WHY IS HOSPITAL DESIGN SO UNHEALTHY?
LISA ROCHON Saturday, December 15 2007
Moshe Safdie stood up for the profession of architecture the other day, and, for having the guts, he needs to be thanked. He did what too many architects fear, or can't afford to do: He quit. He quit working on the master plan of the $1.6-billion McGill University Health Centre, a once-in-a-lifetime commission that would have returned the prodigal son to his hometown. Who could blame him? He was being treated like an ordinary schmo.
"When I was invited to come into this, there was a lot of bravado about ways to think about the hospital for the 21st century - five hospitals merged into one building," says Safdie, over the telephone during a stopover in Jerusalem. "That really excited me."
But engaging architects capable of the kind of clarity that Safdie recently displayed as design architect of the new Terminal 1 at Toronto's Pearson International Airport is becoming a rare reflex these days. Instead, architects are being asked to work as foot soldiers to major developer consortiums whose interest is turning an offshore profit, not inspiring human-based design.
Forget about capturing magical light, or weaving an interesting rhythm of built form along the street. Under the newly imposed regimes now taking Canada by storm, an architect's role is reduced to compiling binders full of bubble diagrams and measured distances between a nursing station and a patient's room. The stupidity is such that even Safdie was being asked to compile output specifications - not design.
Last year, 2.8 million Canadians were admitted to hospitals for an average of one week. What they experienced, for the most part, were factories built to contain the ill. A hospital that helps to heal through a gentle, meaningful design? Don't hold your breath - it's bad for you.
True, there are some exceptions, such as Credit Valley Hospital (photo) in Mississauga, Ont., by Toronto-based Farrow Partnership, which welcomes visitors into a life-giving atrium of massive Douglas fir columns and beams that grow and spread through the space like a dense forest. Light wells are dropped through the space to help orient visitors and staff. And a discreet side entrance into the Carlo Fidani Peel Regional Cancer Centre allows patients to enter into the warm, spa-like radiation-treatment wing, or climb an elegant spiral staircase to the naturally lit chemotherapy floor.
Two small innovations speak volumes about the integrity of the design process when architects have the support of a trusting client: Rather than adopting a sprinkler system that uses ozone-depleting chemical agents, Farrow researched the light misting system used on cruise ships and, satisfying fire-code requirements, was able to install the HI-FOG misters into the hospital atrium. Another kind gesture has to do with wanting to eliminate the heavy steel doors that typically separate the radiation-treatment rooms - and the patient - from the rest of the world. Research revealed that radiation dissipates after a certain distance, so the architects designed an extra-long, wood-lined hall to allow the patient to travel seamlessly from the reassuring warmth of a spa-like waiting area into a treatment room.
There are important lessons here for all those government officials hungry for more private-consortium build-outs. Hospitals are, after all, about the people inside them. And the Credit Valley board understood that inherently. "Collectively, the citizens on the board were uniform in their decision to have a building that mattered," says Bart Wassmansdorf, chair of Credit Valley's building committee. He tells me this while sitting on a bench underneath the monumental curves of the wooden structural trees. Somebody with the waxy skin of a cancer patient is playing a glorious medley on the grand piano nearby. "We have a responsibility," says Wassmansdorf, "to treat public buildings as more than a big box."
And they did exactly that: building something that helps to heal from the moment you step inside, that returns you possibly to an optimistic state of mind, all accomplished for $10-million under budget, and on time. This year, Farrow's Credit Valley has won three major awards from health agencies in the United States, the United Kingdom and Sweden. That's not surprising, but Canada should be producing plenty more of these stellar hospital designs.
Sadly, for the most part, inspired hospital design is wishful thinking. And with public-private partnerships - P3s - being heavily endorsed in Quebec, British Columbia and Ontario, the design of hospitals will become particularly unhealthy. Only cash-rich Alberta has rejected the private-consortium formula in favour of the construction-management way of getting infrastructure built. Maybe this is where the architects serious about designing healing hospitals will begin to flock.
It was at a fancy party at the National Gallery of Canada that David Culver, chairman of the McGill University Health Centre board, first approached Safdie. Within one year, the heady cocktail chatter had translated into a public announcement. The McGill group trumpeted Safdie as the world-renowned architect who shot to fame with the iconic design of Habitat '67: "His return home to Montreal represents a wonderful opportunity to celebrate and assure the city's appointment as a UNESCO City of Design," gushed a 2006 media release issued by the MUHC.
Together with four other Montreal firms, Boston-based Safdie was originally charged with innovating a hospital master plan for the 21st century, one, he says, that might have provided a gracious flow of traffic - cars, subway arrivals, patients and hospital staff - much like a beautifully designed airport. (The old Royal Victoria Hospital, among several other teaching hospitals throughout Montreal, will be demolished or retrofitted and the lands converted into new uses, such as condominiums.)
Naturally, for a complex of its scale, there are implications to consider beyond the walls of the hospital. The reinvention of the rail lands for the Glen campus of the McGill complex has the potential to revitalize several adjoining neighbourhoods. The commission is one of urban architecture: how to heal community both within and outside of the hospital.
But by the summer of 2007, the Charest government, like many provincial governments determined to remove hospital capital costs from their ledgers, backed away from paying directly for the new mega-hospital complex. Instead, a P3 was imposed on the McGill group. In this arrangement, one of two bidding private consortia will be selected to finance, build and own the new mega-hospital complex on the 43-acre (17.4-hectare) brownfield site in the city's west end. The government will then lease back the complex during a 25-year period.
Once selected, the consortium will hire its own architects to actually construct what's in the binders. And this is where myriad problems with the building can go wrong. To save on costs, a window might be made smaller, even though it blocks the view for a patient sitting in a wheelchair. An atrium might lose its interesting wooden timbers in favour of a dumb box. A recycling system of grey water might simply be skipped over. Whether or not the developer architects comply with the recommendations of the client's designer is a moot point - unlike Britain, there are few agencies in Canada that review the design of major civic buildings.
During the 1960s, Toronto architect Eberhard Zeidler was commissioned to develop a design for a highly flexible, intelligent building system. Unlike so much of the work available to architects these days, Zeidler was allowed to author a pure vision. That vision translated (to great acclaim) into McMaster University's Health Sciences Centre. Similarly, Ron Thom was given the authority by his progressive academic bosses to create a new, remarkable environment for learning. Trusted, allowed to fly with the commission, Thom created the magnificent Trent University.
How times have changed. Today, only a handful of superstar architects are being left to the task of true design. "There's the star architects, and they have extra leverage and authority and even admiration and respect," says Safdie. "Even when developers hire them, they treat them with a great deal of regard because they're actually using them for the branding and marketing.
"And, in parallel, the profession as a whole is being treated as less than a service industry. Treated very badly, exploited very badly.
"Some of us have more work than we can handle, so we can afford to be courageous."
Thank you for quitting, Moshe Safdie. For refusing to call bubble diagrams architecture. So now you have been told. Beware the consequences of the P3. Safdie deserves the last word: "This is a tough moment for the profession."