Duncan Finch Avanti Architects, UK Torbay Hospital: strategies for the new paradigm


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Architects for Health & European Health Property Network Event - How can we do more with less?

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Duncan Finch Avanti Architects, UK Torbay Hospital: strategies for the new paradigm

  1. 1. Hospital Buildings
  2. 2. Case Study - Torbay HospitalPresentation to AfH / EuHPN event20th May 2013Duncan Finch
  3. 3. A bit of history…
  4. 4. Torbay Hospital - 1928
  5. 5. Torbay Hospital - 1968
  6. 6. Torbay Hospital - 2013
  7. 7. PFI redevelopment?
  8. 8. A daunting series of challenges…Problems:• Highly congested centre to hospital estate• Layers of ‘improvements’ have degraded the environment• Short term solutions have become permanent• Abandonment of PFI redevelopment strategy has exacerbatedthese issues:• there has been minimal capital spending on new buildings forthe last 15 years• there has been no long term strategy for the existing estate
  9. 9. A daunting series of challenges…Effects:• Accommodation not fit for purpose• Fire strategy compromised• Piecemeal additions result in:• mixing of circulation flows• confusing environment,• doubling-up of services,• poor and inappropriate adjacencies• Lack of storage and support accommodation• Services (AHUs, chillers etc.) spread• No clarity of ‘front of house’ and ‘back of house’• Public entrances are hidden by accretion of permanent and modularbuildings• Maintenance and construction are complicated by congested site
  10. 10. Caring for an aging population• The increasing number of older people as a proportion ofthe population is one of the key challenges facing the NHS• Torbay Hospital is particularly affected by this trend:• As a proportion of the total population, of all agegroups over 50 are among the highest in the UK• The Torbay area has the 11th highest % of people over85 in the UK
  11. 11. The potential of integrated care• In response to the challenge of an aging population,healthcare organisations in Torbay and South Devon havecollaborated to integrate care• The Torbay area was selected as one of 16 integrated carepilots by the DoH• Ongoing plans to further integrate care• In Torbay, integrated care has focused on:• Prevention of admission of older people to hospital,• Enhanced discharge planning,• People in nursing homes with COPD and CCF• Services for low level dementia• A smaller, more efficient acute hospital is envisaged,working in close partnership with community health andadult social care services
  12. 12. Experience of similar sites
  13. 13. the importance of the public face
  14. 14. welcoming, light and easy to use
  15. 15. designing for health and wellness
  16. 16. Our approach
  17. 17. Site analysis
  18. 18. Site analysis - slope+75.57m34m total level change across site
  19. 19. Detailed level study - existing
  20. 20. Detailed level study - Level 4 entrance
  21. 21. Detailed level study - Level 3 entrance
  22. 22. Site context
  23. 23. Site context
  24. 24. Site context
  25. 25. Site context - new main entrance
  26. 26. Site context - new main entranceView from approach
  27. 27. Approach to Main Entrance
  28. 28. Main entrance and drop-off
  29. 29. Site context - views outViews from new tower
  30. 30. Site context - views outViews from existing wards
  31. 31. Landscape design1 Drop off with Torbay palm colonnade2 Courtyard provides views from mainentrance and emergency waiting3 Green heart – healing garden providinggreen access and views4 Existing trees retained5 Green roof to canopy13452
  32. 32. Building section
  33. 33. Building diagram -Roof
  34. 34. Building diagram -alternative organisation
  35. 35. Level 3 - Main Entrance
  36. 36. Level 3 - Phase 2 Emergency Department
  37. 37. Level 3 - Phase 2 Emergency Department
  38. 38. Level 4 ICU• Standardised bays• Daylight and views• Observation
  39. 39. ICU nursing zones
  40. 40. 1 Privacy curtains2 Glazed screens withinterstitial blinds3 White board4 Clinical station5 Daylight and views6 Pendant servicesICU bed space1234656
  41. 41. Levels 5 to 8 - Wards• 14 single bedrooms• 4 three bed bays• 54% single bedrooms• Multi-bed bay layout provides optimumstandardisation, quality and space efficiency• Alternative option with 2 three bed baysand 1 four bed bay achieves 61% singlebedrooms
  42. 42. Wards - daylight and views
  43. 43. Wards - day and dining room
  44. 44. Evidence-based design for older people including those withdementia
