hospital case study architecture

Stanford Hospital: A Case Study

Palo alto, ca.

Bridging human-centered design and technological innovation, the Stanford Hospital sets a new standard for patient care. Along with executive architect Rafael Viñoly Architects, healthcare architect Perkins Eastman envisioned a biophilic and hospitality-infused building that facilitates connection, effective treatment, and healing. With a modular, resilient design that allows for flexibility and future expansion, the building can be adapted to accommodate the evolving needs of the Stanford community and is capable of withstanding a 500-year seismic event.

Project Facts

Sustainability :.

• The HDC 10: Perkins Eastman, noting Stanford Hospital among the firm's distinguishing healthcare projects
• U.S. News & World Report ranked Stanford Health-Care-Stanford Hospital No. 12 in “America’s Best Hospitals: the 2021-22 Honor Roll and Overview”
• Newsweek and Statista Inc. ranked Stanford Hospital No. 13 in their third annual World’s Best Hospitals 2021 ranking
• Landscape Architecture Magazine features Stanford Hospital in an 18-page spread titled "The Best Medicine."
• “Ready for the Big One” – Building Design + Construction
• “US News & World Report’s Best Hospitals 2020-21 Honor Roll” – Becker’s Hospital Review
• “With Hotel-Like Amenities, the New Stanford Hospital Streamlines Patient Experience” – Metropolis
• “Game Changers 2020: The Practices and People Changing Design” – Metropolis
• “New Stanford Hospital in Palo Alto, California Opens Doors” – Hospital Management
• “Stanford Health Care Dedicates New Stanford Hospital” – Facility Executive
• “New Stanford Hospital Sits on ‘Roller Skates’ as Part of Earthquake Safety” – Silicon Valley Business Journal
• “Stanford Health Care Dedicates New Stanford Hospital with Ribbon Cutting Ceremony” – Business Insider
• Best Project: Health Care, Regional Best Projects, ENR California (2020)
• Finalist, Design Showcase, Healthcare Design (2020)

“This building represents a whole new approach to health care, not just in design but in the patient experience.” – Amir Dan Rubin, President and CEO of Stanford Health Care

Conceived of through a collaborative process with Stanford Health Care and the design team, the hospital’s inventive plan mimics a patient’s journey. Four levels, centered on the themes of connect, treat, heal, and care stack vertically and emphasizes overall wellness. An inviting sunlit atrium welcomes patients and caregivers, seamlessly connecting them to advanced treatment areas on the second floor. The third floor’s 40,000 square foot garden, designed with drought-resistant plants and sustainable systems, is the beating heart of the hospital. Integrating nature with nurture, its landscaped terraces are a lush regenerative oasis that promote rest and recovery. Upper level care pavilions comprised of 368 private rooms and ICUs, as well as staff and communal spaces, offer state-of-the-art accommodations for healing and visitation. Stimulating emotional well-being, more than 400 works of art grace the public areas throughout the hospital.

The team set out to reimagine what a hospital room could be with an understanding of how design can directly impact the healing process. In stark contrast to traditional hospitals, each private room features a 14-foot-wide window where patients can gaze out on tranquil views of the Stanford campus and foothills of the Santa Cruz mountains from the comfort of a bed that is set away from the bustling hallways. Large television screens connect patients and family members with health records, service requests, and entertainment options. Loved ones are also encouraged to spend time with patients in recovery, enjoying the privacy and comfort of flexible sleeper sofas and storage space for their belongings. Nurses and doctors have access to a vestibule with a sink, counter, and curtain where they can perform their duties effectively while minimizing disruptions.

Designed to accommodate future interdisciplinary innovations through complex health care technology, Stanford Hospital fosters advancements in medical science at the nexus of Silicon Valley and Stanford University academics. It also embodies advancements in building science and resilience, featuring a highly specialized seismic base isolation system. Built to survive an 8.0 earthquake, the facility can function for the first 96 hours after a significant seismic event, going above and beyond California code requirements. A community-centered institution, Stanford Hospital also has a 900-vehicle garage designed to transform into a triage center during a natural disaster or contagious disease outbreak.

“We used to design for the convenience of physicians and nurses. Today, with the industry’s awareness of the critical link between a patient’s well-being and medical results, Stanford wanted to prioritize the patient-centric experience.” – Erich Burkhart, FAIA, Principal-in-Charge

15 Examples of World’s Most Impressive Hospital Architecture

When you think of hospitals, what comes to mind? For many, the first instinct is to think of rectangular buildings , bright white lights, and a sterile and cold environment – a place one visits begrudgingly. Nobody is ever overjoyed at the prospect of visiting a hospital, a place associated with discomfort and illness. However, research has shown that patient-centric design is critical to a positive experience for visitors and employees. Today, architects all over the world are deep-diving into redefining the hospital architecture, and how they can become spaces of healing and rejuvenation , and reduce the negative experiences and stress that come with visiting a hospital. 

Below are 15 such international hospital architecture that are changing how we experience healthcare facilities. 

1. The Zayed Centre for Research into Rare Disease in Children , United Kingdom (2019) | Hospital Architecture

This research center, designed by Stanton Williams, is the world’s first purpose-built center dedicated to pediatric research into rare diseases, that provides research workspace , laboratories, and outpatient clinics for young people. The building design celebrates the often hidden, yet important, work of clinicians through the transparent façade of glazing and terracotta fins, that allows visual interaction between inside and outside. 

The interiors are designed with concrete and European Oak that make for a ‘non-clinical’ atmosphere, while the interior planning and natural light from the glass ceiling and façade create a sense of openness and calm for the patients and their families. 

2. New Lady Cilento Children’s Hospital , Australia (2014) 

Designed by Lyons and Conrad Gargett , this 12-level specialist pediatric teaching hospital is designed using a ‘salutogenic’ approach – which incorporates design strategies that directly support patient wellbeing. The planning is based on the concept of a ‘living tree’.  

