Shaping_Issue 14_Healthcare

COVER STORY: BOX HILL HOSPITAL

DESIGNING FOR REMOTE LOCATIONS

8 TIPS FOR BUILDING UPGRADES

SOLUTIONS FOR LIVE ENVIRONMENTS

The Healthcare Issue

ShapingA MEINHARDT AUSTRALIA MAGAZINE

14ISSUE

SEPTEMBER 2014

www.practicalimagination.info

A ustralia’s healthcare systems are changing rapidly.

“The industry is constantly battling to build on healthcare delivery value, employment generation and infrastructure development,” says a new Frost & Sullivan report.

Australia’s healthcare industry is therefore tackling increasing patient populations, budget constraints and resource shortages. This makes efficiency a vital component in hospital management and effective service delivery.

This issue of Shaping explores the often complex challenges of working in a live healthcare environment, the importance of pre-planning and solutions for ensuring ‘Operations Come First’.

This was also the theme of our recent imagin8 seminar for which we thank our partners Billard Leece Partnership and Built for making such a success. You can read more later in the magazine.

As always we welcome your feedback.

Denis Young, Managing Director – Australia [email protected]

Message From The TopWelcome to the Healthcare 2014 Edition of Shaping Australia.

SHAPING | HEALTHCARE - SEPT 2014

01 | INTRODUCTION01

ContentsCase Studies

BOX HILL HOSPITALEnabling staged works on an existing campus.

WARRINGAL PRIVATE HOSPITALFlexibility and future-proofing.

Features & Opinion

OUT ON A LIMB: DESIGNING FOR HOSPITALS IN REMOTE LOCATIONSWorking in remote, rural locations throws up its own set of unique challenges.

8 TIPS FOR BUILDING SERVICES UPGRADESGetting it right before, during and after.

WHAT ROLE CAN FAÇADE DESIGN PLAY IN THE HEALING PROCESS How to strike a balance between function and aesthetics.

imagin8

OPERATIONS COME FIRST A recap of our healthcare seminar.

ENGINEERING SOLUTIONS FOR LIVE ENVIRONMENTSWhilst there is often an obvious way to achieve something, it is not always the best way.

DEVELOPING BROWNFIELDSIdentifying challenges with the brownfield hospital developments.

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23.SHAPING | HEALTHCARE - SEPT 2014

T he Victorian Governments $447.5 million redevelopment is a flagship project designed to significantly improve healthcare facilities for the

community. The Meinhardt team has provided structural and civil engineering services for the 45 metre tall building (total area in excess of 52,000 square metres), which connects to the west wing of the existing hospital via an atrium and four linkways.

FORWARD THINKING SAVED TIME & MONEYSometimes good judgement and foresight can reap significant benefits and this was the case with the foundation designs as Senior Engineer, Rudy Susanto explains:

“The structure was already half built – we were at around level 3 – when the project secured additional funding to enable the addition of an extra floor,” said Rudy. “The fact that the builders were on site while designs were still being refined meant we knew that there was always the chance of a change in scope.”

It is much better to plan for eventualities rather than react to the unknown,” he added. “Therefore, when we designed the foundations, we thought it was worth adding an additional 15% of concrete around the footings. The cost to do this is minimal in the grander scheme of things and certainly preferable in

both cost and construction terms to having to strengthen the structure later on.”

This forward thinking meant that the team was able to incorporate the extra floor without any significant additional works or modifications, ensuring minimal impact to the budget and programme schedule.

THE BOILER HOUSE: THE HEART OF THE HOSPITALIntegral to the operations of Box Hill Hospital is the boiler house. If you shut it down, you shut the hospital. Core to the engineering solution was consideration of how to carry out works without affecting its operation.

The challenge was two-fold. Intelligent sequencing of the demolition and construction was one issue the team solved but the structural solution also had to work around the complexities of the actual boiler house structure itself. This meant designing a bespoke framing system to get around

Box Hill Hospital: Staged For SuccessA huge, complex hospital demanding in-depth understanding of healthcare processes to enable staged work and the continuing operation of the existing campus.

