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A hospital is many things. A place of anxiety and relief, illness and joy. But also a place of catering, deliveries, laundry and parking lots.
It must be as efficient as possible, and house some of the most advanced technology in the world, and yet feel human and welcoming. And whatever else it is today, we know that it may need to be something very different — although we don’t know what — just a few months into the future.
The opportunity within healthcare design and build is to address all of these competing value drivers successfully. This is the essence of our core approach — design to value.
Our overarching aim is to deliver a beautiful building which achieves excellence in clinical outcomes, patient safety and user experience, savings in cost and carbon, precision in budget and time scales, and flexibility to allow for future developments, planned and not.
Every project starts with a brief, of course. A clear brief allows for the design to be checked continuously as it evolves. Our approach to developing a brief is to place it firmly in the context of being a part of the process which ends with a fully functioning hospital. The brief cannot — or should not — exist in splendid isolation. It must take into account the massing of the hospital, the plant and MEP requirements, servicing facilities, and the extent and location of the parking lots. In our minds, the brief is intrinsically linked to the construction strategy. It is intrinsically linked to the overall feasibility of the building.
We are an integrated company, with multidisciplinary teams working across all our projects from the earliest stages. We have a strong background in technology, engineering and construction. The result of this is that we do not need to design to approximations and allowances — we can be precise from the outset.
Fundamental to our design approach is that we start from the client’s requirements, which we establish during a series of early workshops. Designing a complex project does not always evolve in a linear fashion, so to deliver a quality design solution we must identify in the early stages of the design the details (technical, organizational, etc.) that have a big impact. Once we clarify the structure of the briefing information, we identify key stakeholders.
We conduct extensive engagement with clinical and nonclinical staff, as well as patients and visitors. We examine the flows and resources of people through the building, in order to maximize efficiency at every opportunity. We reduce avoidable travel by designing to adjacencies and linkages wherever they add value — while at the same time understanding the need to keep certain functions, or categories of user, very separate. We include and consider as many variables as we can to make sure that the hospital will function as well as it can.
We produce detailed functional and support diagrams to guide the process. When these diagrams are agreed with our client, we create spatial diagrams, detailing all required rooms, their shapes and the relations between them. This allows us to engage more specialist stakeholders, and make sure their requirements for each of the rooms are met.
We describe this approach as designing the hospital from the inside out, but we never lose sight of the architectural response to the brief. Creating a beautiful space is a value-driver in itself, with a proven link to clinical outcomes. Nothing is in isolation.
In the case of new build projects, our platforms approach to design and construction will usually inform the concept design. The principle of platforms is to design to the commonalities between spaces both within and across sectors, with the result that construction can make use of a standard kit-of-parts. This brings a wide variety of benefits, not least flexibility.
By recognizing that the space required for a treatment room can be the same as for an office, say, designing on that principle means that, should the need arise, it is easy to convert an office into a treatment room, or vice versa. This is a rational, logical approach.
Our hospital for Circle Health in Birmingham was designed to be a grid of four and eight meter spaces. While the reason for this rationalization was to allow for flexibility and future expansion, a change in business planning meant we had to bring this requirement forward, and expand the hospital while construction was underway, but also while keeping the lower floors operational.
Rationalization of the internal grid does not limit the options for the external appearance or the aesthetic design of the building. A platforms approach places no constraint on the architect’s freedom to create a uniquely beautiful building that responds to its environment.
It is not enough for a hospital to be excellent when it first opens its doors.
It must also be excellent next year, 10 years from now, and another 10 years after that. It must be able to respond not only to its own changing requirements, but those of local and neighboring environments, populations and infrastructure. As we have seen over 2020, those changes can be radical and terrifyingly fast. But as we have also seen over the last 20 years, healthcare priorities can be affected by political and social as much as natural changes.
We are also faced with a climate crisis that requires every building to be designed and built for reduction in both embodied and operational carbon.
The best response is to create the most efficient, flexible and adaptable design. The efficient use of materials is core to the platforms approach, which naturally tends to the leanest and most compact design by optimizing every element, eliminating approximation and allowances, and taking every opportunity to reduce inefficiency and waste.
We apply leading edge technology to our work across sectors as diverse as housing and subways, developing digital solutions that do what digital does best: discover and manage large amounts of disparate data, and create intelligent, efficient outputs.
For hospitals, this may mean managing patient flow through appointments and waiting times, or making sure that people can follow their entire treatment journey (including the physical one from the parking lot to the treatment room) on their phone.
As with design, engineering and construction, digital expertise is part of the Bryden Wood package.
Design to Value is our driving principle as a company. Its application to healthcare delivers exceptional results. We’re very proud to be working across healthcare in the UK to advance the next generation of hospitals.
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