Large-scale hospital complexes, especially teaching hospitals, tend to develop like small cities: buildings are added, under-sized facilities are extended, obsolete constructions may be demolished. Whereas cities usually develop on land with a fixed infrastructural framework, a parceling structure often that originates in ownership titles of the land, large-scale hospitals are ideally based on master plans that, however, tend to lack the long-term validity inherent in urban planning. Moreover, the distinction between public and private components is inexistent and, therefore, the clear planning framework derived from it is also lacking. Consequently, the dynamics of separate components (departments) and the performance of public elements (streets, squares) cannot be balanced. Without a fixed framework and generally acknowledged rules, and the lack of the capacity to pursue long term visions, this leads to a complete lack of consistency. To add insult to injury, departments often need to expand and are likely to do so by just adding volumes seemingly at random in the open spaces surrounding them. Often, the result is similar to what would happen in cities if people would construct buildings in the middle of streets and squares. The rule rather than the exception, this calls for strategies to minimize the damage. In this session we take a look at the Centre for Surgical Medicine II (ZOM II) in Düsseldorf (Germany) by Heinle Wischer Partner and the University Medical Center Groningen (Netherlands) by Kruisheer Hallink, Team 4, Wytze Patijn and Vera Yanovshtchinsky.

1. Edzard Schultz
THE ARCHITECTURE OF HOSPITALS
High-end medical institutions
Dipl.-Ing. Edzard Schultz

2. Edzard Schultz

3. Edzard SchultzMilet

4. Edzard Schultz
structure setting

5. Edzard Schultz
STRUCTURE
Dipl.-Ing. Edzard Schultz

6. Edzard Schultz
snail cheetah

7. Edzard Schultz
construction medicine

8. Edzard Schultz
The genetics of complex systems – like hospitals – consist also of universal
structures. To understand them helps to:
- identify general principles
- make flexibility and elasticity possible despite the “inertia” of building
- open up future options through structural openness
It is essential to shift from “customized room programs” to “modular programs”.
Opportunities arise in:
- the use, e.g. interdisciplinary units with modular examination rooms
- the spaces with high maintenance installation, e.g. OR and ITS or
the utility vaults
- the traffic elements, e.g. traffic knots with elevators, stairs and
supply systems
Structure

9. Edzard Schultz
Modular function program...
Heinle Wischer Gesellschaft
für Generalplanung mbH
Städtisches Klinikum Karlsruhe
Zielplanung
5. Bedarfsprogramm
Teilprojekt Institutszentrum
6. Funktionsprogramm
modulares Funktionsprogr
modula
o.M
Gesamtcampus
Phase 1
Auftragnehmer
Planungsphase
Planinhalt
Bereich
Projekt
Status
Plan-Code
Maßstab FormatDatei-Nr.
Klinikum der Universität Mün
Campus Großhadern
Bauliche Gesamtkonzeption
Heinle, Wischer un
Freie Architekten G
Gutenbergstraßße 4
10587 Berlin
Telefon: +49 30
Telefax: +49 30
E-Mail: 139-kum
Internet: www.he
Staatliches Bauamt München 2
Marchioninistraße 15b
81377 München
Telefon: +49 89 7095-7951
Telefax: +49 89 7095-8878
E-Mail: poststelle@stbam2.bayern.de
Internet: www.stbam2.bayern.de
Fachplaner
Auftraggeber
139_BE_LP 900x5
6.2
- Arbeitszone (Einleitung, Waschen, Diktat, Geräte)
- zentrale Räume (Büro, Aufenthalt)
- Schleusen (Patienten, Güter, Personal)
- Prä-/Postoperativ Patientenholding (Perianästhesiologische Station,
Aufwachbereich, Leitstelle)
Heinle Wischer Gesellschaft
für Generalplanung mbH
linikum Karlsruhe
ramm
ge
Funktionsprogramm
Allgemeinpflege
1.09 Operation
modulares Funktionsprogramm (Beispiele)
OR OROROROR
OR OROR
PLUGGED
CORE
PLUGGED
OROR
... transformed to a modular structure