“ It is much better to plan for eventualities rather than react to the unknown. ”

Rudy Susanto Senior Structural Engineer [email protected]


03 | BOX HILL HOSPITAL

View of Building A from site cam (Jan 2014)

Building A viewed from Rodgerson Road (Jan 2014) Roofworks for drop-off area (Jan 2014)

SHAPING | HEALTHCARE - SEPT 2014SHAPING | HEALTHCARE - SEPT 2014

the existing ducts and pipework and footings that avoided critical underground services infrastructure, such as the high voltage cabling.

BRIDGING THE OLD WITH THE NEWThe third key challenge the team successfully solved was the improvement works to a platform spanning two of the hospital’s existing buildings, which housed mechanical equipment essential to the smooth running of operations.

To further improve servicing, 80 tonnes of additional equipment was proposed for the existing platform. The bridge was not designed to cater for such a load. This meant strengthening the existing frame to support the extra weight, enabling the existing buildings to in turn carry the now heavier platform, while at the same time ensuring no operational disruptions. This was made all the more challenging as underneath the bridge was the maternity ward and at one end were a series of major operating theatres.

The expanded hospital – designed by Silver Thomas Hanley with Jackson Architecture - accommodates 621 beds, an increase of more than 220 beds, and provide a larger emergency department that includes treatment, assessment and short stay beds; a dedicated precinct for women and children’s services; eleven new operating theatres; a new intensive care unit; expanded services for cardiology, cancer and renal patients; additional inpatient wards; and two floors of parking under the building with 225 patient car spaces.

FROM BOX HILL HOSPITAL:“The Meinhardt team has contributed substantially to the extremely successful hospital project at Box Hill. Their personnel have integrated completely into our “one team” approach and have participated in the problem-solving value-for-money environment that has been the basis for its success. This has not been an easy project and the team has had to be flexible in its approach particularly when there was a request to grow the building during its construction which required Meinhardt to pull out all the stops to find a solution that would not delay the project.”

Liz Maddison, Project Director Box Hill Hospital Redevelopment Project

Box Hill Hospital Rendering Box Hill Hospital 2014

Box Hill Hospital officially opened on the 12th of August, months ahead of schedule.


05 | WARRINGAL PRIVATE HOSPITAL

T he redevelopment, designed by architects Silver Thomas Hanley with Built as main contractor, will transform Warringal Private into a full-service

“flagship” Ramsay Healthcare hospital. Custom-designed and purpose-built, it will offer some of the most modern and progressive infrastructure, incorporating state-of-the-art facilities with fresh and contemporary design.

IMPROVING PATIENT ACCESSThe project has been designed to be built in stages with the car park handed over first. This lack of amenity space was seriously compromising the client’s business and the ability to fast track this element was a critical selling point.

“It was a challenging schedule,” admitted Rennie Darmanin, Discipline Leader – Structures at Meinhardt. “We had to make allowances in the programme to ensure delivery prior to all other works. This meant the steelwork, supporting structure and civil engineering requirements all needed to be 100% completed and safe to enable the car park to begin operations.”

Warringal CEO Petra Snelleman said that hand over has been eagerly anticipated, “Patient access has been a

challenge since works began and it will be a significant improvement for our patients and their families to have an expanded onsite parking capacity at Warringal, particularly given the high demand for parking within the medical precinct we share with Austin Health.”

MODIFYING THE EXISTING TO ALLOW FOR NEW WORKSA key component of the design has been a walkway to connect the existing facility with the extension to allow more efficient access, both improving operations and the user experience.

This suspended steel walkway carries over the top of an existing building. The only way to support this was through the existing floor slab. This posed two challenges: ensuring no disruption of critical hospital infrastructure such as oxygen pumps, which had to be relocated, and the continued operation of the space below the overhead construction. The successful solution dropped the supporting posts down behind the corridor walls to ensure this passageway remained useable.

FUTURE PROOFING: THE EXTENSIONAs a private hospital, the client is reliant on occupied beds

Warringal Private Hospital: Engineered for GrowthWith demand continuing to grow for private hospital services, the redevelopment considers existing operations while providing future-proofed flexibility.

Rennie Darmanin Discipline Leader – Structures [email protected]


Warringal Private Hospital Rendering

Warringal Private Hospital 2014


07 | WARRINGAL PRIVATE HOSPITAL

for financial sustainability. They cannot afford to have beds out of action and fall below required utilisation rates.

The design was already significantly progressed when approval was given for a second stage. A full feasibility proposal and redesign had to be developed in collaboration with the builder without any increase in programme. At the same time it also had to enable the future addition of 3 levels while the floors below remained in use as hospital wards.