A network of double-height spaces or ‘branches’ radiates from two atria ‘trunks’, which then extend to frame portals with views towards the city. Green spaces are also part of the healing environment. The brightly colored exterior of green and purple fins is inspired by native Bougainvillea plantings in the nearby parklands. 

3. Bendigo Hospital , Australia (2017) | Hospital Architecture

Designed by Silver Thomas Hanley and Bates Smart, this hospital is the largest regional hospital development in Victoria. The building design is inspired by the vernacular architecture and the natural environment of the surrounding communities and aims to promote patient and staff wellbeing. 

Nature plays a large part in this mission and is integrated into the project through the medium of landscaped gardens, courtyards, green roofs, and balconies to create a tranquil internal environment. The use of timber provides warmth to the interiors, unlike the sterile, cold spaces of a regular hospital. 

A woven timber ceiling provides dappled sunlight in the interiors , and the building façade of reflective glass and concrete panels provides views to the outside while bringing in large amounts of sunlight. 

4. The Gandel Wing, Cabrini Malvern Hospital , Australia (2019)

This 7-story addition to the Cabrini Malvern Hospital is built with a design approach of improving the patient wellbeing and experience. The external façade of natural slatted terracotta provides the patients with clear views of nature outside, maintains privacy from the nearby residential buildings, brings in soft natural light, and also visually connects the new wing to the surrounding masonry buildings. 

The combination of the material palette of wood and white on the interiors, and ambient natural and artificial lighting allows for a peaceful environment within the hospital. 

5. Haraldsplass Hospital , Norway (2018) | Hospital Architecture

The new wing for the Hospital, designed by C. F. M ø ller Architects, lies between the Ulriken mountain and M ø llendalselven River. The façade of oak cladding in white fiber concrete visually connects the hospital to the surrounding buildings and also creates a welcoming entrance for visitors. 

As opposed to the traditional design of hospitals, where long corridors are the main method of getting around, this hospital has no long corridors. Instead, the wards are distributed around two large atriums that also bring in ample daylight.

6. Adamant Hospital , France (2019)

Designed by Seine Design, this psychiatric hospital is docked by the river and consists of spaces like therapy workshops and staff offices. Regular weather conditions like rain, sun, or wind translate into interesting experiences in the hospital – like the interplay of shadow and light from the shutters or the rocking of the building itself. 

The movable wooden shutters control the daylighting and provide strong visual connectivity to the river and surroundings, which results in a comfortable and peaceful internal environment for the patients. 

7. Rigshospitalet Hospital North Wing , Denmark (2020) | Hospital Architecture

Designed by 3XN and LINK Arkitektur, the North Wing is a 7-floor extension to the Hospital. The building is designed as a series of folded V- structures connected by a main ‘artery’ route, the design of which is inspired by the cardiogram graph lines. 

Patient well-being is central to the design – the glass façade and ceiling bring in large amounts of daylight, a variety of artwork adds color and vibrancy to the interiors, the green surroundings create a peaceful environment for the patients, and the façade of light stone and glass provide a welcoming appearance to the public.

8. Umeda Hospital , Japan (2015) 

Kengo Kuma & Associates , who was responsible for the existing maternity and pediatric hospital, returned to design the addition as well. The 4-story front of the hospital was replaced with a 5-story L-shaped addition. The 5-story steel-clad structure is fronted by a 1-story wood-clad main entrance. The 1-story storefront’s exterior – with wood louvers and trapezoid sloping steel roof that extends over the sidewalk creates a welcoming and pedestrian-friendly entrance. 

The interiors use cedarwood in the flooring, walls, and ceiling to create a warm and comfortable environment for the patients. The signages are printed on cloth that covers posts, which add to the softness of the interiors. 

9. EKH Children Hospital , Thailand (2019) 

Integrated Field has designed this hospital to ease the discomfort that children feel when going to the hospital. The hospital façade consists of pastel-colored metal screens with perforations in the form of animal shapes. 

The architects have used various elements to create a friendly environment for the children – pastel-colored spaces, indirect and soft lighting, curved forms used as the design language in doorways, furniture , and windows, playgrounds in the waiting rooms, a giant slide in the middle of the entrance hall – also visible from the glass external façade, and animal-themed patient rooms – all to make the kids’ visit to the hospital an enjoyable experience.   

10. General Hospital of Niger , Niger (2016) | Hospital Architecture

Designed by CITIC Architectural Design Institute (CADI), this large-scale public hospital is designed to withstand the extreme weather conditions of Niger, whose 80% land area is covered by the Sahara Desert. The local economy, culture, and environment have also influenced the design to make it low cost, good quality, and durable. 

‘Halls’ or buildings separated by department or functionality, interlock and form courtyards , and are connected by covered passages and walkways. Elements like small windows in external walls, shading panels, and ‘jali’ walls provide sun protection. Thermal insulating layers made of prefab concrete panels in the roof reduce heat transmission. 

‘Tyrol’ style exterior wall – which is the local traditional construction method – is used on the wall surfaces for durability and easy maintenance. Worship halls that double as waiting spaces are scattered across the hospital, as Islam is the dominant religion here.

11. Pars Hospital , Iran (2016) | Hospital Architecture

New Wave Architecture’s aim was to change the perception of healthcare architecture in Iran, and alleviate negative emotions like stress and anxiety that patients and employees typically experience due to the cold and clinical architectural design of existing hospitals. They designed various blocks connected by atriums and porches that created public-private spaces, allowed ample light in, and created visually interactive spaces throughout the hospital. 

Careful attention was given to the interiors – colorful walls and flooring, comfortable furniture, indoor plants, and brightly lit spaces are all meant to create a soothing environment. The dynamic double-skin façade of travertine and glass creates a lively, hopeful, and inviting appearance for visitors. 