10. Edzard Schultz

11. Edzard SchultzModular organization
Typology Main Courts Landscape
Architecture
extierior substraction surroundingtypology

12. Edzard SchultzSix „All India Institutes of Medical Sciences“

13. Edzard SchultzGeneral Hospitals, Venezuela

14. Edzard Schultz
3
1
4
2
modules connected sheltered filled assembled
Modular structure

15. Edzard SchultzSynergies and elasticity - Institutional versus individual
centre
A
centre
B
centre
C
centre
D
centre
...
logistics and technics
drop-off, walk-in clinic, diagnostic
intervention
inpatient stay

16. Edzard SchultzFlexibility and elasticity
25,60m
12,80 m
1 2 3 4
5 6 7 8
25,60m
12,80 m
1 2 3 4
5 6 7 8
12,80 m
1 2 3 4
5 6 7 8
modular structures variable use elastic extension
1 2 3 4
5 6 7 8

17. Edzard Schultz
+4
+3
+2
+1
0
1
2
3
4
5
6
vacant lot vacant storey vacant room
Unobstructed spaces

18. Edzard SchultzFree manoeuvring

19. Edzard Schultz
SETTING
Dipl.-Ing. Edzard Schultz

20. Edzard Schultz
Surroundings
- urban / rural context
- periphery / transit zones
- history / tradition
Topography
- hights
- site
- open spaces
Connection
- of services
- of information
- of economy
Orientation
- circulation and accessibility
- internal net
- articulation
Climate
- temperature
- wind
- humidity
The specifics of the place

21. Edzard Schultz
outside the city as a city within the city as part of
the city
?
Development
net
greenfield the machine the solitaire the urban
element
chip of the
whole
?

22. Edzard SchultzDrop-off

23. Edzard SchultzSpheres
Info Orientation Safety Action

24. Edzard SchultzExisting Structures

25. Edzard SchultzReality

26. Edzard SchultzFor example: Daylight

27. Edzard SchultzResearch: quality of work environments
Matern et al., „Working conditions and Safety in the Operating Room"
Deutsches Ärzteblatt (German Medical Journal) 2006 (103): 3187-92
OR areas where ergonomic improvements are urgently desired
OR with window and view outside
air condition
cables and tubing
OR lighting
use of devices
OR tables and steps
positioning materials
ceiling supply units
monitors
manual instruments and handles
pedals
OR clothes/shoes
instrument tables
instrument trays
100%0 60% 80%40%20%
84%
92%
nursesurgeon

28. Edzard SchultzDaylight

29. Edzard Schultz
DAYLIGHT
REGULATE
CIRCADIAN
RHYTHM
REDUCE STRESS
AVOID
FATIGUE
IMPROVE
THE RECOVERY
PROCESS
INCREASE
CONCENTRATION
IMPROVE
PERFORMANCE
REDUCE
MEDICAL
ERRORS
OPTIMIZE ACCESS
AND WAYFINDING
REDUCE PAINREDUCE
DEPRESSION
INCREASE MOOD/
SATISFACTION
Daylight linked to outcomes
POSITIVE HEALTH
OUTCOMES
SAFETY
PRODUCTIVITY
POSITIVE EXPERIENCE/
SATISFIED OCCUPANTS