The top level that has now been constructed (5th floor) was therefore designed as an all-encompassing solution with no restrictions on how the expansion can be built.

“You have to find a trade-off,” explained Rennie. “Although it is more expensive initially, it will deliver greater benefits longer term. There is maximum flexibility from a design perspective, there will be no disturbance of the wards below and it will make things easier for the builder to construct.”

On completion the hospital will expand to 215 beds and a total of 11 operating theatres.

Included as part of the $54 million redevelopment are:

• 64 private single rooms with en-swuites

• 5 state-of-the-art integrated operating theatres

• 12 bay recovery unit

• A custom-designed central sterilising department

• Multi-level car parking of 270 car spaces

“ This lack of amenity space was seriously compromising the client’s business and the ability to fast track this element was a critical selling point. ”

Warringal Private Hospital Rendering


Out On A Limb: Designing Hospitals for Remote LocationsWorking in remote, rural locations throws up its own set of unique challenges as Les Simonsen, Deputy Manager – Structures, discovered while working on four regional hospitals for Queensland Health.

Each of the sites at Mt Morgan, Baralaba, Biggenden and Winton, designed in collaboration with architects Thomson Adsett,

comprised large single-storey structures, utilising a combination of slabs on ground and suspended slabs with steel wall and roof frames.

“Ultimately, the idea was to simplify and prefabricate as much as possible and then bring the components from the factory to site,” said Les. “This was because of the lack of skills and materials locally.

Initially though we investigated the use of steel portal frames. This would have enabled a more future-proof solution allowing internal walls to be easily pulled out if required since they are not loadbearing. Upfront costs, however, became the primary business driver. Prefabricated walls and roof trusses, with internal frames to cater for larger spans, such as where x-ray machinery had to hang, were determined to be the best solution to meet this client requirement.”

Given the similarity of the projects, the team duplicated as many of the details as possible to enable the design of the four hospitals to happen concurrently and speed up the programme.

Programme planning, unsurprisingly was critical, as all four sites had existing hospitals that had to remain operational. Staged demolition and construction was instrumental in achieving this successfully.The demolition and site clearing also necessitated that all heritage and environmental issues were properly managed with the rural locations throwing up very particular challenges.

In Winton, for example highly reactive geotechnical conditions were encountered which posed restrictive design parameters and required clever structural thinking to overcome. This was done successfully through a heavy grid of footings to reduce any building movement. Mt Morgan, on the other hand, is situated on the

Les Simonsen Deputy Manager- Structures [email protected]

SHAPING | HEALTHCARE - SEP 2014SHAPING | HEALTHCARE - SEP 2014

09 | FEATURES & OPINION

BIGGENDEN HOSPITALBARALABA HOSPITALMT MORGAN HOSPITAL

side of a hill. This tricky topography meant a design which simplifies\d construction techniques, with high block retaining walls and suspended slabs over steel beams. This was imperative in aiding a quality build outcome within the timeframe needed.

Baralaba, meanwhile, is by a river prone to flooding. With no record of what the flood level was, the team had to base the solution on anecdotal evidence. Research uncovered details of the town’s biggest flood in the early 20th century. “We have designed 500mm above this level to ensure, as realistically as possible, hospital operations will never be affected.”, said Les.All of this work had to be done in the context of detailed project and programme management to coordinate site inspections and reduce cost and travel requirements to these remote areas.

“ Given the similarity of the projects, the team duplicated as many of the details as possible to enable the design of the four hospitals to happen concurrently and speed up the programme. ”

WINTON HOSPITAL

519kmFly to Rockhampton

39kmDrive to Mt Morgan from Rockhampton

519kmFly to Rockhampton

141kmDrive to Baralaba from Rockhampton

283kmDrive to Biggenden

999kmFly to Longreach

179kmDrive to Winton from Longreach

FLY

DRIVE

-

TOTAL DISTANCE TRAVELLED (ONE WAY)

558km 660km 283km 1178km

Going The Distance

+ + + +

= = = =

SHAPING | HEALTHCARE - SEPT 2014SHAPING | HEALTHCARE - SEPT 2014

8 Tips for Building Services Upgrades

1 Prepare for the Live Environment

Working in any “live” environment is a challenge. Preparation is the key here. The client needs to know what areas are affected by the works, what systems are affected by the works, and the timeframes for each.