  45. 45. Acoustic design for older people including those with dementia• Acoustic design will minimiseunwanted sound and ensuregood speech intelligibility• Acoustics will support privacy,dignity and independence• Reduce risk of falls arising outof a noisy, unfamiliar setting• Reduce risk of challengingbehaviour increased by a noisyand over-stimulatingenvironmentHospital wards are amongst the most noisy and busy of all careenvironments.People with dementia can experience a great deal of distress anddisturbance in hospital wards … often just related to the experience ofbeing in an environment which is over-stimulating and, as a consequence,over-whelming.University of Stirling Dementia Design Series
  46. 46. Lighting design for older people and those with dementia• Natural light and externalviews will promote the well-being of both staff and patientsand support Circadian rhythms• Sudden changes of light leveland glare will be avoided bythe use of modified glass,curtains or blinds• Appropriate visual contrast willbe provided throughout• Increased levels of artificiallight, including softer indirectlight, will benefit olderpeople and those with visualimpairments• Innovative lighting andcarefully selected artworkswill enhance internal spaces• Special light panels willreduce the impact of SADand increase naturalproduction of vitamin D -particularly low in peoplewith Alzheimer’s• Higher levels of vitamin Dare shown to reduce falls
  47. 47. Interior design for older people and those with dementia• Handrails and small seatingareas will enliven corridors• Views to landscaped externalspaces, artwork and placedobjects will support intuitivewayfinding and signage• Non-contrasting floor finishesand flush thresholds willpromote safe, unimpededmobility• Multi-sensory designaddressing hearing, sight,touch, smell and kinesthesis(muscle memory)• Unobtrusive safety measuresthat allow patientobservation while preservingprivacy and dignity• Design features to aidindependence and maintainfunctional abilities,particularly important fordementia patientsstruggling to maintain theirsense of self in unfamiliarsurroundings
  48. 48. 1 Glazed doors with privacyoption2 Patient wardrobe3 Clinical station4 Fully accessible en-suite5 Daylight, views, ventilation6 Bedhead servicesSingle bedroom123465
  49. 49. 1 Glazed doors with privacyoption2 Patient wardrobe3 Clinical station4 Fully accessible en-suite5 Daylight, views, ventilation6 Bedhead services7 Touch down base withclear view of patients3 Bed room1235746355
  50. 50. Triple glazed window with interstitial blindTimber window systemwith aluminium externalcappingSide hung window,fully openable for blindmaintenance and cleaningHigh performance fixeddouble glazed unitAdjustable blind in gap betweenfixed and openable units.Blind automated for solar controlon west elevation onlyHigh thermalperformance0.91W/m2K approxProvision of ablind system thatis easy to maintainand meetsinfection preventionrequirements
  51. 51. Concrete flat slabBrick (panelised system)Low window sill to suitviewing angle from bedAdjustable ventilator250mm highservice zoneConstruction and Environment
  52. 52. Environmental control of bedrooms
  53. 53. Access - during construction
  54. 54. Access - during construction
  55. 55. Access - new tower and entrance complete
  56. 56. Access - final condition
  57. 57. Enabling works
  58. 58. Enabling works build new Hetherington entrance
  59. 59. Enabling works demolish old Hetherington entrance
  60. 60. Enabling works modify outpatients entrance
  61. 61. Enabling works provide temporary Level 4 link
  62. 62. Enabling works demolish existing main entrance
  63. 63. Enabling works provide temporary minors unit
  64. 64. Enabling works demolish existing emergency minors
  65. 65. Enabling works re-model endoscopy portakabin
  66. 66. Construction site cleared for main construction phase
  67. 67. Construction construct new ward and ICU block
  68. 68. Construction construct main entrance & canopies
  69. 69. Construction construct drop-off & external works
  70. 70. Construction completed phase 1 works
  71. 71. Construction demolish temporary minors
  72. 72. Added Value• Potential early delivery of Emergency Deptimprovements• Enhanced Emergency Dept and co-locations• Facilitates future change:• Frees up of the refurbishment ‘jigsaw’ for the nextphase• Space made available for enhanced assessmentfacilities• Day case improvements made more straightforward
  73. 73. Timelines
  74. 74. • Wholly deliversclinical brief• Bespoke• Accessible• An all ages internalenvironment• Comfortable,simple &sustainable• Safe• Deliverable• Affordable• Added Value