Girvan Community Hospital

A Case Study

1 Girvan Community Hospital

Overview The new Girvan Community Hospital provides a much needed hub for health services within this Ayrshire town. Sitting low in the landscape it packs a significantly large amount of accommodation, while still managing to appear small.

‘There’s a large amount of accommodation and services within the hospital, however you don’t really appreciate that from the road.....it looks quite small, but it’s actually a big building.’

Iain Wylie – Architect – Austin Smith Lord

The new community hospital was commissioned to replace the Davidson Cottage Hospital and two other ageing facilities within the town and had to ensure that it would meet today’s medical requirements and also Hospital Approach and Main Entrance remain a flexible and adaptable facility for the future. Girvan Community Hospital on landscape Image credit: Keith Hunter Photography Image credit: NHS Ayrshire & Arran The hospital provides a mixture of services including 26 GP acute inpatient beds, two GP practices, outpatient services (dental, podiatry, speech and language therapy, and rehabilitation) as well as other support services and helped draw out key information about the nature and scale of the such as a community pharmacy, social care, the Scottish Ambulance service provision and gave the project team a clearer picture of what was Service, and soon the local police. required. Further, a visit to Mid-Argyll Community hospital in Lochgilphead was arranged to show the stakeholders what could be achieved from In choosing the site for the new hospital, several potential options a similar scaled community hospital, and how this model of healthcare throughout Ayrshire were investigated. However it was ultimately decided delivery would be beneficial for Girvan. that the facility should remain part of the local Girvan community and sites in and around the town were proposed. These initially located close to the ‘The stakeholder consultation mainly involved the users, however town centre with some of these being more speculative to allow the Board the community were also heavily engaged as there was real (emotional to understand both the scale and nature of the facility and the size of the and historical) attachment to the Davidson, the old hospital, and people land required. were concerned about losing this from the town.’

In the end the chosen option was a greenfield site located on the edge Iain Wylie - Architect - Austin Smith Lord of the town. Due to this being a greenfield site, planning for a building of Cafe Outlook this type and scale may have presented a challenge, however a previous To help stakeholders visualise a major aspect of the hospital a bedroom Main entrance with meeting room above Image credit: Keith Hunter Photography approval for an unbuilt supermarket on the site allowed a re-interpretation mock up was built in the Davidson Hospital, Girvan and a further test Image credit: Keith Hunter Photography of the zoning to suit a hospital and the permission was granted. mock up for bed/hoist/equipment movement in Ailsa Hospital, Ayr to help test out how these rooms might be used. This was indicated by the One of the main benefits of this site was the opportunity to create a stakeholders to be something that was extremely helpful in order to see gateway to the town, while offering good transport links to the facility, the proposals and offer feedback within the consultation process. and joining it with the wider community. Regular bus and train services operate throughout the year meaning that access to public transport Further regular dialogue with both the public and stakeholders helped to is good, encouraging use. A pleasant scenic route runs alongside the ease the level of apprehension surrounding the closure of the Davidson river from the town to the hospital giving patients, visitors and staff an Cottage Hospital, which was an important and much loved facility within opportunity to gain some exercise and benefiting wider health promotion. the Girvan community. Adequate parking is provided for those who need to travel to the facility by car. During the build both NHS Ayrshire & Arran and the Design Team opted for a traditional procurement route as they felt this could offer the best The successful delivery of the hospital was aided by a strong stakeholder results for the project in monitoring both cost and quality. and public engagement process undertaken at an early stage in the project. The extensive consultation process took over a year to complete

Ambulance Drop-off and Entrance Cafe and edge of service yard with timber cladding Image credit: Keith Hunter Photography Cover Photo - Girvan Wind Turbine Image credit: Keith Hunter Photography

2 3 Girvan Community Hospital Key: Fishermans path Walking route to hospital Pedestrian areas Roads Fire exit Entrances Experience The street When approaching the facility, the first thing noticeable is the wind turbine, which is visible from quite a distance. The hospital building is quite large, yet it has been designed to give a less dominant presence on approach and doesn’t show its true size until you enter the building. Externally, you are still aware of the natural surroundings as the roof sits just under the tree lines, allowing the landscape beyond to remain the feature view.