Engineers need to essentially become projects managers in this regard. They have to forward think the process of the construction works and give an indication of the shutdown periods of systems, not to mention the added review of the risks involved to the patients.

3 Plan Plant Equipment Requirements

The solution needs to consider whole of life costs and how the existing systems can be kept running as long as possible while transitioning to the new system. New plant should be located outside of sterile/clean zones but where?

Fighting for new space for this equipment can be a challenge. It often means encroaching on space already being used by Hospital personnel for whatever reason. Often the initial reaction is to just request this space via the Hospital’s project representative but this can become a lengthy process. Ultimately, however, it is our responsibility to manage stakeholder concerns and review requirements until a happy medium is reached. Good interpersonal skills are therefore a must.

And perhaps most important of all is pre-order equipment. There are long lead times that can adversely affect programmes, if not planned in advance.

2 Co-ordinate Closely With The Architect

In such a complex environment, high level co-ordination from the outset with the architect is imperative to ensure effective delivery of critical components, such as the production of room data sheets, and technically challenging areas, such as achieving the required pressurization within the room and providing sealed services to avoid air leakage.

Services should be kept off the floor and recessed to avoid collection of dust and assist with infection control.

Daniel Moore Associate – Building Services [email protected]

Lee Watson Senior Electrical Engineer [email protected]


11 | FEATURES & OPINION

4 Explore The Benefits of BIM

With many clients now seeing the benefits of BIM, we have delivered a number of these projects using Autodesk REVIT software to coordinate the building services, structural and architectural in 3D using a virtual model of the building. This approach to project delivery is especially valuable in a healthcare setting where coordination with additional specialist services, such as medical gas, is required.

In addition, good housekeeping around records of existing services is key when trying to make modifications in the future. BIM can assist as a building management tool, albeit this functionality is not used much yet. Having good records will reduce the risk of variations for the client.

5 Ensure Post-Disaster Functionality

Services should be designed to provide a high level of reliability and redundancy. This means future gazing and future proofing. Buildings services systems should have the ability to be progressively upgraded, while facilitating future expansion. Key areas of consideration may include a Central Energy Plant including chillers, thermal storage (ice), steam boilers and back-up generators with significant expansion capacity.

6 Allow Flexibility To Integrate New technologies

Healthcare is a rapidly evolving sector. New technologies are constantly coming onto the market. They provide significant opportunities to improve staff effectiveness. It is important to understand the challenges of planning flexibility into design solutions to incorporate these new technologies, many of which are yet to be realized..

7 Optimise Building Management Systems

ESD is intrinsically linked to more cost-effective operations and improved patient and staff well-being. The design features of the building and building services systems need to correspond with thorough consideration of issues such as indoor environment quality, daylight access and thermal comfort. Energy benchmarks need to be set that significantly improve on current practice.

8 Maximise Generator Capacity

Generators are normally sized to cover “essential” electrical loads, but often the generator can be oversized so as not to fall short of requirements or to allow future spare capacity. But, in the case of power failure, how can the Hospital make use of the difference between the essential load and the available capacity of the Generator and thereby optimising the power available? An intelligent power control and power monitoring system is fundamental.

“ Buildings services systems should have the ability to be progressively upgraded, while facilitating future expansion. ”


imagin8 is a series of educational seminars designed to share the latest global thinking in the built environment space.

T he speakers are sector and discipline specialists, who encourage interactive debate, with the aim of giving you imaginative, but practical ideas, to help

meet your challenges and give you an edge.

White papers and presentations from the events will be available to download.

visit site

“ A great way to create conversation and build networks.” Feedback from our imagin8 seminar.


13 | IMAGIN8

http://practicalimagination.info/imagin8/

http://practicalimagination.info/imagin8/

“ A great way to create conversation and build networks.” Feedback from our imagin8 seminar.


Michael Brand Senior Project Engineer – Meinhardt

Engineering Solutions for Live Healthcare Environments

W hether it is patient welfare or the business of the hospital, working in a live healthcare environment can be challenging. How do we keep beds

operational? How do we ensure no disruption of critical infrastructure? How do we design for future flexibility? The following articles are case studies from the seminar.

