Back to the Future

Aachen Klinickum University Hospital Aachen

An International conference on the hospital of the 21st century held in Maastricht primed Graham Cooper for a visit to the Netherlands' newest mega-hospital HD October 1991.

In August an international conference called Hospital in the 21st Century was held in Maastricht, the Netherlands, to coincide with the official royal opening of the new Academic Medical Centre in Maastricht (AZM).

I would like to reflect on issues raised at the conference before taking a look at this new hospital. American representatives at the conference boldly predicted a future driven by competition and market forces, based on the consumers' right to choose which 'centre of excellence', for example, would provide the most comfortable and least stressful surroundings. A survey was quoted which indicated that 75% of US healthcare demand is made by women and that amongst their requirements are: high quality of service; con- venience; quick attention, and a familiar and caring atmosphere. The American architects believed that by the year 2000, outpatients will outnumber inpatients by 8:1; the traditional hospital as we know it they declared is in decline.

The European speakers, mainly from the Netherlands, Germany and Belgium, were more cautious. The Belgium architect Professor Delcrue countered that in the US people were underinsured and the main priority should be to keep healthcare affordable for everyone. He cast doubt on the 'hotel room' solutions and provocatively stated, "if you can enjoy the wallpaper you are ready to go home". In his spicy 'back to the future' analysis he took us on a European tour of traditional and modern hospital models, pleading that older hospitals still had an important role to play. He was particularly critical of the new Klinickum University Hospital in Aachen, Germany, which he said is a "sick building and is bad for your health. It is a piece of art but not a hospital." He concluded his tour by commenting favourably on two nearby Belgium hospitals St Jansziekenhuis, Genk, and the Universitarie Ziekenhuizen, Leuven. At the Leuven hospital Delcrue is introducing a new "nursing unit' concept to the new 350-bed phase 3 development. He claimed these nursing units are more versatile than UK DoH Nucleus Hospitals and will produce a 30% reduction in nursing costs.

There appeared to he a consensus of opinion that technology will play.

an important part in shaping the hospital of the future and there was much support for the development of non-invasive treatment and day surgery techniques.

Using 'patient friendly technology' the plan of hospitals will no longer need to he generated around imaging services such as X-ray departments. Advances in digital communication will allow the bulk of the image processing equipment to be placed at some distance from the clinical services.

It is clear that for the next decade district hospitals will continue to perform a significant public service and will have to satisfy the demands of the users and the medical consultants, whose status is often measured by the quality of their hospital facilities. People's expectations are rising. When they arrive for treatment they expect an intelligent service with high-tech support and they wish to recuperate in a caring and pleasing ambience, with fine views of the natural landscape.

Delegates were now sufficiently primed to examine whether the new AZM at Maastricht was an appropriate hospital for the 21st century.

Swinkels Passchier, the Maastricht architects and engineers responsible for the £140m AZM University Hospital and Medical Centre were pivotal to the discussion. The AZM complex consists of the university hospital, the faculty of medical science and the centre for health sciences of the Limburg state university. The funding, which came from three separate administrative regimes, is evident in the building's blueprint. The AZM is the latest addition to the mega university hospitals in the Netherlands, its predecessors being the Academisch Medisch near Amsterdam AMC and the Academic Zickenhuis in Utretch AZU (see 'Dutch Courage' HD Oct '90).

In his presentation 'the taming of a giant' Passchier described hospitals as the "largest public building schemes we give ourselves - they are meant for people and must be accessible to all". The key design elements of the new AZM he described as follows: Flexibility and adaptability; Compact layout; Public domain.

The architect described the public domain as the starting point - a meeting place on a par with the foyer of a major theatre or concert hall, combining functions such as circulation and waiting. For inspiration he had turned to the beautiful old town of Maastricht itself and its medieval street pattern. In the town, a network of streets empty into great spaces - busy squares with markets and other social functions. In the hospital the architects perceived a clear and simple pattern of large distinctive halls with linking streets. An important design factor was the attempt to reduce the distances that patients, nurses and doctors have to tread. Efficient industrial plants Passchier claimed have short and simple production lines; likewise, the service at the AZM benefits from a compact plan which encourages a grid-like circulation throughout the hospital. Linear hospitals he warned obstruct integration.

The five-floor layout produces a deceptively compact volume for such a massive 900-bed complex. The vertical circulation is installed into the impressive five-storey gallery and atrium spaces. A compact volume Passchier said is more energy efficient. Reduction in distances also reduces insulation, service networks and structure.

Passchier claimed his hospital is flexible and adaptable, describing potential changes to the interior as 'inbuilding' and expansion as 'outbuilding'. The interior has a temporary value and is adaptable allowing wards, offices and corridors to be rearranged. Outbuilding this symmetrical building however may prove difficult.

The planning of this hospital is thus rather introspective, the exterior being composed around the inside. Consequently, the visitor is greeted by a massive, yet orderly and well-mannered, white clad giant which stretches across the Randwijck, the southern outskirts of Maastricht - a green field setting forever transformed into a densely grained urban connurbation of masonry, steel and glass.

Public transport users enter the main entrance under a circular restaurant at the front of the building, while the motorist approaches from the side car park. These routes converge at the information point inside the concourse shopping mall. Clearly in view of the information desk are the splendid polychrome stairways which animate the generous open space.

Signage, seating and planting have been carefully chosen and arranged. An abundance of natural light, and pristine white walls and floor, present a fresh backdrop for the boldly coloured ironmongery, detailing and foliage.

A short distance behind the information desk, in the middle of the diagnostic block, the visitor arrives at the outpatients waiting area, spread across an enormous top-lit square. Each clinic is flagged by rings of seating, creating an auditorium around the central reception desk. The clarity and loftiness of these areas inspires confidence and wellbeing. The galleria spaces would have been ideal locations for artworks on a grand scale. Unfortunately the percentage for art fund (a mere £1.4m) seems to have evaporated into the vastness of the surroundings. Clearly the 1 per cent was focused on a few selected artists such as Panamarenko, whose 'Antwerp voor mankracht helicopter is suspended loftily in the main entrance foyer. Most of the art- works appear to he post-contract and very few form part of the building fabric. Their apparent sparseness and their location out of the public realm raises interesting questions as to how the percentage scheme coffers are allocated.

Once the visitor enters the clinical and staff areas, the experience quickly deteriorates into just another hospital environment. Fortunately, at the last moment, the whole masterplan of the AZM was rotated by 180' to allow inpatients to enjoy a view over the river Maas into the centre of town.

The year 2000 is not far away; it is unlikely that any major new hospital programme will he completed before then. Despite radical changes in healthcare services in the UK, it is interesting to note the apparent absence of discussion on the future of hospital design. Can this be attributed to our insular nature, or to a fear of what the future and Europe has to offer?

Graham Cooper is artist/designer with Medical Architecture & Art Projects (Maap), a new practice whose members used to comprise the Medical Archi- tecture Research Unit of the Polytechnic of North London.


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