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Academy Journal Academy Journal October 19, 2005 | | Academy Journal Home Planning for Change: Hospital Design Theories in Practice Letter from the Editor Abstract | Article Planning for Change: Hospital Design Architectural change was a major feature of the 20th- Theories in Practice century hospital. The rapid speed of medical research in all Nirit Putievsky Pilosof, fields required changes in the typical hospital environment MArch, McGill University School of Architecture in cycles of as few as 5 or 10 years. This is remarkable, Abstract | Article given that most hospital structures were typically designed to last 50 to 100 years.1 Because the process of design and The Peaceful Garden construction is both long and expensive, planners faced the Dana Pulis for James G. Shepard, AIA, and Alan challenge that many new hospitals are out of date the S. Godfrey, AIA, CTA moment they open.2 One of the challenges facing the Architects Engineers architecture profession in the 21st century, therefore, is Abstract | Article how to design a flexible hospital to suit unpredictable future needs. A Form Full of Function: The Aesthetic of Efficiency and the In the last three decades, a fundamental shift has taken Planning of German place away from highly centralized, large-scale hospitals Outpatient Treatment 3 Centers toward smaller, decentralized healthcare facilities. New Scott McCuen Koytek and trends in healthcare design such as sustainable strategies, Georg P. Müller, top the use of nature as a therapeutic modality, and the consult köln influence of information technologies, have diverted Abstract | Article attention away from the issue of change, yet the need to Incorporating Patient- plan the hospital for future, ever-changing needs remains. Safe Design into the New medical technologies, too, have changed society’s Guidelines expectations of hospital environments. Stays are shorter, Kenneth N. Dickerman, most patients and visitors arrive by automobile, and the AIA, ACHA, FHFI, Leo A. demand for homier, regionally inspired architectural Daly Co. Igal Nevo, MD, Center for imagery has increased dramatically. Patient Safety Paul Barach, MD, MPH, This article documents the theories and approaches of Jackson Memorial hospital planning for change as a context for the healthcare Hospital and University of Miami Medical School projects of Zeidler Partnership Architects, perhaps Canada’s Abstract | Article best-known healthcare architects. It explores an iconic hospital, McMaster Health Sciences Centre in Hamilton, New Standard of Ontario, and documents its evolutionary process over the Practice for the Design last three decades. The article analyzes the architectural of MRI Facilities Robert Junk, AIA, and intentions of the McMaster project through the seminal Tobias Gilk, Junk text, Healing the Hospital: McMaster Health Sciences Architects Centre: Its Conception and Evolution. It is here that the Abstract | Article project’s main designer, Eberhard Zeidler, Hon. FAIA, declared that the hospital was “never to be finished.” In The Next Generation of addition, the project explores the firm’s current model for Operating Rooms Naresh S. Mathur, AIA, healthcare design, a paradigm shift in this highly HKS Inc. specialized field. Abstract | Article Small and Rural Hospitals: Critical http://info.aia.org/journal_aah.cfm?pagename=aah_jrnl_20051019_change&dspl=1&abstract=abstract[11/22/2010 4:42:32 PM] Academy Journal October 19, 2005 | | Academy Journal Home Planning for Change: Hospital Design Theories in Practice Letter from the Editor Abstract | Article Planning for Change: Introduction: Theories and Approaches of Hospital Planning for Hospital Design Change Theories in Practice Nirit Putievsky Pilosof, Change over time is a constant feature of architecture, yet the MArch, McGill University School of Architecture pace of change and its intensity are much greater in hospitals Abstract | Article than in any other type of building. Changes in all areas of healthcare—scientific, operational, technical, and social— The Peaceful Garden necessitate frequent changes in the typical hospital environment Dana Pulis for James G. that often result in complexity of function and neglect of Shepard, AIA, and Alan S. Godfrey, AIA, CTA aesthetic quality. Because the changes occur rapidly, it has Architects Engineers become almost impossible to predict future needs. The challenge Abstract | Article is to anticipate as far as possible where changes are most likely to occur, to plan in advance for hospital expansion, and to A Form Full of provide maximum flexibility in design. Function: The Aesthetic of Efficiency and the Planning of German Outpatient Treatment Centers Scott McCuen Koytek and Georg P. Müller, top consult köln Abstract | Article Incorporating