Operations Come FirstHeld in partnership with Billard Leece Partnership and Built., we recap our seminar – Operations Come First: Solutions for Live Healthcare Environments.

OUR SPEAKERS

“Pre-planning is a critical issue facing our organisation that we need to give most consideration to. ”Sandra Hilton - Redevelopment Liaison Nurse | Epworth Healthcare


15 | IMAGIN8

Mark Mitchell Director – Billard Leece Partnership

Developing Brownfields

Shayne Young Construction Manager – Built.

Maintaining Business As Usual – From a Builder’s Perspective (Pt. 1)

Guy Finnis Project Manager – Built.

Maintaining Business As Usual – From a Builder’s Perspective (Pt. 2)

“Pre-planning is a critical issue facing our organisation that we need to give most consideration to. ”Sandra Hilton - Redevelopment Liaison Nurse | Epworth Healthcare


http://www.blp.com.au

www.built.com.au

I n 1860, the Metropolitan Railway Company of London decided to build a train tunnel under Euston Road at King’s Cross. The solution, which chief engineer John

Fowler came up with, was to simply dig it up. And so Euston Road was shut for two years (Figure 1).

If all the train lines in design were constructed in this way, it was projected London would become a “temporary” excavation for the next 60 years. It was obvious a new approach was required. This led to some clever engineers of the day devising the Tunnel Shield method (Figure 2), which took over soon after this, allowing the rest of London to continue being a major city while the tube network was constructed underneath.

Whilst there is often an obvious way to achieve something, it is not always the best way.

This is true with live operating hospitals. As engineers it is the way we achieve the required outcome that is most important. More often than not, the critical factor is to design for minimum impact on the core operations of the

existing hospital. At the heart of this is maintaining hospital beds - they bring in the revenue, and they perform that vital role for the surrounding community.

As part of the early works prior to the major campus redevelopment at Box Hill Hospital, the operating theatres in the 70 year old North Wing desperately required brand new plant equipment upgrades. However, access was impossible.

Operations were being performed in the North Wing, the West Wing is a live hospital ward and, meanwhile, babies were being born on the ground floor in Biralee House.

The obvious and easiest solution was to take the John Fowler approach and simply shut down the operating theatres for 4 weeks, rip the ceilings out, decommission the old equipment and replace it with the brand new technologies.

Of course, Box Hill Hospital couldn’t fathom the thought of operating theatres being knocked out for 4 weeks. The entire process needed rethinking.

Engineering Solutions for Live Healthcare EnvironmentsMichael Brand, Senior Project Engineer at Meinhardt, discusses the importance of operations in live healthcare environments.

Michael Brand Senior Project Engineer [email protected]


17 | IMAGIN8

Figure 1: Euston Road

Figure 2: Tunnel Shield method


By positing large beams between the two, separate existing brick buildings, a bridge was created forming an external plant platform up at this level so that all the new kit could be installed while the hospital remained fully operational (Figure 3).

A construction sequence drawing was developed which showed how the lightweight roof was to be protected with plywood during construction. Little things like positioning a lightweight aluminum scaffold 2m from the edge demonstrated how this would facilitate installation of the platform from the outside, with no access through the wards required for this task.

In addition to this, a hanging walkway was built at the lower level. The existing roof over the birthing suites was not strong enough to take the load and the ability to put columns through here was just not appropriate. The steel structure was designed for quick installation using a mobile crane with minimum noise and vibration disturbance. It also created a new access connection which could be utilised to transfer mental patients, negating the need to use ambulances that were previously required for this task (Figure 4).

Connecting big steel beams to 70 year old existing brick walls is not a simple task. Typical connections were complex because differential movement between the two buildings had to be allowed for (Figure 5).

But the beauty of this solution, despite the potential headaches for engineers and builders, was less the final engineered outcome but more the way that it was designed. It allowed all the construction activity to take place while babies were being born and the operating theatres were only down for one weekend rather than the 4 weeks if the obvious, simple path had been trod.

At Warringal Hospital, similarly, emphasis was on the ‘how’.

Foresight in the design phase will hopefully pay big dividends in the future, with the capacity for 3 future floors to be added down the track. But instead of just stopping at designing the columns for the additional load, as would be typical, holistic consideration was given to the occupational health and safety issues around major construction work over a functional hospital building.

