor isolation spaces should also be considered (Photo: P&T Group)
Fig.2 Gleneagles Hospital Hong Kong(overleaf)(Photo: P&T Group/ Gleneagles Hospital Hong Kong)
Location: Wong Chuk Hang
Client : Gleneagles Hospital Hong Kong (Parkway Pantai/NWS Holdings Ltd)
Awards: 2017 Design & Health Academy Awards, International Health Project over 40,000m2
Fig.3 Christ the King Chapel stands in front of the Phase 1 block of St. Paul’s Hospital Redevelopment.
Redevelopment of St. Paul’s Hospital
Location: Causeway Bay
Client: Soeurs de Saint Paul de Chartres (HK)
Completion: 2009 (Phase 1)
2016 (Phase 2)
GFA: 62,673 m2
Fig.4 Scritical care unit, Gleneagles Hospital Hong Kong (Photo: Gleneagles Hospital Hong Kong)