30. Edzard Schultz
Mroczek, J. et al. 2005
REGULATE
CIRCADIAN
RHYTHM
REDUCE STRESS
Scott, H. 2004
Leather, P. et al., 1998
Alimoglu, M.K. et al., 2005
Kueller, R., et al. 2006
Figueiro, M.G. et al., 2002
Buchanan, T. L., et al. 1991
Walch, J.M., et al., 2005
Beauchemin, K..M. et al., 1996
Beauchemin, K..M. et al., 1998
Benedetti, F., et al., 2001
Lewy, A. J., et Al., 1998 Wallace-Guy, G., et al., 2002
Oren, D.A., et al., 2002
Terman, J.S. et al., 2001
AVOID
FATIGUE
IMPROVE
THE RECOVERY
PROCESS
INCREASE MOOD/
SATISFACTION
INCREASE
CONCENTRATION
IMPROVE
PERFORMANCE
Boyce, P. , Rea, M.S. 2001
Windows and Offices: A Study of
Office Worker Performance and the
Indoor Environment
Heschong, L. et al. 2003
Heschong, L. et al. 2003
Windows and Classrooms:
A Study of Student Performance
and the Indoor Environment
REDUCE
MEDICAL
ERRORS
Hospital design and staff
perceptions
Working environments have
a direct impact on care
The impact of light and colour
on psychological mood
Daylight and productivity - a possible
link to circadian regulation
Illumination and errors in
The effect of sunlight on post opera-
tive analgesic medication usage
Daylight exposure and the other
predictors of burnout among nurses in a
university hospital
Windows in the workplace: Sunlight,
view, and occupational stress
Sunny hospital rooms expedite recovery
from severe and refractory depressions
Dying in the dark: Sunshine, gender and
outcomes in myocardial infarction
Morning sunlight reduces length
of hospitalization in bipolar
depression
Morning vs. evening light
treatment of patients with winter
depression
An open trial of morning light therapy
for treatment of antepartum depression
Evening light exposure: Implications for
sleep and depression
Circadian time of morning light
administration and therapeutic
response in winter depression.
Lighting and human performance
REDUCE PAINREDUCE
DEPRESSION
Daylight and productivity - a possible
link to circadian regulation
Figueiro, M. G., et al., 2002
Malenbaum, S., et al., 2008
Pain in its environmental con-
Harris, P.B. et al. 2002
A place to heal: Environmental sources
of satisfaction among hospital patients.
Kim, J.J. et al. 2005
Are Windows and Views Really Better?
Figueiro, M.G. et al. 2002
Daylight and productivity - a possible
link to circadian regulation
Heerwagen, J.H.1998
Design, Productivity and Well Being:
What are the links?
DAYLIGHT
Daylight linked to research
POSITIVE HEALTH
OUTCOMES
SAFETY
PRODUCTIVITY
POSITIVE EXPERIENCE/
SATISFIED OCCUPANTS

31. Edzard Schultz
2 Bestandsbewertung (Analyse)
Krankenhaus als zukunftsfähige Struktur (Idealtyp)
flexibel (Neutralstruktur)
elastisch (betriebliche Anpassungen)
modular (wandelbar/teilbar)
erweiterbar (nicht final)
Verknüpfungen (funktionell)
menschlich !
A B C
Struktur - Leitgedanken
modular (convertible / separable)
flexible (neutral structure)
elastic (operational adjustments)
extendible (not final)
links (functional)
humane!
Masterplanning for huge structures

32. Edzard Schultz
INV HAN
VER
FOR HHK
HUH
UPR
RKP
WES
OST
MIT
POR
ABZ
Mittelallee
SÜD
FEM-Tierh
altung
Experimen
taltierhaltun
g
Park
FEM
RRI
P3 P6 P2 P7 P2 P3
P1
P1
P4
P3
P5 P6
P2
P3
P2
P1 P4
P5
P6
P7
P8
P3 P6
P1
P4
P5
P2 P7
P8
concept
capacity
infrastructure
potential
space
projects
Site I Site II Site III Site IV
Master
Plan PI
Master
Plan PII
Master
Plan PIII
Master
Plan PVI
strategy
area calculation
efficiency
need for action
project list
vision
Overall Strategy

33. Edzard Schultz
Institution Population
Isolation Cooperation, networking
Inpatient Outpatient
Room program Modular structures
Disciplines (“kingdoms”) Patient flow (interdisciplinary)
Investment Lifecycle cost
Dark Light (orientation, daylight)
Analogue Digital
“Closing time” Shift work
Technocracy Creativity
Change of paradigm

34. Edzard SchultzUniversity Hospital Essen, Paediatric Clinic

35. Edzard SchultzRooming-in concept

36. Edzard Schultz
"The Geographer"
Johannes Vermeer, 1669

37. Edzard SchultzIt doesn't matter!?

38. Edzard Schultz
Heinle, Wischer und Partner
Freie Architekten
Edzard Schultz
Heinle, Wischer und Partner
Freie Architekten
berlin@heinlewischerpartner.de