When does a hospital room have to face south? Answer: When it’s in China, where patients want the positive feng shui of a sunny view. Or try this one: When does a hospital have to build a dedicated space large enough to accommodate all its employees and visitors in prayer? Answer: When it’s in one of the Persian Gulf States. “In the U.S. you’d probably have a small non-denominational chapel,” says Brad Barker, executive vice president and director of the healthcare practice at U.S.-based CallisonRTKL, a leading international building-design consultancy. “But not in the Middle East.”
Hospital development projects in many regions of the world are frequently the result of international collaborations. But that raises an interesting challenge for experts, consultants, contractors and other partners involved in hospital-building projects far from their own regions. Namely, hospital environments now have to reflect the attitudes, interests, concerns and values of their local populations — and those cultural metrics can vary wildly from one country to the next.
Consider the build-out of Children’s Cancer Hospital Egypt in Cairo, which is currently undergoing an expansion of close to two million square feet that will take it from 250 beds to 550 beds, all in private rooms. The project will also add a new outpatient center with 260 infusion chairs for children undergoing chemotherapy, a separate administration building, and an academy for the continuing education of nurses and other healthcare staff.
Outcomes-wise, the hospital’s achievements speak for themselves: Before its construction in 2007, the five-year survival rate for children with cancer in Egypt was 45 percent; today it is more than 70 percent. But getting a good design outcome for the expansion, to be completed by 2021, is an entirely different challenge.
One key criterion of the project is to get away from the conventional notion of the hospital as a place to house and treat sick people, and instead reinvent the hospital as a warm, familiar, psychologically comforting place to heal. That’s been a leading trend in the U.S. for some time. Now it’s taking hold across large swaths of the world’s emerging healthcare markets, particularly in flagship facilities. But in the case of Children’s Cancer Hospital Egypt, how to achieve that goal while also highlighting the country’s unique culture and history?
The answer for Children’s Cancer Hospital is an architectural design that in part recalls a lighthouse, a gesture to the fact that ancient Egyptians invented the first lighthouse at Alexandria. Additionally, the building facades have been designed to mimic the structure of papyrus paper, while interior screening will reference patterns found in traditional Egyptian weaving. These are the sort of local touches that Hesham Dinana hopes patients and visitors will find uplifting. “We want this to be a place of hope, not worry,” says Dinana, vice president and managing director of the Cairo branch of EFESO Consulting, the global company that has been advising the hospital on all of its major strategies since the project first began in the late 1990s.
The project is full of references significant to the region. One of the walls of the outpatient building faces the Aqueduct, a then-state-of-the-art structure built in the ninth century to bring water from the Nile to what was Egypt’s capital at the time. The hospital wall is made of the same stone as the Aqueduct, and will showcase a carved history of the region’s historical contribution to medicine from the pharaohs’ days to modern times — a big point of cultural pride.
Other cultural influences on the design of the outpatient center will include local Islamic stonework, solar shades on the front facade of the building that curve in and out in a ripple intended to suggest the desert winds, and a vibrant blue wavy glass wall recalling the flow of the Nile. Native Egyptian flora will highlight the Outpatient Center garden.
The design was intended to protect local jobs, too. In the U.S., new hospitals are built with pneumatic tube systems to zip blood and other medical materials through the facilities. But this renovation purposely left the tubes out, because the hospital is in a poor neighborhood that depends on the employment of locals as in-hospital runners, among other positions. “They don’t want technology taking away jobs,” says Jim Curran, a vice president at CallisonRTKL, which had a big hand in the project.
Some of the design components of the project are fairly common to major new hospital designs around the world. These features include atrium-style, skylit lobbies, and private patient rooms in corridors made wide for ease of movement and intuitive wayfinding. There are roof decks and gardens, and water elements for quiet contemplation or meditation. And the use of warmer, less-sterile and high-tech-looking materials helps to avoid the stark institutional feeling all too commonly found in hospitals.
