Streets Ahead


Rapid advancements in media technology suggest healtheare facilities as we now experience them are in serious danger of becoming obsolete. Internet- based information, innovative smart materials and mobile diagnostic systems suggest that the traditional hospital territories could dematerialise in our own lifetime. Home-based telecare and localised day treatment can deliver the bulk of Outpatient demand, leaving critical care, mid- and longer-term inpatient care. Faced with dissolution of the existing hospital regime, what are the key remaining elements to salvage? Of primary concern of course is inpatients' comfort, dignity and well-being.(see HD May2002) Currently there is a tendency towards single occupancy. but, in addition, corresponding' to the privacy of the bed room is the server space

Described as the 'common activity space' in planning parlance, the ubiquitous hospital corridor promises the solution to the achievement of more efficient as well as pleasing environments. The server space is the vital transport and communication link between the patient and the outside world. For the isolated individual it is literally their lifeline, supplying food. medicines and clean linen. Apart from the provision of the individual necessities, the hospital street is also the focus of social interaction and information. As a nonspecific activity space the street is the interface for the patient and the community at large. It is the flexible nature of this circulation and information channel which offers the potential for innovation in healtheare design. The internet age has brought with it new ways of thinking about the relevance of existing work spaces. In modern commercial and production facilities we witness the phenomena of hot desking and new style communication modules taking the pressure off the bench or desk space. Modern schools are attractively open planned, providing precious social spaces where students can learn to interrelate and transfer their ideas and aspirations. Why not therefore apply contemporary measures to the interface spaces in the streets of modem hospitals?

The hospital corridor provides a vital link between the hospital front-of-house service, its 'public profile'. and the patient's personal space. It is the fundamental space 'in between', which provides the oxygen and lubrication without which the individual parts would seize up. The street is also used to facilitate social participation, a possible location for a transient population to enjoy themselves whilst within the hospital community. To minimise the impact on its surroundings however, a more ambitious programme for the expanding multiple space must he eco-friendly and to save energy should be orientated for passive solar gain. As well as functioning as a watering hole niche to 'gather around the stove', it would become a place to communicate with the surroundings. In the Japanese teahouse tradition the space would become the medium to experience and engage with nature. It is where the exterior merges with the interior. Imagine a wide tree-lined boulevard, punctuated with micro-gardens, patios and terraces; like the teahouse, a place to encourage and parade some architectural delight. For health facilities to progress and transform into centres of well-being, the whole planning process needs to be freed up. The orthodox symmetries of hospital massing, with their predictable and monotonous routing. require rigorous interrogation. Compacting will reduce circulation distances, and squeezing the voluminous front-end atria to inflate the corridors will open generous and useful street galleries or arcades. The opened-up atrium corridor will allow more daylight and natural ventilation to penetrate and animate the common activity and transport space. The double-height gallery spaces (see pic of Dohtai Clinic, Japan. by architect Noribiko Dan, with its double-height circulation and terrace) would he dispersed with floating pods where the client-server interface is encouraged.

A quiet contemplation and reading room at one end complements the internet cafe at the other. The client/server interface podiums cantilevered from the mezzanine float the length of the galleria. The server spaces need not be stand-alone structure but may be strung around the ward accommodation like an 'engawa" platform or veranda. The new communication streets may be conservatories, winter gardens or made up of infornal atria from spanning interstitial spaces between clusters of ward accommodation and diagnostic suites. The front entrance vestibule could be aligned to the multi-pupose circulation system to provide the impression upon entering of a cavernous public space.

What if the geography of hospitals was defragmented into smaller sectors, each with their own entrances arranged through the corners of the elevations? Much more interesting opportunities could be created by topological, sensitive structures, each revealing a surprising manner of circulation experiences with unfolding volumes and lightwells, expressing the direction and character of the sunlight at particular times of the day. Accommodating perhaps an art gallery, stage and store, the flexible space offers a multitude of possibilities.

NB According to a government report commissioned in the aftermath to the Kobe earthquake it was recommended planners of health care building increase the area of public space in order to facilitate the care of a high number of casualties in the likelihood there would be further natural disasters. Extra accommodation in the common activity space in the case of a major crisis would be very useful!


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