Water of Girvan There are two walking routes to the hospital from Girvan one of which runs along a scenic river path (Fisherman’s path) wrapping around the car Parking park with the second being a path that follows the main road from the town. This passes a fire escape route from the internal circulation ‘street’, and was initially designed as an entrance, however the decision was made to have only one public entrance, which seems to be a missed opportunity View of wind turbine and would have provided a more direct link into the building for those Image credit: NHS Ayrshire & Arran walking from town.

As you arrive at the hospital by car from the A77 southbound, the entrance to the site is clearly marked from the roundabout. The route to the car park flows naturally and offers the user a glimpse of the main A77 entrance as you pass, giving an indication of where you need to be.

From the car park you are directed along a landscaped walking route to the main entrance. The service yard is situated at the beginning of this route, with users having open views into the yard, however, the impact of this is lessened at the front of the yard where it is screened by a timber clad wall.

The main entrance, provides a link to both the Minor Injury Unit and GP facilities/Outpatient services, meaning that when the building is accessed Water of Girvan out-of-hours users will use the same entrance, helping to enhance wayfinding. The secondary entrance located at the café end to the The Street ‘street’, was initially a staff entrance and is much smaller and underplayed meaning it has generally been used less frequently, often used by those Main Reception Desk familiar with the building.

Both entrances bring you into the spine of the building (the street), an area which links together all the wards and services within the hospital

The Street around a logical plan. The reception desks for both the GP surgeries, Bridgemill Roundabout outpatient and inpatient departments are situated opposite the main entrance doors, with the waiting area quite close to these. There have been some comments from staff that draughts caused by the positioning of the doors allows cold air to pass through, causing some discomfort to both staff in the reception and people using the circulation area.

The central waiting space is bright and airy, with plenty of seating and a Street The pleasant view to the hills outside. The GP receptions are well placed to allow monitoring of both the waiting area and the main entrance.

Within the waiting area large display screens inform patients of their appointments and graphic elements displaying facts surrounding the Inpatient Bedroom - Scenic view to hills buildings ecological attributes and other healthy facts add a playful A77 Site Plan indicating Walking Routes element to the overall wayfinding strategy.

Girvan 4 5 Girvan Community Hospital

The waiting area is used by most GPs, however, some have opted to using the sub-wait areas for patients, helping to reduce walking distances to some of the more outlying consulting rooms. Majority of the sub-wait areas are double height spaces with many of these being internalised spaces often having a rooflight over the seating area. The waiting areas without rooflights appear less comfortable for the user.

The ‘Street’ and supporting spaces, such as the waiting area and café, have provided some additional benefit to the hospital. Various activities, such as performances and community groups for both patients and visitors has taken place within these spaces. These activities often run during holiday periods and give an opportunity to bring the wider community into the hospital extending the connection to its locality and giving a positive impression of the facility. The café provides a valuable Inpatient Ward - Staff Base destination for those within the inpatient facility as a means of getting out of the ward when visited by friends and family.

‘So there’s a whole lot of different activities that come in. There’s music therapy and baby massage and a whole lot of other things…. Mothers and toddlers come in and meet in the café for lunch.’

Gillian Lowrie – Nurse

During the consultation process there was a significant amount of discussion around the ward environment and in particular around the type and mix of bedrooms. The project team opted for a mix of bedroom types and although departing slightly from guidance, the team felt that as the patient demographic had a higher degree of elderly patients, the use of single rooms with a few multi-occupancy rooms suited their specific needs Inpatient Ward - Communal Space better. Hospital staff were then able to pair elderly patients with buddies when this need arose, which was especially useful for patients who were less mobile.

Through the design of the bedrooms every effort was made to ensure that each patient bedroom had either a view out to the wider Ayrshire landscape or an internal landscaped courtyard space. Staff have noted that this has been particularly beneficial for patients with dementia, where having a view to a familiar landscape allows them to recognise their surroundings.