12. Teletón Infant Oncology Clinic , Mexico (2013)

Designed by Sordo Madaleno Arquitectos, this hospital was developed to support children with cancer. The site itself, with its undulated topography , provides extensive views of the city. The building consists of nine conjoint volumes, made up of a series of columns, organized in a circular manner. 

Each volume is differentiated by color and inclination angle. The form is derived from the concept of cell regeneration, where each volume is a ‘cell’ forming a chain of cells. The façade informs the interiors, where each volume serves a different department and purpose. 

The colorful columns allow for column-free interiors, reduce excess solar gain, and create a dynamic, playful, and colorful façade that is visually pleasing for children. The colorful interiors and choice of furniture resemble a play school rather than a hospital, which puts the children at ease.

13. The New Hospital Tower Rush University Medical Center , USA (2012) 

Designed by Perkins and Will, the hospital consists of a rectangular 6-story base, connected to an existing treatment facility, which houses diagnostic and treatment facilities topped by a 6-story curvilinear bed tower. The geometry, while unusual, is in response to the site conditions, and maximizes views and natural light for patients, while also creating an efficient and effective layout. 

Nurse stations located along the core of the star-shaped tower encourage quick access of the staff to patients. Facilities like a roof garden with sculptural skylights, and lounge areas for staff and patients creates a comfortable environment for all visitors. 

14. Buerger Center for Advanced Pediatric Care , USA (2015) 

Pelli Clarke Pelli Architects’ designed Buerger Center is the first healthcare building of the Children’s Hospital of Philadelphi a’s new South Campus. It consists of a 12-story building with a 6-story wing, both consisting of stacked floors with a rippled façade, but the building is rippled on one side to create playful lobbies, and rectilinear on the other where clinics are located. 

The façade comprises glazing and primary colors – which is attractive and uplifting for children and their families. Some great features to help reduce the stress for patients are – an interior material palette of warm wood and bright colors, curved forms, learn and play waiting areas, medicinal gardens, a rooftop garden for rehabilitation and play, and a landscaped plaza. 

15. Christ Hospital Joint and Spine Center , USA (2015) | Hospital Architecture

Designed by SOM, this 7-story orthopedic care facility is a modern addition to the Christ Hospital’s Cincinnati medical campus. SOM worked closely with patients, medical professionals, and hospital staff while designing the hospital, resulting in a space that supports the healing process of patients. 

Spaces are designed keeping patient comfort in mind – floor to ceiling glazing brings in plentiful daylight, rooms have a residential character with sufficient storage, and flexible seating for visitors and family is provided. Decentralized nursing servers placed next to patient rooms disperse activity across the patient floors. 

Breakout spaces and outdoor green spaces provide respite to visitors, patients, and staff. The exterior façade of red brick and limestone is a nod to the vernacular architecture of the neighborhood. 

Vidhi Agarwal is a practicing architect and designer, striving to be a better person and architect every day. She loves reading fiction, exploring new cities, finding the next best spot for brunch, and drinking coffee. For her, architecture is about resilience and optimism, capable of limitless positive change.

Elenberg Fraser Office by Elenberg Fraser

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Kuwait Children’s Hospital On the Way to Becoming the World’s Largest Children’s Hospital

Kuwait City, Kuwait

The Challenge

To design the largest children’s hospital in the world, of significance to national, regional and global health care precedence. It is the first consolidated pediatric care model in the Middle East, designed experientially, through variance in scale.

The Design Solution

HKS architects proposed a crystalline design connecting the historic traditions of science, healing, and the life-supporting nature of water. The podium’s solid masonry shell wraps the precious treatment functions it protects. The healing tower rises above with a glimmering façade of facetted metals and glass, reflecting and filtering light through a layered shade screen.

Building surface materials—masonry, metal, and glass—and their treatments respond to the harsh environmental conditions of the desert. Penetrations in the skin allow windows and ventilation points, each derived from the triangular crystal form of the overall concept.

Inpatient rooms are located on both east and west faces of the Ward Tower. They are accessed from the rest of the hospital by central vertical circulation cores which handle and separate patient, visitor, staff, and service access. Each bedroom, thanks to its non-orthogonal geometry, has a directed view to the sea and they can accommodate two family members to stay overnight with the patient.

Public areas include a 375m-long (1,240 feet) enclosed atrium, 30m in height. The atrium is conceived as an underwater scene of larger-than-life sea creatures that become ambassadors for the patient journey. “The Great Sea Adventure” tells the story of the local Kuwaiti marine ecology and an oceanic heritage.

Illuminated fish suspend from the ceiling, occupiable turtles sit upon puppet-like stilts and are accessed from the upper floors across bridges. A blue whale hosts a sibling play area and gaming theatre while a shark contains one of two public cafes.

The atrium was designed not as a health care environment, but akin to a civically-scaled entertainment complex intended for community engagement, positive distraction, and national pride.

The Design Impact

Kuwait Children’s Hospital is positioned to be the largest children’s hospital in the world at 595,000 square meters (6.4 million square feet) and was delivered with a forward-thinking design that incorporates state-of-the-art technology and energy conservation. The 120,774 square meter (1.3 million square foot) site sits by the sea in the Sabah Health Region of Kuwait City.

Project Features

• 595,000 square meters (6.4 million sf)
• 12 Hectares (29.6 acres)
• 11,000+ rooms
• 48-bed NICU
• Eight MRIs + one Hybrid MRI
• Six CT scanners + one Hybrid CT
• 19 X-ray rooms
• 30 Operating Theatres
• Dedicated Cancer care inpatient wing
• Trauma centre with dedicated helipad and high-speed lift connection to OT floor
• Extensive roof gardens incorporating food and entertainment venues with rehabilitation zones and therapy gardens for mental health
• 2017 Finalist in Future Project of the Year: Health Category (World Architecture Festival)
• 2017 Award of Excellence (AIA Orlando Chapter)

Explore Further

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Mexico City

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Designing Cancer Care Facilities of the Future

Children’s Hospital of Richmond at VCU Children’s Pavilion

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Building for Change: Comparative Case Study of Hospital Architecture

Nirit putievsky pilosof.