The solution is a roof slab to act as a future construction deck; designed for a 20kPa live load rather than a traditional roof load of 3kPa. The cost-benefit analysis showed that whilst there was a small increase in the initial capital cost, the long-term time and cost benefits would be outweighed by this future proofing.

Much of this future planning and strategy can and should be teased out before much design work is carried out.

“ Much of this future planning and strategy can and should be teased out before much design

work is carried out. ”


19 | IMAGIN8

Construction zone

Figure 3: The hospital operations were maintained around the construction zone thanks to some smart design

Figure 4: New bridge (plant platform) Figure 5: Bridge bearing connection


Before: disjointed buildings, no carparking.

A traditional roof would pose OH&S issues during construction in the future.

The 20 kPa construction deck will allow 3 additional levels to be constructed in the future, without affecting the live hospital beneath.

Figure 7a Figure 7b

Now: houses a 3-storey basement carpark.

Figure 6a Figure 6b

Figure 8a Figure 8b

Future basement connection

Physiotherapy department

Traditional underpinning. Physio department including the therapy pool stayed operational throughout.


21 | IMAGIN8

Epworth Rehabilitation Hospital is another case in point. A conglomerate of old brick buildings has been transformed into a brand new facility, which opened last year (Figures 6a and 6b). But what you can’t see from the unassuming street view is the enormous 3-storey basement car park excavation below (Figures 7a and 7b).

The site was pushed to its limits by digging out the maximum possible footprint, hard up against the existing hospital on 2 sides and the main roads on the other sides.

It certainly wasn’t the easiest approach, especially when significant amounts of rock were encountered, but it was worth it for the subsequent benefits.

Of primary benefit was again minimising impact on key hospital operations.

The physiotherapy department, which included a pool in this case, is crucial to any rehabilitation hospital, and the bored pier system allowed the massive hole to be dug vertically right next to it, without affecting the department’s daily activities (Figures 8a and 8b).

For no additional cost to anyone, by arranging the retention wall system in the basement, it will allow an easy connection to the future expansion of the hospital with just a simple cut.

And, of course, major car parking problems at the hospital are now a thing of the past.

A final example is at Monash Children’s Hospital in Melbourne where a 3-storey extension, incorporating 24 new beds including an intensive care unit, was built over the existing single storey main entrance of the hospital.

The way it was designed made all the difference.

Here, the hospital entrance remained functional by stacking new columns directly over the existing columns, and utilising composite steel construction for minimum weight to enable the fastest construction timeframe. The tired old existing entrance has now been dressed with a new canopy and a double storey curtain wall to deliver a welcoming experience.

Four very different approaches but they all demonstrate how smart design solutions can keep core operations running at all times. It is this ‘minimum disruption option’ that more and more hospitals are demanding as key to the final solution.

“For no additional cost to anyone, by arranging the

retention wall system in the basement, it will allow an

easy connection to the future expansion of the hospital with

just a simple cut. ”

Monash Children’s Hospital


Developing BrownfieldsMark Mitchell, Director of Billard Leece Partnership Architects, discusses some issues to look out for in brownfield hospital developments.

Mark Mitchell Director [email protected]

Royal Melbouorne Hospital


23 | IMAGIN8

L ike health organisations, hospital architects need to keep an eye on the big picture, the client’s vision. For every stakeholder there will be a list of

issues, the key drivers for success. Opportunities for cost effectiveness, quality issues, attracting and retaining staff, patient surveys that guide the hospital’s performance from a consumer perspective, reliable infrastructure, interaction with neighbours . . . More and more, in brownfield hospital projects, we find it’s about doing more with less.

WHY BROWN IS THE NEW GREEN Having masterplanned some of the most intensive and complex sites in the country, inevitably the start up meeting includes a suggestion to push it all over and start again. However healthcare providers have a vested interest in making their built infrastructure work hard for them. It means they can focus their investments on tightening recurrent costs, and updating equipment. The first clue is in a smart site strategy.