‘Patients like the view on the road up to the hills. If it’s a wee bit unsettling, then you can put them in that room and they recognise the geography of where they are, which can be quite calming for them.’

Gillian Lowrie – Nurse

Within the inpatient ward, communal spaces have been centralised to create more opportunities for social interaction between patients. This was initially envisaged as a larger open space, including dining area monitored directly from a nursing station. However, due to current fire regulations these have become individually enclosed spaces with glazed partitions. These appear to be less used by patients.

Sustainability Infographics by StudioLR

6 7 Girvan Community Hospital Girvan Community Hospital

On the upper floor there is a mix of staff and third sector accommodation. Sustainability Social services who were to initially occupy most of this floor decided against doing so just prior to the building opening, however from late Sustainability of Girvan Community Hospital has been an important factor August 2015 the local community police moved in. An additional hot desk in the overall design, with a number of passive and active measures being room bookable by social care staff working in the South Ayrshire Health introduced to help reduce its carbon footprint. and Social Care Partnership, demonstrates the flexibility of the hospital to deal with change. Overall, the combination of services within the building The building has been designed to be passive with an enhanced helps to reinforce Girvan Community Hospital as a hub for the local thermal envelope exceeding the building standards requirements of the community. time. There has been some on site energy generation with heat being generated through a 700 kW biomass boiler and some of the power being The use of future technologies has been considered, with provisions in provided by a 100 kW wind turbine. The wind turbine has been hailed a place for access to telemedicine and video conferencing to extend and huge success and has surpassed expectations by performing 18% better enhance the use of the facility and experience for GPs and clinicians alike. than initially expected. This is something the GPs are keen on developing and utilising further in View of Rehab Courtyard the future. ‘The Client should be commended, in a sense, as they went ahead View of the Wider Landscape Space with all these sustainable measures when they didn’t necessarily need to, ‘The space we used for meeting rooms and patient group I don’t think there are many hospitals that have gone this far.’ meetings allowed us to occasionally use the video conferencing… Part of our strategy with this facility was to have this future proof so that we Iain Wylie – Architect – Austin Smith Lord could move towards a lot more telemedicine.’

Dr Bruce McMaster – General Practitioner

Access to the secure external spaces within the ward environment has been provided with wards and departments structured as fingers of accommodation allowing landscape space and river views between these wings. Access to these landscaped courtyards is restricted at the moment due to an issue surrounding deactivation of the security system to the external doors, resulting in an underutilisation of these external spaces, however, staff are keen to find a solution to resolve this.

The use of the wider landscape has been bolstered with the incorporation View of the Central courtyard of a green gym and a community garden in conjunction with a local horticulture club where they provide weekly classes promoting and encouraging an active lifestyle. This has brought about a requirement for a part time gardener to develop and maintain the green gym.

Additionally there is a nearby walking and cycling route (Fisherman’s Path) running between the hospital perimeter and the river. This area is well used by dog walkers and those out for a general stroll - unfortunately there is currently no link between this and the wider hospital landscape for beneficial use by both patients and the community.

‘There were a lot of different concepts proposed about what a green gym was and how we could use the space out there, the one that seems to have evolved is the community garden.’

Dr Bruce McMaster – General Practitioner

Courtyard between outpatients and rehabilitation areas

8 9 Girvan Community Hospital

The local sourcing of woodpellets keeps both the cost and carbon footprint down adding to its ecological credentials. Food waste is collected through a vacuum system and dried before being taken off-site for composting, ensuring any waste is used in an ecological way and not sent to landfill. Additionally there is a rainwater recovery system in place for use for flushing the toilets, however, due to the potential infection risk from aerosols arising from flushing this system it is currently not in use. To illustrate some of the sustainable measures employed within the hospital a graphic design company was commissioned to develop a series of infographics demonstrating what impact these will have. The approach takes an interesting and light hearted way of illustrating this and in simplistic terms help to provide distraction in spaces such as waiting areas. The response also helps to supplement wayfinding.