1 Faculty of Architecture and Town Planning, Technion–Israel Institute of Technology, Haifa, Israel

This study assesses how architectural design strategies impact the flexibility of hospitals to change over time.

Background:

Most hospitals are designed for highly specialized medical functions, which is often in conflict with the need to design the hospital facility to accommodate evolvement and change of functions over time. Architectural design strategies provide different approaches to the need to design for a specific medical program while planning for its future change.

The study compares two hospital buildings with a very similar configuration and medical program but with significantly different architectural design strategies: One was designed for an unknown future medical function, and the second was designed for a specific medical function. The study analyses the two hospital buildings by their design strategy, planning, design process, and construction by phases and compares their change in practice over the last twelve years.

The design strategy to fit a specific function limited the hospital affordance to make changes during the design process, construction, and occupancy phases. Systematic design of system separation for an unknown function, in contradiction to a “tailor-made” approach in the design for a specific function, was found to support a variety of changing medical programs.

Conclusions:

Architectural design strategies developed in an early stage of the design process has a major impact on the future evolution of the hospital facility. The different results between the two projects also demonstrate the greater influence of healthcare policies, hospital organization culture, and infrastructure funding models on the architecture and flexibility of hospitals.

Most hospitals are designed for highly specialized medical functions. This purpose may conflict with the need to design the hospital facility to evolve and change functions over time ( Kendall, 2008 ). While many buildings are currently designed to be loose fit, such as residential, offices, or commercial buildings ( Lifschutz, 2017 ), hospitals need to be designed to optimally fit a specific function and still be designed as loosely as possible to accommodate future functional changes. This challenge raises important questions: Can hospital design meet both our current needs and future demands? What is the optimal design? Is it a design that fits a specific function or one that supports future change of function?

…hospitals need to be designed to optimally fit a specific function and still be designed as loosely as possible to accommodate future functional changes

Hospital design for a specific medical function is often based on the current known needs of the hospital specified in the projects’ brief. The functional goal, usually a result of a participatory design process of the design team with the local medical team and management, often drives hospitals’ design processes and serves as the main criteria to evaluate the design success. Hospital flexibility to support future change of function is also an important design goal, considered to be more critical in hospitals than in most other types of buildings since the frequency and degree of change are both greater. Accordingly, flexibility is often a requirement to be built into the hospital plan to anticipate the growth and changes of the facility.

The unprecedented rate of medical, technological, and social change has led to the development of different healthcare architectural approaches to design for a specific medical program while planning for its future change ( Preiser et al., 2018 ). In his book A Pattern Language , Christopher Alexander questioned if it is possible to create a space specifically tuned to the needs of people and yet capable of an infinite number of various arrangements and combinations within it ( Alexander, 1977 ). Brand suggested developing scenario planning instead of programming. He explained that like programming, scenario planning is a future-oriented formal process of analysis and decision. Unlike programming, it reaches into the deeper future and instead of converging on a single path, its whole essence is divergence. The building is treated as a strategy rather than just a plan ( Brand, 1994 ). Cole explained that strategic planning of new healthcare facilities needs to address two planning horizons: specific planning requirements for short to midterm based on statistical analysis and emerging models of care, and generic planning requirements for the mid- to longer term based on much less firm knowledge and a more global hypothesis ( Cloe, 2006 ). The Clinic 20XX series studies by HKS Center for Advanced Design Research and Evaluation (CADRE) defined four spatial attributes of flexibility: versatility, modifiability, convertibility, and scalability, to allow hospitals to plan operational strategies against specific spatial modifications over the building’s life cycle ( CADRE, 2019 ).

A more extreme approach by Llewelyn-Davies and Weeks declared that functions change so rapidly that designers should no longer aim for an optimum fit between building and function. The real requirement is to design a building that will allow change of function ( James et al., 1986 ). Zeidler declared that the concept of “form follows function” does not meet the modern-day requirements of a hospital, and therefore, the true gestalt of a hospital lies in the acceptance of the unpredictability of future needs ( Zeidler, 1974 ). Kendall also argued that the functionalist approach to facility design is obsolete. While this way of thinking has been the norm, we can no longer assume that if we determine a program of uses and design a hospital to suit, its future functionality is assured. The opposite is more often true; building designed according to the functionalist paradigm performs poorly, while those designed to accommodate varying functions gain value over time ( Kendall, 2011 ). The open building theory, developed as a response to the rigidity of a “whole” design solution, a departure from the conventional functionalist thinking and architectural management practices, recognizes the different life spans and decision-making processes related to the built environment and proposes a method of system separation between what is relatively stable and what is relatively changeable ( Habraken, 1972 ).

While many studies have investigated the topic of hospital flexibility, only a few have assessed how architectural design strategies—design for an unknown function versus design for a specific function—impact the flexibility of hospitals to change over time. This study explores and compares the two design strategies in the context of two hospital buildings in Israel: The Sammy Ofer Heart Center at the Tel Aviv Sourasky Medical Center (Hospital Building 1), and The Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus in Haifa (Hospital Building 2). The study was based on primary data collected from the hospital and the architecture firms, including architectural drawings, programming documents, and reports. The design and construction process were analyzed based on unstructured expert interviews, including hospital management, chief architects, project managers, and consultants. Survey information was also obtained by site visits and observations of the building’s construction and performance-during-use from 2006 to 2018. A systematic analysis of the documents and interviews revealed a framework of five main categories for comparison: (1) design strategy, (2) planning, (3) design process, (4) construction by phases, and (5) change in practice. The comparison of the hospitals by these categories in the discussion leads to conclusions regarding the impact of the design on the functionality and flexibility of the buildings to change and evolve.

