Architecture New Zealand, November/December 2003

Why do large hospitals struggle to be seen as architecture? Why is their development often not valued by our profession? These buildings are essential components of our society and significant elements of our urban fabric. As such they deserve the respect and enthusiasm -- and the creativity -- of architects.

The specialization perhaps does have more than its fair share of challenges. Healthcare provision is increasingly driven by cost, evolving clinical process, technological advance, and the demands of a vocal customer -- the patient -- who has the ready ear of the media. New hospitals are constantly in the public eye, with the taxpayer quick to judge expenditure against end results. Therefore, hospital design, especially in the public sector, includes extensive process, wide consultation and detailed analysis well beyond facility design.

The secret to overcoming these obstacles lies in seeing each commission as an exercise in total design. From this point of view, they perfectly illustrate the kind of multi-skilling that lies at the heart of our architectural training. Why should the architect not fill other associated roles if the result is a successful built environment? Take, for example, the Christchurch Women's Hospital and Day Surgery Unit project, currently under construction. Here, our practice not only designed the building, but is also responsible for the health facility planning, interior design, urban design and project management. This integrated approach, I believe, has been successful in simplifying a complex project.

For this paradigm to work, it is important that the architect is involved in the project from its inception. The Waikato District Health Board is currently undertaking an extensive service and campus redevelopment project in which early architectural involvement and strategic design thinking has been essential. Intimate involvement in the clinical service planning process has generated valuable insights into the project's service goals, allowing a more meaningful response at the strategic and conceptual design levels.

This is a perfect case of bringing design thinking to the process as much as to the creation of the facility itself, and this is important in healthcare. Hospitals typically don't start with a traditional brief to the architect. Instead, the brief must be developed alongside the design, simply because in an environment of change clients' requirements constantly evolve in response to new methods and technologies.

Because healthcare is in a constant state of flux any new building must accommodate the probable trends, clinical practices and care models of the next 10 or 20 years. All the elements and functions of the facility must be catered for, and the seemingly contradictory requirements of staff efficiency and patient demands for privacy, dignity and control must be met.

Therefore, under a total design model, it's often a case of designing processes as well as structure, and of adopting a generic or modular approach throughout to allow effective management of change. This means the architect needs a thorough understanding of the clinical functions and processes specific to healthcare and a comprehensive knowledge of international trends to facilitate constant benchmarking. An enormous volume of complicated information must be systematically codified into cohesive and co-ordinated design documentation. This kind of systems thinking is not a core element of New Zealand architects' training, but is essential to the logical and informed progression of the design.

Juggling user needs and design requirements calls for exhaustive consultation, so the total design architect must also possess a raft of negotiation and mediation skills not commonly associated with the profession. It is much easier if past experience can be drawn on, and relationships carefully cultivated. At Middlemore Hospital, for example, we found that a long-standing alliance with the client has resulted in a considerable level of trust and understanding, obviating unnecessary learning curves on a range of projects over the last 10 years.