Grounds for improvement

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Article explores ³hospital landscape as image² and provides a vision of a future facility where nature is allowed to subjugate institutional blocks. HD Hospital Development

Imagine a visit to your local healthcare centre as being as a delightful and valued experience. You are welcomed at the site entrance with a smile and invited to take a gentle walk through the beautiful and well nurtured gardens. Stroll along the meandering pathways of the grounds, so peaceful with only the sounds of rippling streams and bird song. Through the scented foliage there is little evidence of an institution with vast intimidating edifices and brutal traffic systems, here the natural landscape prevails.The ugly service plant has been relocated buried beneath the fresh vegetation. Gone are offensive and monotonous elevations, replaced by only hints of habitation, perhaps turfed roof gardens of chalet accommodation.The single floor "wards" are semi submerged below grade, the terraces moulded into saucer-shaped cuttings located amongst trees and ponds. Gone is the institutional entrance with its emblems of authority, and the regime of bewildering corridors and departments, no need for wayfinding instructions here. The barrack-like territorial hierarchy of pavilions, white cells and clinical paraphernalia have all but vanished.

We enter the patient accommodation across a rocky stream at the corner of the footprint. Here there is no maze of endless corridors but an open-planned conservatory, with an array of fountains, pools and thoughtfully arranged timber seating offering tactile comfort and relaxation. Just-in-time management means no stacks of trolleys or warehousing of patients at the casualty entrance. No offensive smells, just the sweet calming scent of lavender and seasonal herbs from the kitchen garden to greet you. The imposing front-of-house lobby is replaced by an informally-shaped atrium space achieved by gently spanning the volumes of the individual care suites. The large forbidding crowded assembly halls of the former main building now replaced by much more human-scaled and convivial common activity space. These flexible spaces provide positive leisurely distraction and social interaction for the healthcare recipient. The sun-soaked spaces now resemble a health spa, and the patients¹ family members are invited to share a refreshing dip in an onzen hot spring whilst taking a sip of refreshing fennel tea. The patient returns to their individual bedroom, engaged in the surrounding natural habitat, watching the reflected ripples gently dancing on the ceilings above.

Introduction Resolving the image crisis

As city dwellers become increasingly detached from nature, the more the demand for trees and gardens grows. Witness the crowds flocking to the Chelsea Flower Show or the Eden Centre. As health facilities grow in size and complexity, overtly imposing their presence, the negative perception of the population is reciprocated. Quite apart from the ethics and damage of overdevelopment, the scale, massing and elevations present mainstream hospital management with a massive image crisis. This kind of fearful mass infrastructure challenges the confidence and trust of the user who seeks individual care and attention. Instead of the factory plant approach to medicine, vested interest would be better served in the production of spaces which were conducive to the well-being of patients and the morale of staff. Downsizing will help to bring nature closer to the patient¹s experience but will require a rigorous reassessment of healthcare priorities and delivery A heightened awareness of surroundings and concern for the environment will effect the expectations of users, and suggests designers in the post-machine age need to boldly press the frontiers of the hospital its grounds and context.

Hospitals as we experience them remain isolated edifices with their control and demeanour well rooted in the ethos of the nineteenth century. Apart from the grandeur of its engineering the Victorian era also known for its splendid commons and public parks. The parks provided an important escape from the industrial pollution and pressures of the city, and similarly the grounds of the municipal hospital offered users retreat and sanctuary. Many will have powerful memories of the manicured landscapes seen from the glazed verandas of former Institutions. The well-tended cloister gardens and lavender fields of the St Remy Asylum brought inspiration for tormented artist Vincent Van Gogh to produce some of his most beautiful oils. Today, with the exception of the occasional garden festival, hospital grounds like most impoverished public amenities are sadly neglected and all too often in disrepair. The recently reopened Piccadilly Gardens located on the former site of the Manchester Royal Infirmary is a rare example of a city centre garden regeneration. The concept was to provide a calm haven, an open respite and contemplation space out of the brutal commercial district. Designed by Tadao Ando the concrete pavilion offers a foil and backdrop protection from the busy transportation hub, the fountains drown the noise of traffic and the largest green lawn laid at the heart of the city in recent years aids meditation. The sensibilities of this renowned Osaka-based architect are expressed through the image of landscape rather than the building itself. His buildings act as a conductor between man and nature, a process he calls shakkei - the borrowing of landscape. He wishes to capture climatic features such as seasonal and weather changes, allowing the user to experience the beauty of wind and rain as part of the daily routine. Borrowing the landscape does not unfortunately appear on the agenda ot health service commissions. Nevertheless hospitals curtilage must be respectful of the topography, and a rigidly prescribed template formula not nested satisfactorily will be rejected by its surroundings. Better to carve and bed into the ground rather than simply to model on the top surface. A site-specific context-inspired and driven artifice, sympathetic to the local topography or cityscape, is a prerequisite to the successful hospital development.