Comparative Case Studies

Hospital building 1 and hospital building 2 have a very similar typology, program, and vision. Both buildings were constructed in 2010–2018 in Israel by local architecture firms ( Table 1 ). They have a similar architectural configuration, scale, and style ( Figures 1 and ​ and2). 2 ). Both hospitals accommodate similar medical programs of oncology and cardiovascular care ( Table 2 ) and provide service as part of the Israeli health system, dealing with similar challenges of health policies and demands. Both projects were designed by a multidisciplinary team and were realized through private donations of funds raised by the hospital. The two projects had a long design process and were constructed in phases, supported by a method of system separation ( Figure 3 ). Despite these similarities, they significantly differ in their design strategy for functional change. Hospital building 1 was designed to provide flexibility to change medical programs, and hospital building 2 was designed to fit a specific medical program.

Architectural images of the hospital buildings. [1] The Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center and [2] the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus.

Architectural plans illustrating the division to two medical units per floor. [1] The Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center and [2] the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus.

Comparison of the Hospital Buildings Architectural Data.

[1] The Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center and [2] the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus.

Comparison of the Hospital Buildings Current Program.

Note . [1] The Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center and [2] the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus.

Diagram of the structure and MEP shafts in the hospital buildings. [1] The Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center, and [2] the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus.

Hospital building 1 was designed to provide flexibility to change medical programs, and hospital building 2 was designed to fit a specific medical program

Hospital building 1, The Sammy Ofer Heart Center at Tel Aviv Sourasky Medical Center, designed by Sharon Architects and Ranni Ziss Architects, opened in 2011. The building, located in the center of Tel Aviv, was designed as a monolithic cube clad in glass with prominent red recessed balconies ( Figure 1 ). The building was designed to connect to an adjacent, historical “Bauhaus” hospital building through an atrium. The building consists of 38,000 m 2 (409,000 ft 2 ) and includes twelve medical floors of 3,100 m 2 (33,300 ft 2 ) per floor and three underground parking floors designed with the possibility of conversion to an emergency 650-bed hospital. The 15,000 m 2 (161,400 ft 2 ) underground “sheltered” floors were designed to be resistant to chemical and biological warfare. The construction of the building was made possible through the donation of the Sammy Ofer family to the Tel Aviv Sourasky Medical Center in 2005. The private donation supported the construction of the buildings’ base and envelope and the fit-out of the cardiology center on floors 0–2. The other medical units that were completed in the shell floors 3–9, after the building opened in 2011, including the oncology division, were made possible through additional donations made to the hospital by private donors ( Figure 4 ).

Diagram of the construction phases, including the medical units on each floor and wing, location of fortifies units, and a schematic diagram of conceptual horizontal division of medical program in the Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center (Hospital Building 1).

Hospital building 2, The Joseph Fishman Oncology Hospital and the Eyal Ofer heart Hospital at Rambam Health Care Campus in Haifa, was designed by Mochly-Eldar Architects. The building was designed as a cluster of two connected structures, while in fact, it is one structure with two separate medical centers ( Figure 1 ). The two centers, divided vertically, were designed and constructed in separate phases. The Oncology Center was opened in 2016, and the Heart Center was still under construction in 2019. The building consists of 24,000 m 2 (258,300 ft 2 ) and includes nine medical floors of 2,500 m 2 (26,900 ft 2 ) per floor and three underground floors with four linear accelerators for radiation therapy, part of the hospital underground fortified emergency 2,000-bed hospital. The construction of the building was made possible through two significant donations. The first donation of Joseph Fishman and his family supported the construction of the oncology center. To maximize the donation, the hospital decided to construct the complete base building including both south and north wings, in addition to the construction of the envelope and interior of the oncology center on the south wing. The donation of Eyal Ofer and his family, years later, supported the realization of the cardiovascular center on the north wing of the building, including its exterior façade and interior units ( Figure 4 ). The hospital continues to seek additional funds to finance the completion of all the medical units and to purchase new equipment. For example, two floors of radiotherapy were completed by additional fundraising in 2016, after the oncology center had already opened.

Design Strategy

The main objective of the Sourasky Tel Aviv Medical Center in the design of the hospital building 1 was to construct the largest structure possible to enlarge the hospital-built area for future development. The hospital management decided to maximize the building area and height by applying pressure on the municipality planning guideline limitations. This objective led to a design strategy aimed to build a “container with capacity” for future infill of unknown medical programs. As a result, the building was designed as a base and envelope with seven shell floors for future fit-out completion, implementing a method of system separation between what is relatively stable and what is relatively changeable.

The design strategy of the Rambam Health Care Campus in the design of hospital building 2 evolved from the west campus development plan that specified the possibility to build only one building on the hospital site. The hospital’s immediate need to develop two new medical centers—one for cancer and one for heart treatment—led to the decision to locate both of them in the same building. The vertical division of the building was an attempt to create an image of two separate buildings to attract different donors to finance the project. The administration management explained that most donors want their names on a tower in honor of their donation. Consequently, the management even insisted on creating two separate entrances, but the architect managed to convince them otherwise due to lack of space and designed one main entrance leading into two different lobbies with separate circulation systems ( Brumberg, 2015 ).

Hospital building 1 was initially planned to accommodate a cardiology division. The hospital management decided to relocate all the hospital cardiac units, clinics, and surgery units to one central location. The cardiac program occupied less than 30% of the building on three main floors, leaving seven floors for future programming and planning ( Table 2 , Figure 4 ).

The two centers in hospital building 2 were planned separately in different periods of the project. The oncology center was designed to offer comprehensive cancer treatments, including linear accelerated chemotherapy, radiotherapy, and brachytherapy, complementary medicine, and outreach programs for prevention and early detection of cancer. The heart center was programmed to consolidate all cardiovascular diagnoses, treatments, research, and disease risk-reduction programs, including cardiac and vascular surgery, interventional cardiology, electrophysiology, advanced cardiovascular imaging, and cardiac intensive care ( Table 2 , Figure 5 ). The main concept of planning was to create two central divisions to implement integrated medical care models and to enhance patient-centered care.

