Hospital uses power of architecture to promote healing

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Gerry Latham has worked in a lot of hospitals in her 40 years as a nurse and administrator.

She has seen the strain that old hospital buildings put on nurses, who spend too much of their time walking from one supply room to another, and on patients, whose already frail health is tested by living in rooms with one to three other patients, by the noise of the hospital, by infections.

She has also seen the excitement of being in a new hospital fade, as people quickly realize the new building is shinier but it doesn't work much better.

So when the $44-million, architecturally stunning addition to St. Mary's Hospital in Sechelt, B.C., opened in March – an addition that its designers say will make it the greenest hospital in Canada – she waited to see whether it would really make a difference.

Cautiously, Ms. Latham, the hospital's interim operational director, says it looks as though it did. "After one night, patients are sleeping like we've never seen before," says Ms. Latham, emphasizing that so far it's all just observations with no quantified data.

One doctor said he believes his patients are healing faster. Nurses are noticing that patients, who now have private bathrooms, don't need as much medication to help with bowel problems. Nurses and doctors are spending less time walking back and forth to nursing stations, computers and supply rooms because of the way the hospital has been designed.

And, Ms. Latham says, "personally I do notice the quietness of the hospital, the natural light, the non-cluttered rooms, the spaciousness. Would I say our staff are in a better place? Absolutely."

Experiments in hospital design are not unusual in North America, as the never-ending demand for new health-care facilities fuses with the green movement in architecture.

But St. Mary's has achieved an unusually high level of innovation, due to a combination of factors: a willingness to experiment from the hospital side, a provincial requirement to build to a high environmental standard, and a push-the-boundaries architectural team.

One part of the team was Tye Farrow, whose Toronto firm Farrow Partnership Architects, has designed hospitals everywhere from Truro, N.S., to Mississauga and Thunder Bay in Ontario, with another B.C. project on the books in Mission.

The other was Kirsten Reite, who oversees health-care projects at the B.C. firm Perkins + Will, which is known for its advanced work on green-building design.

"Most hospitals are big square boxes. In this one, 75 per cent of the spaces have natural daylight," says Ms. Reite, whose firm includes an engineer who has researched Scandinavian hospitals. "The biggest impact on people in hospitals is the natural daylight."

The design also includes windows that can be opened – almost unheard of since infection-wary hospital designers of the 19th century decided to seal everything – a geothermal field, green roofs and an energy bill that's a third of the old, smaller hospital.

But, just as important, the building was also designed to promote maximum health and happiness for both patients and staff.

That started with hospital managers, who, Ms. Reite says, "wanted to push the limit" at St. Mary's. They wanted individual rooms for patients, an efficient workspace for staff, and a high environmental standard. To do that, they were willing to bend the normal Canadian Standards Association rules for hospital construction, a route that larger hospital projects often avoid.

That made it easier for the design team.

Mr. Farrow, who has a near missionary faith in the power of architecture to promote health, said he often starts out planning hospitals with administrators who don't know much more than that they want a new, modern box.

He often has to take them through an education process to see how investing in better design and an environmental approach pays off in health outcomes.

Not in this case, though, where the province requires all new government-funded buildings to be built to the gold level of Leadership in Energy and Environmental Design – or LEED – certification system. Or where the hospital planners themselves wanted a design that cut down on unnecessary walking by staff.

At St. Mary's, Mr. Farrow's team created a full-scale replica of various work spaces with large Styrofoam blocks to help staff show them whether a design was workable and efficient. The team also made windows and light a priority.

"The quality of daylight and views makes people feel better. When you have a long view out, it creates a meditative moment. You take a breath, look up," Mr. Farrow said on a recent visit to the West Coast to view the hospitals in Sechelt and Mission.

They also talked to the Sechelt Indian Band, which had donated the land for the hospital, about what elements of native tradition to incorporate.

"They have a tradition of bent[wood] boxes in cedar, which held the most precious things. I thought, 'Why don't we begin to use that.'"

It's unusual for hospitals to use exposed wood – unsafe, is the fear – but St. Mary's hospital directors were willing and Mr. Farrow has a history of using wood in other hospitals. He's been able to prove to the satisfaction of Canadian regulatory authorities that wood can be protected during a fire without using sprinklers, which typically mean that wood gets so wet that mould develops. Instead, he installs a fog-producing system that, in the case of a fire, chills wood to the point where it won't burn.

As a result, the building incorporates a lot of visible wood, and many of the architectural lines inside and out are curved to suggest the boxes of Sechelt tradition. All of that makes St. Mary's feel much less like a hospital, which is what Mr. Farrow was aiming for all along.

"It's an intangible that has tangible impacts. Most people in the health-care field or the sciences focus on the tangible things. But health care is a very emotional and human thing."

St. Mary's facts

The expansion of St. Mary's, a community hospital on B.C.'s Sunshine Coast, was planned with the goal of offering the latest in green design.

– The project includes 125 boreholes into the ground, each 76 metres deep, which provide a source of zero-carbon geo-thermal energy for heating and cooling the building. A high-performance building envelope minimizes energy loss.

– The project targets LEED Gold certification. The interior was designed using LEAN space-planning principles to ensure efficient department and room design.

– The project also accommodates two new floors of single-patient rooms – which means more privacy and a reduced risk of hospital-acquired infections. Acute-care beds have been increased to 63 from 41.

– Patient rooms have large windows that maximize natural daylight and spectacular views of the Strait of Georgia.

– The 5,400-square-metre addition, which doubles the size of the hospital, includes new and larger emergency and radiology departments, intensive care rooms and a new labour and delivery unit.