Photography by Stephane Brügger
Canada was ground zero for a radical transformation of modern medicine and how healthcare facility design became a valued healing tool. In 1972, the McMaster Medical Centre in Hamilton, Ont. designed by Craig, Zeidler & Strong Architects employed futuristic structures, new spatial organization principles, patient and family friendly spaces, bright colours and other elements to improve both care delivery and recovery performance. A decade later, McMaster’ s David Sackett and Gordon Guyatt introduced “evidence-based medicine” (EBM), “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” By 2002, Sackett had amended his definition to include understanding the recuperative significance of involving both the patient and care-giving family.
This patient-centred collaborative system reflected McMaster’ s original physical design as well as the team-based, family-centred practice also introduced back in 1972. About the same time, considerable evidence emerged suggesting existing facility design could itself be a major health hazard, thus consolidating the importance of more evidence-based facility design. J. Stickler defined this approach as “the use of scientific method to guide design decisions based on empirical knowledge.”For example, reconfiguring nursing stations to improve patient/nurse interaction, reduce walking and decrease medication errors, as well as positioning hand washing facilities to reduce nosocomial infections and humanizing patient environments improved outcomes and shortened hospital stays.
These same principles underlie the interior architecture of the new research and special care units at Montréal’ s CHU Sainte-Justine Hospital. Designed in consortium by Menkès Shooner Dagenais LeTourneux Architectes and Provencher_Roy, the latter addition adds 261 single-occupancy beds, a 14-room surgical unit, high-risk pregnancy unit, labour ward, pediatric and neonatal intensive care unit and medical imaging facilities, making it one of North America’s largest mother and child health centres.
Located west of the existing hospital on the lower north slope of Mount Royal, the care unit is E-shaped with three wings that ensure each spacious, single-occupant care room along the exterior wall receives generous views to the picturesque mount. Its visible presence, says architect Jean-Pierre Letourneaux was “the inspiration for our ‘ hypernature’ concept that brings nature in and spreads it throughout the building.” Such connections to nature, evidence-based medicine has found, are conducive to faster healing.
At the south end of each wing, floor-to-ceiling windows with fritted tree trunk-like patterns, bathe the corridors with light creating almost the sense of walking in a forest. Against part of these end walls are family rooms that provide retreat spaces. The large flashes of rich colours animating rooms and corridors have again both aesthetic and therapeutic roles. Gone, says architect Claude Provencher, are the drab tones we associate with past hospital environments.
Each bedroom has a generous padded bench providing family caregivers a comfortable bed for remaining overnight. Letourneaux compares this favorably with uncomfortable nights spent in a chair he experienced attending his elderly mother in an older hospital. Similarly, the usual lack of a “filter” that could reduce intrusive entry of medical staff while patients are resting or talking with relatives has been corrected. Doors are glazed and shuttered. “Thus,” he continues, “the shutters can be turned just slightly to see if the patient is asleep or occupied, thus again making the environment more humane.” The incorporation of small, carefully detailed workstations along the corridors minimizes nurses’ movements, reduces medicinal errors and ensures better work lighting.
The three, four-storey bedroom wings sit on a contiguous podium containing medical services, delivery rooms and surgeries and are spaced around open, landscaped courtyards, although bridges connect the wings for ease of ward circulation. One courtyard is animated by a mobile designed by Cirque du Soleil and composed of multiple shards of coloured acrylic. Shimmering in the breeze, it provides a dynamic, playful spectacle for the young patients. “They did a very delicate, beautiful job with the mobile,” says Provencher. When light hits these small polycarbonate bits it reflects sunlight everywhere during the day or illumination at night; it is moving, it is never static, it sparkles for the kids. Additionally, Dominique Blain’ s origami-inspired glass murals that great you when you exit the elevator “are like a puzzle of triangle shapes out of which children can discern a bird, a bear, etc…..the animals of the Boreal forest.”
The architects’ “hypernature” organizing concept finds its way into the facility’ s wayfinding signage. The use of colourful graphics depicting plants and animals characteristic of Mount Royal’ s eco-territory is intended to create an environment that is healing, welcoming and even playful.
The idea of present nature is most dramatically evident in the public indoor/outdoor spatial spine stretching along the core of the site. This public heart of Sainte-Justine includes an almost three-storey atrium conjoining the care and research blocks. It serves to welcome and orientate visitors to both buildings, but it is also defined on the west by a protected and heavily treed linear courtyard. Visible through the atrium’ s massive west wall of glass, it steps upwards towards a children’ s play area covered in pink rubber tiling. This urban retreat, as is the rest of the complex’ s nature-defined landscaping, is the work of Montréal-based NIP Paysage.
The atrium’s voluminous space sparkles under a reflective, aluminum-tiled ceiling that invokes a cloud flecked sky; but, is also punctuated by eight large irregular pentagon-shaped skylights to let the real sky penetrate. Its white floor is crisscrossed by green “branches” that both extend out into the courtyard and rise up to become benches under an interior bridge. This span, supported by irregularly placed and leaning trunk-like columns, provides access to the upper of two piggy-backed auditoriums.
The auditoriums’ chiseled, boulder-like volume, (“the mother rock,” says Letourneaux) is extruded to the outside through the atrium’ s east façade. It acts as an enigmatic reference, says Provencher, to the hard magma rock that forms Mount Royal, one of eight Monteregian Hills dotting the St. Lawrence Plain. The larger black auditorium on the first level draws researchers and visitors for international seminars into the atrium’ s public space while the smaller upper white auditorium is used for presentations and shows for the children. In the latter, a west facing glass wall offers views across the atrium and out toward the courtyard and play area.
All these elements, whether functional or aesthetic, promotes healing indicative of evidence–based design. And if you want “evidence” say the architects confidently, just ask the users, patients, families and medical staff.