Diagram of the construction phases, including the medical units on each floor and wing, location of fortifies units, and a schematic diagram of conceptual vertical division of medical program in the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus (Hospital Building 2).

The architectural image of the two buildings represents their design strategy. The monolithic cube in the hospital building 1 was planned to enable changing functions by not revealing the interior use. The conscious decision to complete the exterior glass facade at an early phase while the interior was still under construction reflects the motivation to create an illusion of a complete “whole building.” The cluster of the buildings in hospital building 2, on the contrary, was planned to emphasize the functional separation of the two medical centers as two complete buildings, and their exterior was designed to distinguish certain functional floors, such as the top floor of the oncology center that was planned for research labs. The floor program later changed to an additional outpatient clinic, but the exterior accentuated design remained.

Design Process

The design process of hospital building 1, which began in 2005, reflected a variety of concepts to deal with the unknown future medical function, tight budgetary, regulatory, and environmental constraints. The design team used a method of developing design options and capacity studies to support decision making by the hospital management. The long design process of over 12 years involved many different professionals and decision makers. Many of the hospital medical managers were replaced, resulting in a reconsideration of the design and requests for alternative design options. The development of the project by phases, using system separation, allowed the architects to divide the workload between the two collaborative offices and to control the development of the project by different design teams, project managers, and consultants.

The conceptual division of hospital building 2 led to two separate design processes for the specific functional program of the oncology center, and years later, for the cardiovascular center. The two design teams, which included different architects, hospital managers, and consultants, worked in different periods and schedules. The design process took over eight years and dealt with many limitations and constraints. The underground sheltered hospital that was constructed five years earlier restricted the design of the structure, the location of the core, columns, and shafts. Also, the decision to build the complete base building at an early phase, years before there was even a program for the cardiology center on the north wing, challenged the team to decide where to locate the cardiac units that needed to be fortified according to the Israeli civil defense unit. This decision had massive implications on the design of the base building and the cardiovascular center. Previous research also demonstrated that fortified structures restrict the units’ future potential to expand, change function, or move to other locations ( Pilosof, 2018 ).

Construction by Phases

Hospital building 1 was constructed in five main phases: (1) the underground emergency hospital, (2) base building and envelope of Floors 1–10 including a mechanical roof floor, (3) interior fit-out of floors 0–3, (4) interior fit-out of floors 4–6, and (5) interior fit-out of floors 7–10 ( Figure 4 ). The phasing stages, divided by the floors in the building, created a process of fit-out from the bottom upward. Although this process of deferred completion was planned, it still created a challenge for both the construction and the operation of the running units.

Hospital building 2 was also constructed in five main phases: (1) the underground emergency hospital, (2) base building including the two wings, (3) completion of the south wing including its envelope and interior fit-out of Floors 0–7 of the oncology center, (4) completion of the north wing including fortifying the structure of the third floor, construction of an additional eighth floor, and interior fit-out of floors 0–8 of the cardiovascular center ( Figure 5 ). The construction phases, divided mostly by the buildings’ wings, created a process of vertical evolution. Although this process caused fewer interruptions in the operation of the running units, it affected the image of the building. When the oncology center on the south wing opened in 2016, the north wing was still a construction site with only a concrete core structure ( Figure 1 ).

Change in Practice

Following a study of the evolutionary process of the hospital building 1 in the years 2005–2018, documenting the changes that were made to the building during the design process, construction phases, and occupancy ( Pilosof, 2018 ), this study illustrates the significant variety of medical functions in the building, including an oncology division, neurology, dermatology, internal medicine, outpatient clinics, and research labs, transforming it into a multidisciplinary medical center ( Table 2 and Figure 4 ). The seven shell floors, designed for future completion, provided an opportunity for the hospital management to relocate their oncology division and centralize the cancer treatment in one location, to enhance hospital efficiency and patient-centered care. The main change of function from a heart center to a cancer center can be explained by changing needs since cancer became the number one cause of death and statistically surpassed cardiac diseases. Also, the hospital management decided to relocate other functions to the building since their previous locations required renovation or extension or because they received funds to reconstruct a specific medical unit. The hospital also added two shell floors to the building just before construction began, which required redesigning the buildings’ primary system including the structure, Mechanical, Electrical and Plumbing (MEP) systems, and facades and caused a delay of a few months in the design and construction process.

The changes made to hospital building 2 during the design process, construction phases, and occupancy were primarily a result of the design strategy to divide the building vertically into two units. The changes included modifications in the cardiovascular program to fit into the structures’ limitations, as the base structure of the north wing was already constructed ( Table 2 and Figure 5 ). To fit the extended program of the oncology division, the hospital management decided to build an additional eighth floor on top of the existing north wing structure and to fortify the third floor to include another interventional cardiology unit. The hospital management also changed the program of the oncology center during Phase 3 to add an outpatient clinic on the seventh floor of the south wing for future needs.

The difference in the architectural design strategies—to design for unknown future medical functions versus design for specific functions—had a major impact on the planning of the buildings, their design process, phases of construction, funding models, and change over time. The approach to design for an unknown future medical functions led to the design of a monolithic cube with horizontal interior shell floors for future infill, and the approach to design for specific medical functions led to a cluster of two structures with vertical separate medical centers. Both strategies limited the building’s option to grow and expand. Their exterior form was determined in advance, leaving only shell spaces for future completion that were all occupied in a few years. Eventually, the limitations of both the buildings area demanded compromises on the building program. For example, neither hospital included the hematology department with the oncology division even though the building was programmed as a comprehensive cancer center ( Table 2 ). One of the greatest limitations of the vertical strategy at the hospital building 2, according to its architect, is the deterministic size of the units within each wing. Having two different medical programs on the same floor limited the unit’s flexibility to expand or divide the space ( Figure 6 ). The horizontal strategy, on the contrary, at the hospital building 1, enabled changes of unit sizes and forms. The larger floor area, used for the same medical function on each floor, in comparison to the division to two wings with different functions, provided flexibility of use between units and enhanced collaboration between the units’ staff ( Figure 6 ). In this regard, the only area in the hospital building 2 that connects the two wings behind the service core became a space for negotiation between the oncology and the cardiology units on the same floor, to share and use during different hours. This finding indicates how inner politics between division and medical specialties influence the design and the use of the building.