Natural light to corridor from the adjacent Through these combined measures, Girvan Community Hospital has courtyard space gained recognition through a number of awards including the UK-wide ‘Building Better Healthcare’ award for sustainability as well as the Health Facilities Scotland own sustainability award.

Reaction

The overall reaction to the new facility has been positive. Staff have felt involved in the whole process and believe that the engagement has, from an early stage, had significant benefits on the final designs.

‘They brought all services together and sat around the table, they looked at all sorts of issues, how people could coordinate and what the best adjacencies were etc.’

Frances Thomson – Community Services Locality Manager for South Ayrshire

Sustainability Infographics by StudioLR

View towards the Main Entrance

Wind turbine adajcent to the Hospital Car Park

10 1111 Girvan Community Hospital

In general there have been a few issues identified by staff that are potential areas for learning for other projects. For example;

• The alignment of the entrance doors can often cause internal draughts within the reception area. • A technical problem in relation to the design of the heating system caused overheating in the offices and GP surgeries. This has largely been addressed with positive results. • The weight of the doors to the inpatient bedrooms and the default activation of these to be closed means that patients can sometimes feel removed from the life and activity of the ward and giving the potential for them to be overlooked. Subsequent funding has now been granted to adjust the door closers for these rooms to resolve this issue. Minor Injury Unit - Treatment Room • The provision of the fire exit door on the western face of the building, designed to look like an entrance point and linking directly into ‘the street’, can on occasion cause confusion for users of the building and would have served better as an entrance point, particularly for those arriving from the town.

Staff believe that aspects such as the co-location of services and the integration between departments is a good example of the benefit of being in a community hospital. Further, the use of technology has allowed GPs to check availability and book appointments with other clinics online. This ability to send a patient directly to another service has allowed for much speedier appointments, and has reduced the possibility that patients might wait days or even weeks to gain an appointment.

‘That kind of usability from the practice side of things has come and I think patients do appreciate that they can come and get almost everything they need here.’ Physiotherapy - Rehabilitation Gym Dr Bruce McMaster – General Practitioner

The provision of a new Minor Injury Unit has resulted in lower numbers of patients making the journey to Ayr to be treated for minor injuries reducing pressure on those services and helping to meet the Scottish Governments objective of ‘treating people closer to home’. In addition to this, a couple of radiographers now travel to Girvan twice a week to deliver these services and one GP is running their own Chronic Obstructive Pulmonary Disease (COPD) clinic. Each of these is providing additional benefit to the patients within the locality that would not previously have been possible.

The use of the main ‘Street’, while providing good connectivity between all services, is also allowing the central spaces to be used for other functions. The cafeteria, which is well used by staff, patients and visitors alike, gives a place for informal conversations to take place in a relaxing environment. Some patients like being brought here by friends of family as it can feel like a welcome break from being in the ward at the opposite end of the Minor Injury Unit - Consulting Room building. Inpatient Ward - External Landscape Space with Timber Pergola (top) Patient Dining Room (bottom)

12 13 Project Information

Client body: NHS Ayrshire and Arran Location: Girvan Community Hospital, Girvan, Ayrshire Architect: Austin Smith Lord LLP Principal Contractor: Barr Construction Ltd Value: £20 Million Opening Date: February 2010 Procurement Type: Traditional

A&DS would like to thank the following for their time and candour:

Owen McNee, RSP Consulting Engineers LLP, Mechanical and Electrical Design Engineers David Cairns, Project Manager from Capitol Planning Iain Wylie, Austin Smith Lord Architects Colin M Miller, Austin Smith Lord Architects George Wren, Austin Smith Lord Architects Bruce McMaster, GP, Girvan Community Hospital Stacey Ross, Practice Manager, Dr McCulloch and Partners Frances Thomson, Community Services Locality Manager, S Ayrshire Donna Connaghan, Community Services Locality Coordinator, Girvan Community Hospital Gillian Lowrie, Nurse, Girvan Community Hospital

All images provided by A&DS unless noted otherwise

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