News - June 2019
A unique approach to design?
Ten years ago Papworth Hospital bosses were given the opportunity to develop a site on the world-renowned Cambridge Biomedical Campus to create a new, purpose-built facility for the delivery of 21st-century specialist heart and lung services.
It was an opportunity not only to modernise the environment for staff, patients, and visitors; but also to set a new standard for healthcare design.
Kirstin Ziemer, a senior medical planner for architects, HOK, explains: “Our starting point, from a clinical design point of view, was based around two of the trust’s documents – its Clinical Output Specification, covering how many people worked there, how they wanted and needed to work, and what they did; and its Schedule of Accommodation, a room-by-room breakdown of activity.”
A matter of size
Using these for guidance, the design team, led by Ian Fleetwood, was able to draw up a basic plan for the proposed site, which sits right in the centre of the campus, adjacent to Addenbrooke’s Hospital.
“We had a very-tight site”, said Ziemer, “and we knew we could not go over a particular square meterage.
“But the building the trust outlined in its Schedule of Accommodation was too big so our first major challenge was to come up with ways of not compromising clinical services while reducing the size.”
This was achieved in a number of ways.
The designers looked at combining staff rest and social spaces, which were traditionally departmentally based.
Ziemer said: “We talked to staff and worked with the idea that instead of staff areas for every department, if you placed something between adjacent departments then they would have to use these and it would help with collaborative working.”
This forward-thinking approach saved the trust 5,000sq m of space.
Finding their way
The next challenge was to look at how staff and patients used and moved through the building.
“Everything we talk about in healthcare design is about easing the patient through a journey which can be stressful,” said Ziemer.
Entry into the building is designed around two main atria which draw natural light deep into the building.
The main reception desk, visible from the entrance doors, provides clear and concise navigation through, either to the second atrium waiting area or to lifts which go to the upper floors.
Journey times from the main entrance to the upper inpatient floors are as little as 80 seconds.
Downstairs in the outpatient area, all clinical and diagnostic rooms are accessed from a single waiting area, overcoming the traditional problem where patients have to visit several different places within the hospital.
“Improving the patient journey in this way was a very-important aspect of the design,” said Ziemer.
Getting into shape
This approach also informed the shape of the building, which has two distinct forms – a square base at the lower level and an oval on top.
“This was the best site on the campus,” said Fleetwood.
“We could have made this the tallest building on the site, but we wanted to do something different.
“The square base connects the hospital to Addenbrooke’s, which is important as a lot of patients have other ailments as well and previously they would have to travel across the countryside.
“This base means that as you approach the building there is a similar language in terms of architecture and materials.
“Then there is the striking oval shape which creates the upper levels and spans around the base.”
Using this curved form has also helped to overcome several design issues.
Firstly, a more-angular design made fire safety a challenge. And it impacted negatively on patient observation – which is critical as the trust wanted staff to be able to see at least 60% of patients from the central nursing station on each ward.
Ziemer explains: “Originally we had more of a rectangular design in mind, but this evolved as we tried to resolve issues around fire safety.
“Instead what we had was a quite-unique design.
“There are two wards, North and South, with 42 beds on each side approached from a central link bridge.
“Once at the entrance, you move into the staff base and reception and then into the lounge, if you are visiting, or straight onto the ward if you are a patient.
“One of the key design elements was good observation and, using this curved form, we have managed to go over and above what the trust wanted, ensuring 70% of patients can be observed.”
The inpatient rooms themselves are single en-suite facilities with the bed located on the corridor side and visibility enhanced through the inclusion of fully-glazed sliding doors. This layout has pushed the en-suites to the back of the rooms.
Fleetwood said: “Usually in hospital wards you can see the end wall and it makes it seem very institutional. With our design you get a nice window so you can see a view out of the building to the landscape.
“It doesn’t feel claustrophobic at all.
“The whole impact of the building and the way it has been designed means you can orientate yourself very easily.
“There are no long corridors, no signage left and right. It’s all very simple.”
With a project which has taken 10 years to deliver – during which time clinical pathways and technology have changed considerably – there are obvious concerns that the design may already be out of date.
But the team is confident its forward-thinking, clinically-driven approach will mean the building can evolve in the future.
Ziemer said: “The overall concept is one of standardisation and flexibility.
“In terms of keeping up with clinical advancements and progress, we designed a modular structure working with repeatable rooms.
“As such, outpatient consulting rooms and specialist testing rooms, for example, are exactly the same area, which gives the flexibility so if you make a change you are able to do the same thing in every room.
“Specialist testing rooms, such as ultrasound, body tilt etc, are designed to meet every standard and are roughly the same size, as are outpatient rooms.
“If you needed to change the function of the room in the future, say you do not need so many outpatient clinic rooms but more space for testing, we know we can get that into the current footprint
“It is the same for our hot floors, where a Cath lab suite could become operating theatres or vice versa.”
And, in the building there is also quite a lot of ‘soft’ space for administration functions. These could be repurposed in the future if there was demand for more clinical space.
Advances in technology
The team even worked with all the major specialist suppliers of key equipment such as scanners, to gather the space and technical requirements for each item.
The design of the rooms ensures that, whichever piece of equipment the trust might wish to procure, it will fit into any of these standard rooms.
Ziemer said: “We started designing in 2010 and by making sure we understand all the requirements, we can feel very confident that the trust can choose anything on the market and put it in these rooms.
“Such a long planning process does not mean you have to end up with a white elephant.”
She concludes: “We were given a very-unique opportunity to completely redesign the way the trust delivers healthcare.
“That doesn’t happen very often and it has been an amazing journey for us and for the trust.
“What we have now is a really-beautiful and unique building that is very practical and the people we have spoken to absolutely love it.”
The project at a glance
- Start on site: February 2015
- Completion: February 2019
- Internal floor area: 33,000sq m
- Procurement route: PFI
- Construction cost: £200m
- Architect: HOK
- Client: Royal Papworth Foundation NHS Trust and Skanska
- Main contractor: Skanska
- Structural engineer: Skanska Tech
- M&E consultant: troup bywaters + anders
- QS: Skanska
- Fire consultant: Fire Ingenuity
- Landscape consultant: FIRA
- Acoustic consultant: SRL
- Acoustic products: Rockfon
- CDM co-ordinator: Capita
- Approved building inspector: HCD Bureau Veritas
- CAD software used: Revit