Diagram of the hospital flexibility to locate medical programs. Note . A, B,…Medical Program (Oncology/Cardiology/Other); 1, 2,…Medical Units (inpatient/outpatient/surgery/ICU/clinics). [1] The Sammy Ofer Heart Center at the Sourasky Tel Aviv Medical Center and [2] the Joseph Fishman Oncology Hospital and Eyal Ofer Heart Hospital at the Rambam Health Care Campus.

The approach to design for an unknown future medical functions led to the design of a monolithic cube with horizontal interior shell floors for future infill, and the approach to design for specific medical functions led to a cluster of two structures with vertical separate medical centers

The larger floor area, used for the same medical function on each floor, in comparison to the division to two wings with different functions, provided flexibility of use between units and enhanced collaboration between the units’ staff .

To design for an unknown future function, the design team of the hospital building 1 incorporated scenario planning by preliminary schematic capacity studies, which was found to be effective in the development of the design strategy for flexibility. The method of system separation was used in both projects, yet the reason for its implementation was different. The hospital building 2 design team used it only as a method for gaining financial support and subsequently phasing the construction and the fit-out of the two wings. This approach is evident in the unsystematic configuration of the MEP shafts that were located according to the specific needs of each unit with superposition between the floors, without consideration of future changing needs ( Figure 3 ). The hospital building 1 design team also used it as a method for phasing the project, but the primary purpose was to defer the decision on the uses of seven of its twelve floors for later consideration. The need to design shell floors for an unknown function led to the configuration of a systematic structural grid of columns and MEP shafts ( Figure 3 ). This finding is also evident in the architects’ reflections on their designs. In the vision of the architect of the hospital building 1, the building was designed to be flexible and to provide optimal space for future advances in medicine ( Sharon, 2012 ), while the architect of the hospital building 2 declared that his design was not designated for future change. He explained that the limitation of the site, the hospital requirement to design the building as two separate buildings, and the extended program demanded that they create a “tailor-made” solution.

While the strategy to design for an unknown function supported the flexibility of the building to accommodate a variety of medical programs, the strategy to design for a specific function limited the building potential to change its medical programs to only oncology and cardiovascular units. This limitation is significant since researchers predict that new technologies of personalized and precision medicine will improve cancer treatment protocols and have a substantial impact on occupancy rates of future patients. Such changes were disregarded in the program and the design of the buildings. Another missed opportunity was the option to plan for change in the connections between different medical units as new models of care are developed to treat multimorbid patients. For example, cardio-oncology is an emerging medical specialty that focuses attention on preventing heart damage caused by cancer treatments such as radiation therapy and certain chemotherapy drugs that carry a risk of hypertension and bold clots ( Herrmann et al., 2014 ). This new model of medicine is not supported by the hospitals, although they both integrate cardiology and oncology in the same building. The program and the design of the buildings focused on separating and distinguishing the two medical specialties, for economic and policy reasons, and missed an opportunity to engage a collaborative effort to advance patient care.

While the strategy to design for an unknown function supported the flexibility of the building to accommodate a variety of medical programs, the strategy to design for a specific function limited the building potential to change its medical programs

Conclusions

The study showed that architectural design strategies, developed in an early stage of the design process, have a major impact on the future evolution process of the hospital facility. The results illustrate the impact of the two architectural approaches—design for an unknown function versus design for a specific function—on the buildings’ evolvement over time, horizontally oriented evolution versus vertically oriented evolution, which defined the affordance to make changes during the design process, construction and occupancy phases. The horizontal evolution process, led by an architectural design strategy to design for unknown future function, supported the change of medical programs in the building and enhanced flexibility of use between medical units on the same floor. The vertical evolution process, led by an architectural design strategy to design for a specific function, restricted change of medical programs and limited the units’ flexibility of use and collaboration with other units located on different floors. The study also found that the size and configuration of the building floors had a major impact on the flexibility of the medical units. System separation was efficient in both projects, yet the systematic design of the structural grid of columns and MEP shafts for flexibility purposes, in contradiction to a “tailor-made” approach to locate the columns and MEP shafts according to the specific needs of the function, was found to support a variety of changing medical programs.

System separation was efficient in both projects, yet the systematic design of the structural grid of columns and MEP shafts for flexibility purposes, in contradiction to a “tailor-made” approach to locate the columns and MEP shafts according to the specific needs of the function, was found to support a variety of changing medical programs

The different results between the two projects also demonstrate the greater influence of healthcare policies, hospital organization culture, and infrastructure funding models on the architecture of hospitals. As most hospitals in Israel are in need to find immediate solutions for their inadequate infrastructures in the face of growing demands and advances in medical technology, hospital directors attempt to maximize the potential for financial support. The dependence of hospitals on private donations to initiate the design process and construction of new buildings has significant implications. The case studies showed that such policy decisions defined the design strategy of the two buildings and resulted in many limitations, not only in the planning and design of the new projects but also in the potential of the hospital to change and evolve over time. Eventually, it even affected the medical care models of the hospitals, limiting emergence of new medical fields.

The dependence of hospitals on private donations to initiate the design process and construction of new buildings has significant implications on the flexibility of the medical facilities to evolve and change over time. .