Patient- Safe Design into the Guidelines Kenneth N. Dickerman, AIA, ACHA, FHFI, Leo A. Daly Co. Igal Nevo, MD, Center for Patient Safety Figure 1. A 19th-century surgical amphitheater at Massachusetts Paul Barach, MD, MPH, General Hospital, compared with a 21st-century ZEUS "Intelligent" Jackson Memorial operating room. Hospital and University of (Sources: Richard A. Miller. "Hospitals: The Race with Change." Miami Medical School Architectural Forum 120 (1964): 80, and Bobbi Bennnett Photography. Abstract | Article 24 April 2003.) New Standard of Practice for the Design of MRI Facilities Robert Junk, AIA, and Tobias Gilk, Junk Architects Eberhard H. Zeidler, Hon. FAIA, has been fascinated with the Abstract | Article notion of time in architecture throughout his prolific career. In The Next Generation of his practice as well as in his writings, Zeidler highlights the Operating Rooms importance of hospital flexibility and demonstrates how to Naresh S. Mathur, AIA, achieve it. All of the approaches to planning for change that were HKS Inc. identified in this study—master plan, expansion methods, and Abstract | Article design for flexibility—touch Zeidler’s approach to healthcare Small and Rural design. Some of these approaches were found to be more Hospitals: Critical http://info.aia.org/journal_aah.cfm?pagename=aah_jrnl_20051019_change&dspl=1&article=article[11/22/2010 4:43:29 PM] Academy Journal effective than others over the years, and some were developed to Access and Beyond respond to changes in the economy, politics, and society. James G. Easter Jr., Assoc. AIA, FAAMA, President and CEO, Master planning remains a basic tool in planning for an unknown Easter & Mason future, yet its success depends on the client’s understanding of Healthcare Consulting architectural ideas and the willingness of successive hospital Corp. authorities to honor the architect’s original vision. In terms of Abstract | Article providing expansion possibilities, horizontal expansion is preferred to vertical expansion because it is more economical, HOSPITALity: Surgery Center Design for although it requires large areas of land and consideration of People, Not Procedures walking distances. A concern for maximizing flexibility continues to be achieved by modularity, full or partial interstitial spaces, Charles A. Huber, Assoc. and the separation of functions. AIA, Hobbs & Black Associates Inc. John S. Barker, AIA, Hospital Change in Practice: McMaster Health Sciences Centre in Hobbs & Black Associates Hamilton, Ontario Inc. Abstract | Article The McMaster Health Sciences Centre (MHSC) in Hamilton, Ontario, designed in 1972 by Craig, Zeidler, & Strong Architects, commemorates an important moment in hospital design. To keep a step ahead of the rapid changes taking place in medicine, Zeidler created an infinitely flexible space, deliberately designed never to be finished. This utopian vision, a concept of ever- changing architectural form, is demonstrated clearly in MHSC’s design, function, and image as a prototype of the “plug-in machine” modern hospital. While critics rejected the high-tech mechanical image of the hospital, others understood Zeidler’s intentions and appreciated his achievement. Even today, 30 years after the building was completed, its presence is powerful. Figure 2. A view of MHSC's front elevation, a view of MHSC in the context of its community, and an aerial view of MHSC. (view larger PDF) (Source: Zeidler Partnership Architects) MHSC’s original master plan defined the hospital’s location, form, and function, and it determined the future development of the hospital in two phases. Located on the campus of McMaster University, the center combines accommodation for medical and health sciences, education, and research, with a 418-bed hospital and extensive facilities for outpatient treatment. The building was designed as a compact, four-level structure with a parking level http://info.aia.org/journal_aah.cfm?pagename=aah_jrnl_20051019_change&dspl=1&article=article[11/22/2010 4:43:29 PM] Academy Journal below and the possibility of an additional fifth level in the future. This megastructure complex features an immense building area of 1,716,500 square feet, built at a total cost of approximately $70 million. One of MHSC’s most important design principles was growth. All the building components of MHSC were planned in advance for horizontal expansion and for vertical expansion of a fifth floor (Figure 3). The structure of the building was designed to support the extra weight, and mechanical and electrical systems were installed to support any function that would be located on the additional floor. Even the elevators and stairs were raised to the level of the fifth floor. In addition, as part of the construction and development process,
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