Changing requirements and new challenges
Initially intended to have a mix of financing sources, Huashan Hospital is now a public hospital receiving the Chinese equivalent of federal funding. This shift in ownership and project requirements, including a change in the size of the facility, means the design team has had to reconsider the approach and reaffirm the goal of bringing the best of two cultures together.
“Cost has become more of a concern as the project has evolved, but even though it is receiving public financing, they are committed to making it unique from a flow and design perspective. The size may have changed from 150,000 square meters to 120,000, but we’re still focused on not designing a standard Chinese hospital. It starts with Chinese requirements, but we are trying to bring the best from the East and the West,” says Stewart.
Huashan Hospital’s landmark-quality design creates spaces and forms that express the dual roles that nature and technology play in the healing process. Patients and caregivers in the radiology department, for example, benefit from ample sunlight and rooftop gardens that provide natural, recuperative settings. Windows throughout the facility open to let in outside air, which, while adding to the engineering challenges of designing the central heating and air-conditioning system, was essential to meeting the cultural expectations of the Chinese, who value the movement of fresh air.
Cultural differences and the hospital’s emphasis on patient-focused care are reflected in the design of individual patient rooms, says Stewart.
“Most of the rooms have a southern exposure to bring in as much natural light as possible. To honor this Chinese custom, we studied the hours of sunlight and shadows a room will receive throughout the year. Unlike the United States, where private hospital rooms are the norm, most of Huashan’s patient rooms have three beds and are intended to become a community of patients and families offering mutual support to one another. All of the beds are angled toward the windows, and headwalls extend to provide a degree of privacy when desired. A patient’s expectation of personal space is different from ours, and a patient in a private room might feel isolated. Culturally speaking, the design of the rooms makes sense.”
Huashan Hospital’s innovative design also brings new technology and efficiency to the caregiving process. Intraoperative operating suites combine MRI, surgery and DSA (digital subtraction angiography) in order to provide physicians with immediate feedback during surgery without having to transfer patients to separate rooms. Relatively new to China, intraoperative operating suites have become a state-of-the-art feature in a growing number of U.S. hospitals, where they save time and improve patient outcomes.
Designed to promote well-being
Huashan Hospital’s patient-focused design begins with the entrance lobby, which is arranged to reduce anxiety among inpatients, outpatients and visitors. Such a feature is especially important in China, where most healthcare services, even ordinary doctor’s visits, are delivered in a hospital setting and facilities can be crowded. At Huashan Hospital, natural light, clearly designated separate patient entrances and intuitive wayfinding promote a sense of well-being. The hospital’s thoughtful design separates inpatient circulation from public hallways and other areas used by individuals on their way to or from appointments with a doctor, a feature that guarantees greater privacy for patients and their families.
The design also satisfies Chinese-specific regulations, such as requiring strict separation of soiled materials from clean supplies and from patients and their families. The GS&P team designed soiled circulation flows through separate elevators and hallways to a dedicated mezzanine level, and eventually to a special dock where they are placed on trucks that travel along a dedicated route leading away from the hospital.
“There are many separate circulation routes that we have to map. This is part of the government review and is very intensive,” says Stewart. “It helps to ensure that patient and material flows are seamless all the way from the patient’s room to the main road.”
Huashan Hospital is designed with an emphasis on efficiency and will have optimal connections to future buildings in the International Medical City complex, including the GS&P-designed Shared Facility, which will be the central point for all logistical services including food, laundry and supplies, as well as diagnostic technology, treatment centers and surgery. As new specialty hospitals are constructed on the campus, they will connect to the Shared Facility and avoid the expense of duplicating those services.
“When we were working on the campus master plan, we spent countless hours making sure circulation was not only efficient, but also as stress-free as possible for visitors,” explains Kevin Kim, principal-in-charge for Huashan. “The same principles were naturally carried into our design process for the individual facilities. At this level we know it can have an immediate impact on staff efficiency and, ultimately, positive outcomes for the patients.”
Close adjacencies of related departments, a feature of many Western hospital designs, will create compact and efficient circulation and maximize operational relationships among the emergency room, imaging department, operating rooms and intensive care units. Huashan Hospital will also connect to the Shared Facility and future buildings through multiple levels above and below ground.
“Patients and staff will use sky bridges to transfer from one building to another. The public will use the ground level, and materials will move through a basement tunnel to facilitate logistics,” says Stewart. “You can actually drive to the Shared Facility completely underground. It’s similar to the Disney model. All this is happening without the public seeing it.”
The hospital’s design features gentle, organic curvatures that are expressed in modern materials. The team found inspiration in nature, and the design is intended to have a connection to the environment so the buildings appear to rise out of the ground.
“It’s designed to feel like there is ample green space—a park-like setting instead of urban sprawl,” explains Stewart. “Certain shapes repeat themselves, which provides a cohesive design and even subconsciously ties the elements together.”
“Most of our work overseas, particularly in China and Korea, has a strong emphasis on incorporating natural elements into the design, perhaps even stronger than patients see in the States,” adds Kim. “For instance, the open outdoor spaces—courtyards, gardens and such—are often so well integrated into the designs that they become a part of the buildings rather than just a secondary element or add-on.”
The connection to nature is strengthened by features that enhance the hospital and Shared Facility’s environmental sustainability. The most obvious is the green roof above each structure which consists of planter systems of living grasses, flowers and other small plants. GS&P has designed green roofs for healthcare facilities in the United States and recognized that such a feature would meet the client’s goal of reducing energy consumption.
“Sustainability is a key issue in China, and green roofs have wide-ranging benefits, from energy efficiency and controlling water runoff to extending the life of your roof,” says Stewart. “A green roof makes a clear connection to nature and is integral to our design. Sustainability is hard to see in a building. Sometimes you need a visual element that everyone can recognize.”
Also making a clear connection to Mother Nature is the south-facing glass façade. Made with high-efficiency glass to control solar heat gain, it incorporates exterior shading devices and beautifully accentuates the design’s natural elements.
Becoming a reality
Originally hired to perform a feasibility study for the Shanghai International Medical City campus, GS&P was ultimately commissioned to prepare the master plan. The team is now working on the design of individual buildings and looks forward to its growing international presence.
“The International Medical City has evolved over many years and it’s exciting to see Huashan Hospital come out of the master plan to become Shanghai’s newest healthcare facility. It represents an opportunity for the city to project an image of a thriving, dynamic and modern metropolis,” says Kim.
“Even the materials selected for the hospital convey the understanding that it is strong technologically,” says Stewart. “You’ll know when you walk in that you are going to get the best care. It’s exciting for all of us to see the campus begin to take shape.”