Limitations

This study compared two hospital buildings with different architectural design strategies. Further work is needed to evaluate other architectural design strategies and building typologies. The study documented changes over the last twelve years during the design process, construction, and occupancy phases of the two hospitals. While this time frame is significant, further work is needed to evaluate healthcare facilities over their full life cycle period. More studies on the economic implications of designing for an unknown function versus a specific function are needed, as well as studies on the impact of funding models, including private donations, on the hospital architecture and performance over time. Further research on healthcare facilities designed for functionality and flexibility from different environmental, cultural, and economic context will enhance the knowledge base needed for the successful design of sustainable healthcare architecture.

Implications for Practice

• Hospitals need to be designed to optimally fit a specific function and at the same time be designed as loosely as possible to accommodate future functional changes.
• Architectural design strategy, developed in an early stage of the design process, has a major impact on the future evolution process of the hospital facility.
• Horizontal-oriented evolution, in comparison to vertical-oriented evolution, supports change of medical programs and enhances flexibility of use and collaboration between medical units on the same floor.
• Systematic design of the structural grid of columns and MEP shafts, designed for an unknown function, in comparison to a “tailor-made” approach to locate the columns and MEP shafts according to the specific needs of the function, was found to support a variety of changing medical programs.
• The dependency of hospitals on private donations for the construction of new buildings has significant implications on the design strategies and future evolution of the hospital.

Acknowledgments

The author would like to thank the management and staff of the Tel Aviv Sourasky Medical Center and the Rambam Health Care Campus, Ranni Ziss Architects, Sharon Architects, and Mocly-Eldar Architects for their collaboration in the research.

Declaration of Conflicting Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the European Research Council grant (FP-7 ADG 340753) and by the Azrieli Foundation.

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Hospitals and Health Centers: 50 Floor Plan Examples

• Written by Fabian Dejtiar | Translated by Zoë Montano
• Published on August 17, 2018

A floor plan is an interesting way to represent and approach the functional program of hospitals and health centers, where the complexity of the system implies the need for specific studies of the distribution and spatial organization for proper health care.

From our published projects, we have found numerous solutions and possibilities for health centers and hospitals depending on the site's specific needs.

Below, we have selected 50 on-site floor plan examples that can help you better understand how architects design hospitals and health care centers.

Maggie's Cancer Centre Manchester / Foster + Partners

Hospital Complex Broussais / a+ samueldelmas

Livsrum - Cancer Counseling Center / EFFEKT

Villa el Libertador Príncipe de Asturias Municipal Hospital / Santiago Viale + Ian Dutari + Alejandro Paz

Municipal Healthcare Centres San Blas + Usera + Villaverde / Estudio Entresitio

San Jerónimo Hospital Refurbishment / SV60 Arquitectos

Villeneuve-Saint-Georges Hospital / Atelier d’architecture Michel Rémon

Psychopedagogical Medical Center / Comas-Pont arquitectos

D’olot i Comarcal Hospital / Ramon Sanabria + Francesc Sandalinas

Sant Joan de Reus University Hospital / Pich-Aguilera Architects + Corea & Moran Arquitectura

Angdong Hospital Project / Rural Urban Framework

Hospital de la Santa Creu i Sant Pau / Silvia Barbera Correia + Jose luis Canosa + Francisco Rius + Esteban Bonell + Josep Maria Gil

Dronning Ingrids Hospital / C. F. Møller Architects

Cerdanya Hospital / Brullet Pineda Arquitectes

El Carmen Hospital Maipu / BBATS Consulting & Projects + Murtinho+Raby Arquitectos

Hospital Tierra De Barros / EACSN + Junquera Arquitectos

Nuevo Hospital Universitario La Fe de Valencia / Ramon Esteve, Alfonso Casares

Kangbuk Samsung Hospital / Hyunjoon Yoo Architects

Hospital Campus de la Salud / PLANHO + AIDHOS arquitectos S.A.

Hospital of Sant Joan Despi Doctor Moises Broggi / Pinearq + Brullet-De Luna Arquitectes

Nemours Children’s Hospital / Stanley Beaman & Sears

Vall d’Hebron Hospital / Estudi PSP Arquitectura

Hospital of Mollet / Corea Moran Arquitectura

Hospital General de la Línea de la Concepción / Planho Consultores

Subacute Hospital of Mollet / Mario Corea Arquitectura

Hisham A. Alsager Cardiological Hospital / AGi Architects

New Lady Cilento Children's Hospital / Lyons + Conrad Gargett

The Christ Hospital Joint and Spine Center / SOM

Fundación Santa Fe de Bogotá / El Equipo de Mazzanti

Hospital General de Níger / CADI

Nelson Mandela Children's Hospital / Sheppard Robson + John Cooper Architecture + GAPP + Ruben

NGS Macmillan Unit / The Manser Practice

Rocio's Hospital / Manoel Coelho Arquitetura e Design

Healthcare Center in Valenzá / IDOM

Urban Hospice / NORD Architects

Legacy ER Allen / 5G Studio Collaborative

Advocate Illinois Masonic Medical Center / SmithGroup

Kraemer Radiation Oncology Center / Yazdani Studio of CannonDesign

Nozay Health Center / a+ samueldelmas

Health Municipal Clinic / studiolada architects

Bridgepoint Active Healthcare / Stantec Architecture + KPMB Architects + HDR Architecture + Diamond Schmitt Architects

Asahicho Clinic / hkl studio

Health Clinic Ruukki / alt Architects + Karsikas

Medical Centre Cortes / Iñigo Esparza Arquitecto

Healthcare Center in Tordera / Carles Muro + Charmaine Lay

Primary Care Center / Josep Camps & Olga Felip

Urban Day Care Center for Alzheimer Patients / Cid + Santos

Health Center in Oleiros / Abalo Alonso Arquitectos

A Parda Health Centre / Vier Arquitectos

Centro de Salud de Quintanar del Rey / MBVB ARQUITECTOS

• Sustainability

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