But in more and more hospital design projects around the world, it’s the special, locally significant considerations that create challenges and opportunities for hospital designers. Consider the South Korea hospital Seoul St. Mary’s, a 1,300-bed facility handling upwards of 7,000 outpatient visits a day. More than one out of ten people in South Korea are Catholic, outnumbering Buddhists, and as a Catholic institution, Seoul St. Mary’s determined its 2009 build-out should provide a sense of nurturing consistent with the image of the Virgin Mary. “We wanted a mother-holding-a-baby kind of feeling,” says Jun-Su Lee, team leader of the hospital’s Health Promotion Center. “It was designed with psychological comfort in mind.” Contributing to that goal are exterior terracotta panels, and textured wood and copper finishes in patient rooms and most common areas.
The hospital, which is accredited by the Joint Commission International (JCI), also enlisted state-of-the-art design practices aimed not at comfort but outcomes. One element of that effort was separate conveyor belt systems in each ward for sterile and non-sterile supplies — one component of a system that Lee credits with helping to keep the hospital free of the viral respiratory illness Middle East Respiratory Syndrome (MERS) last year when some other leading South Korean hospitals were struggling with the outbreak.
The 2012 expansion of Chile’s Clínica Las Condes was another unique undertaking, designed to reflect the hospital’s dense urban environment while also providing a refuge from it through more open, expansive design elements. The build-out, which took the hospital from 250 to 338 beds, along with the capacity for another 162, left the front of the hospital almost right at the edge of the street, but raised the ground level up from the street to provide a sense of separation from it. Several open-air plazas abut the facility to create a rural-feeling oasis shielded from the surrounding hustle and bustle, allowing visitors to bask in the generally warm weather that the region is known for. Inside the hospital, extra-spacious private rooms accommodate not just patients and clinicians, but also the large visitor parties common in Latin America hospitals. “It’s part of our culture for patients to receive a lot of visitors,” notes Mauricio Gonzales Munita, Clínica Las Condes’ director of facilities.
The need to accommodate large groups of visitors is even more strongly felt in the King Faisal Specialist Hospital and Research Centre in Saudi Arabia, now under construction and scheduled to open in mid-2018 amidst a 21-million-square-foot campus in Jeddah. The rooms in the new hospital, which are all private, won’t merely allow groups to fit in and sit comfortably for visits, but will accommodate family members who want to eat and even sleep in the rooms.
Artwork at the hospital will contribute another link to local culture. Jeddah is known as a city of street art, and the walls of the hospital will be a showcase for it. The governor of Jeddah, Mishaal bin Majid, is an artist himself and personally became involved in the design planning. “The governor told me, ‘I don’t want people here to feel like they’re in a hospital in Boston,’” says Adel Elhammady, an architect who oversees large projects for the King Faisal hospital system. “‘I want them to know this hospital is a gate to Jeddah.’” The pieces that will be on display in the hospital are being chosen by a special jury for a competition among local artists.
China will be the next frontier for culturally aware, leading-edge hospital design, according to CallisonRTKL’s Barker. “The market is really coming alive right now,” he says. “The country is shifting spending from retail, entertainment and housing to healthcare, and that should continue for ten years.” Meeting all the demands of good feng shui through hospitals could present a real headache for designers, he says, and make it difficult to keep budgets in line. For example, he notes, a hospital would have to be laid out as a long, thin rectangle to keep most patient rooms facing south, and that would create huge inefficiencies in internal traffic — especially for clinicians, who can work more easily around a central core surrounded by a ring of rooms.
Fortunately, adds Barker, cost and other practical considerations are leading China decision-makers to cut designers some slack in adhering to feng shui and other challenging cultural dictates. “They’re beginning to loosen up on that sort of thing,” he says — but only to a certain extent.
While design challenges may cause designers to lose some sleep, the emphasis on more comfortable, familiar and locally sensitive hospital environments will be welcomed by patients and their families. And increasingly, that’s the metric that’s driving trends in healthcare.
— Larry Lindner
Larry Lindner is a freelance writer based in Hingham, Massachusetts.