A sustainable image
The general perception of the community is influenced by the graduated experience of external appearances. Opinions of outsiders will be formed by incremental impressions of how the hospital image is presented and promoted. This image is formed by how the building elevations relate to the overall setting and how the footprint physically impacts on the townscape. Opinions reflect type of site and context whether urban, campus, suburban greenfield, community, or rural cottage. Choice of location such as lakeside, riverbank, seascape or uptown is crucial and will add atmosphere and theatre. Messages about pride in the establishment and whether it is valued and well maintained all matter in the beauty competition stakes. Self image is exposed upon entering the grounds. Access, general detritus, barriers, barrages of signs, hard and soft landscaping, all affect public opinion. Creative interventions by artists have added to the lifestyle of hospitals and engaging with nature will provide a further layer of added value in the promotion of health. As art has played its role in a positive self image in future so will landscaping positively affect the organisation¹s "green credentials".

Semi-detached from normal pre-occupations, hospitals are places for curing, caring and healing ­ a half way house between daily existence and the laws of nature. With its constantly changing priorities the hospital itself is a living organism, and facilities without flexibility which fail to meet expectations and demands are unsustainable. Like other public utilities building regulations and environmental pressures dictate that the health sector will need to reduce greenhouse gas emissions. The admittedly ambitious target must be to reduce carbon emissions across the site to zero. This is an enormous social responsibility suggesting drastic reconfiguring, dramatically reducing energy consumption and extensive recycling of raw materials. The aim is a sustainable architecture which responds to natural phenomena, is climate-sensitive and which grows in harmony with its environment. Addressing global ecological anxiety will not however necessarily provide aesthetic pleasure or promote well-being but passive and renewable energy, water and woodlands management now offer hospital designers a unique fresh palette of opportunities. To make measurable improvements greening guidance and targets have to be established. Passive solar gains can be obtained by orientating patient accommodation toward the sun and sheltering the cooler north building perimeters. Reducing building heights and limiting depth of volume will reduce reliance on costly mechanical and electrical services. Photovoltaic and solar heating mounted to exploit reusable energy and low energy equipment such as battery-petrol hybrid vehicles require environmental auditing.

Green and leafy neighbourhoods are most popular and highly valued, and trees help to clean the air and make us feel less stressed.. Dense tree planting can protect against harsh winter winds and improve shade and ventilation in summer. As buffer zones woodlands provide privacy, reduce noise levels and inhibit traffic impact. Woodlands and the creative use of water will contribute towards a richer quality of wildlife. The introduction of eco-corridors across green bridges and roof gardens throughout the building envelope and estate encouraging interaction of species and bio-diversity.Channelling rain and ground water into scenic lakes will improve the quality of surrounding vegetation and habitation. Recycling grey water through reed beds offers a natural filter to assist wild life and water reserves. Water is the great healer and its harnessing can offer an enormous canopy of aesthetic potential. Location and its relationship to the local scenery is the most important aspect of healthcare development. Despite value for money and best practice rhetoric millions are spent on forbidding and anti-topos accommodation, soon to be largely redundant which no one values or wishes to visit.. What ever become of those centre of excellence projects and low energy studies which promised much more intimate eco and user friendly solutions in which we may trust?

 

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