Greenfields offer a lot of opportunities, but some say that if you build it all at once, you need to replace it all at once. The replacement cost of the built assets on the Royal Melbourne Hospital site (left) is some $3-4 billion. So who wants to

fund replacing this one? Over the years we have looked at relocating it wholesale, moving services to the suburbs, pulling it inside out and rebuilding it piece by piece. Staged redevelopment works included, as a first priority, inpatient accommodation - but where to put it? Stacked, generic, a couple of floors funded at a time, but no shut down time for future stages. Then operating theatres – how to extend them (on the third floor)? Then there are the multiple other players on a major campus: the researchers, the staff support – they need to be close. The answer involved a carefully planned progressive barn dance where spaces are decanted out of the way, built and/or refurbished, then plugged back into the hospital chassis.

MINIMISE DISRUPTIONIn regional areas, there is no other place to send patients during construction, so it is paramount that new components do not interrupt the patient, public and logistics flows of the existing hospital. This should not be to the detriment of patient amenity. Key strategies for the Albury Wodonga Cancer Centre included building away from the main building, but connect back in late in the project and placing wards next to wards wherever possible offering long term advantages for staffing and operational efficiency.

Albury Wodonga Cancer Centre


Ballarat Base Hospital

“ The key success factors of a project are time, cost and

quality. In brownfield projects, another factor needs to sit in this ensemble: the response

to the site. ”


25 | IMAGIN8

DESIGN FOR THE BUDGET, THE TIMEFRAMES AND THE SITE The key success factors of a project are time, cost and quality. In brownfield projects, another factor needs to sit in this ensemble: the response to the site. In a brownfield, there is likely to be a number of constraints just waiting to be turned into opportunities. For the Mornington Centre, we called on the slope of the site to put the dementia ward on the first floor. This enabled privacy from the ground floor rehab program, and also enormous scope for outdoor spaces for training – learning to post a letter, wait for a bus, wandering, pacing. Sunny courtyards are intimate in scale and like outdoor meeting rooms, with seasonal gardens. These places respond to human needs, they are places for people.

FUTURE PROOFING Future proofing needs to be carefully considered for a brownfield project. It can be the difference between saving a bundle down the line or throwing money down the drain. Not every healthcare provider wants to invest in a masterplan document, but inevitably design discussions return to future expansion scenarios. Some kind of loose fit expansion strategy is required – an identification of potential growth avenues.

In the case of Werribee Mercy, the brief was to double the capacity of what was developed as a prototype single storey 120 bed community hospital, one funding batch at a time. So the first batch needed to cover a whole lot of infrastructure - planning for carpark infrastructure, electrical and other services infrastructure, and building infrastructure – like a new front door. The current “ground scraper” left little land available for development, so the future proofing strategy needed both horizontal and vertical expansion. Space for spare lift shafts was allowed for and the roof structure and façade system carefully detailed for effortless expansion in the future.

STANDARDISATIONA key strategy for patient safety is standardisation. Question one is whether to match the old standard, or create a new one. It doesn’t take long for yesterday’s state-of-the-art to become today’s old practice. At Ballarat Base Hospital, we looked at the most popular of design discussions – the perfect ward:

• Start of a major vertical expansion on a space-constrained site

• Grid – 3x7 modules, projected up for future expansion

• New processes from research and experience

• Consider variety of cohorts

• New model of care and technology tools – test these in existing building, then build them in the new one.

• Short term pain (but rip the band-aid off quickly)

There is often a discussion on brownfield projects about staging and program. Most hospitals will suffer some short term pain of disruption if there is some longer term gain - a bit like ripping off a band-aid. This period of pain needs to be very carefully planned and managed – any extensions of time for these portions can leave the hospital business highly vulnerable.

For St John of God Berwick, some 13 stages of refurbishment followed the new component, as the hospital wanted to avoid any shutdown. This meant patients and doctors working around a construction site for the best part of a year. The lesson learned here was that larger areas of construction/fewer stages may have been a more successful outcome – same pain, but over a shorter period of time.

Mornington Centre

Werribee Mercy


T ypical building façades require the design team to strike the right balance between a host of parameters that pull the design in different directions, including

structural, aesthetic, thermal, technological, acoustics, security, and more. Healthcare facilities have not only these to contend with but a unique set of challenges that require consideration of multi- stakeholder needs, including patients, operators, health authorities, builders and architects, with often conflicting demands.

Through a combination of early façade consultant engagement and the incorporation of imaginative thinking and the latest technology, the façade can literally unify these demands.

PATIENT COMFORTPatient comfort is one of the prime concerns when designing hospitals and healthcare premises. Patients require a quiet atmosphere, plenty of natural daylight, as well as thermal comfort in order to recover in the best possible environment.

This involves the deployment of a variety of design solutions such as multi-functional low-emissivity coatings, laminated double-glazed units, exterior shading screens, or even responsive façades, if budget allows.

This may involve a slightly higher capital expenditure, but has the potential to reduce operating expenses, as well as provide the actual benefits sought for patients, hospital staff and visitors.

The design brief for a recent healthcare facility required the courtyard to be accessible to patients in all weather, despite the hospital being located in a tropical location, with frequent storms. This was intended to allow the patients to take a stroll or get some exercise every day.

“We elected to adopt ETFE cushions instead of glass panels for the skylight covering the courtyard, so as to minimise the framing sizes and maximize the panel modulations,” said Mathieu Meur, Managing Director at Meinhardt Façade Technology. “This provided an elegant

What Role Can Façade Design Play In The Healing Process?Typical building façades require the design team to strike the right balance between a host of parameters that pull the design in different directions, including structural, aesthetic, thermal, technological, acoustics, security, and more.

Mathieu Meur Managing Director – Façades, Singapore [email protected]


27 | FAÇADES

Figure 3. staggered, overlapping glass louvers, with open gaps between the glass blades.


solution, without the need for additional columns or heavy steel members, all within budget.” (Figure 1)

Natural daylight is often cited as helping with patient recovery. Achieving high access to daylight within the rooms, while ensuring the thermal comfort of patients is essential.

“In one case, our strategy has been to adopt highly spectrally selective glass, and spandrel panels extending up to the bed level,” said Meur. “In another project, the strategy has been to have planters running horizontally along the façade at every other level, and having rows of creeping plants extending up onto stainless wires in order to provide shade to the patients, while offering a soothing, natural experience.”

AESTHETICS More than many other buildings, the appearance of healthcare facilities is of the utmost importance. Whether you patronise them as a patient, go there daily as a staff, or visit a sick acquaintance, the last thing that you hope for is a drab-looking building. The building envelope should be as pleasant and welcoming as possible, so as to make the experience of staying, working or visiting the building as agreeable as possible.

“This, of course, depends largely on the architectural design, combined with the technical know-how of the

Figure 1. RWS EFTE canopy

“ The solutions devised by technical teams need to constitute not only a translation of the architectural vision for the buildings, but also the synthesis of the multitude of requirements by the various stakeholders. ”


29 | FAÇADES

specialist design team,” explained Meur. “The right colour scheme and material selection can uplift the appearance of the building at minimal or no additional expense as compared with traditional unappealing solutions. This is particularly noticeable on hospital façade refurbishment projects, which can be completely transformed visually through a simple and clean re-cladding exercise.”

INTERNAL ENVIRONMENTAir infiltration is another key consideration when designing healthcare facilities, as some of these buildings impose much stricter air infiltration or exfiltration limits as compared to other building types.

This could be due to the need to prevent harmful bacteria affecting patients, or conversely to prevent infectious diseases from spreading to the outside. Designs are thoroughly tested, both on- and off-site, to ensure that the design parameters are met.

In one recent hospital project, the brief called for naturally ventilated wards, but a façade solution which should still keep rainwater out. Given the additional requirement for ample natural daylight, the developed design involved staggered, overlapping glass louvers, with open gaps between the glass blades (Figure 3). This allowed for cross-ventilation while keeping the rain out. Alternate glass blades were operable so as to reduce or close the gaps

between them in case of major rainstorm. This can happen automatically using rain sensors, or can be operated manually whenever required.

SECURITY & OPERATIONAL NEEDSIn many countries, healthcare facilities also represent essential premises that need to be designed to remain operational in the face of disasters.

In particular, we have had to design hospital façades to resist terrorist threats, such as improvised explosive devices (IEDs). This involves the implementation of hardening measures in and around the buildings, including the building envelope itself.

“The solutions devised by technical teams need to constitute not only a translation of the architectural vision for the buildings, but also the synthesis of the multitude of requirements by the various stakeholders,” concluded Meur.

“The building envelope is designed so that patients enjoy a peaceful and pleasant environment favourable to their recovery. And at the same time, the hospitals themselves garner a welcoming and attractive, yet highly efficient outcome.”

Figure 2. Yishun section


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Shaping_Issue 14_Healthcare