Building Health

PROJECT The John C. and Sally Horsfall Eaton Centre for Ambulatory Care at St. John’s Rehab Hospital, Toronto, Ontario
ARCHITECTS Montgomery Sisam Architects in joint venture with Farrow Partnership Architects
TEXT Paige Magarrey
 PHOTOS Tom Arban

Driving up its tree-lined thoroughfare in North York, St. John’s looks more like a turn-of-the-century resort then a rehab hospital. Blue striped canopies and meandering rose gardens flank the original structure, built in the late 1930s by the Sisterhood of St. John the Divine on a 25-acre farm as an embodiment of what health care should be. Eighty years–and a few more misguided (one might even argue unsuccessful) additions to the hospital–later, and the original building’s ideals are again being brought to light in a 4,500-square-metre expansion that illustrates how crucial the built environment can be to the wellness process.

Both Toronto firms involved in the project, Montgomery Sisam and the Farrow Partnership are well-versed in health-care design; among Montgomery Sisam’s recent completions is the LEED Gold-certified Sister Margaret Smith Addictions Treatment Centre in Thunder Bay. But the John C. and Sally Horsfall Eaton Centre for Ambulatory Care, the latest addition to the St. John’s Rehab Hospital, feels decidedly different. Completed earlier this year, the addition unites all the hospital’s outpatient facilities into a flexible, shoebox-style space designed to shift easily to new configurations and uses in the future. The team also negotiated new parking lots onto the site without disrupting too much of the natural surroundings, and shifted the main entrance from the original building (which was accessible only by stairs), to an accessible at-grade drop-off in the new wing. The new entrance sets the tone for the whole space: a glass-walled, light-filled atrium that overlooks a pristine courtyard, tightly nestled between the new wing on one side, and an older addition on the other. The “therapy garden,” accessible via the lower floor and completely at grade for wheelchairs, features immaculately tended greenery and lines of young trees that will eventually provide shade to strolling patients and staff. It’s these two elements, the entryway and the lush natural setting beyond that really connect back to the original structure’s English country manor-style back terrace and gardens, according to partners in charge Terry Montgomery and Tye Farrow. But rather than create a similar multi-level outdoor space, they instead opted to turn the idea “inside out,” says Farrow, and make the second-storey entrance atrium a kind of indoor veranda that soaks in views of the garden below, setting the tone of the space the minute patients come inside. “How can you just lose that anxiety that’s inherent in hospitals?” says Farrow. “You’re coming in anxious, something significant is happening to you. If you’re uncertain about something, your mind begins to fill in the blanks with what it sees and hears and smells. And so if you walk in here and you sit up looking out, and the light is beginning to bleed in, that communicates to you that you’re in good hands.”

Another important component to alleviating that tension involves helping patients to quickly orient themselves to the space with ample windows and wide corridors. In most hospital environments–and even in the other wings of St. John’s–the corridors are double-loaded in the centre of the space. “The circulation never touches the outside,” says Montgomery. “Unless someone has their door open and you see through their window, it’s hard to know where you are.” At St. John’s, they situated the main thoroughfare along the edge of the shoebox space, against a glazed exterior wall tracing the perimeter of the courtyard so that patients are connected to their surroundings throughout the space. And while most hospitals want to minimize corridors as much as possible–to gain more room for other areas and keep patients from walking too far–Farrow and Montgomery saw these hallways as important spaces to the design, particularly in a rehab hospital where patients are constantly using them for their therapy sessions and physio. “For us, these spaces are the nicest. They make the difference between a good design and a mediocre one,” says Montgomery.

The main corridor skirts around the open-concept rehab gym, which constitutes most of the wing’s second-floor space. A window into the busy space runs the length of the corridor, bringing in natural light and views of the courtyard. The opening also brings a sense of dignity; there was some concern that patients in the gym wouldn’t respond well to being so visible to passersby. “Do people want privacy? Do they want to be seen?” says Montgomery. “But I think that’s what this place is about. There’s no reason to be stigmatized about it.” Instead of complaining about the lack of privacy, patients are happy to have a connection to the outdoors. In fact, from inside the gym, the corridor space all but disappears and gives the appearance that the gym window leads directly outside (the team used a similar treatment in the reception area, where an interior window overlooking an exterior window in the therapy pool room brings sunlight deep into the building). Skirting around the gym’s periphery, the corridor leads to smaller clinic rooms and offices with floor-to-ceiling windows that further reduce the need for artificial light.

A staircase by the front entrance leads to the therapy pool below. Putting the staircase in a more conspicuous spot than the elevator goes against traditional hospital layout mantras, but it encourages patients to work toward convalescence and staff to stay active. It also doubles as training space for patients. Downstairs, the therapy pool room is clad in concrete and cedar panels for a distinctly spa-like feel. The team incorporated a ramp and an overhead lift for patients to use when getting into the water, as well as an inset walkway along the length of the pool that allows the therapists to be closer to eye level with their swimming patients. They also installed a floor-to-ceiling window with a cedar-slat privacy screen to bring in natural elements while still offering privacy. “The materials evoke a feeling of somewhere else,” says Farrow. “It doesn’t evoke hospital. It plays to your senses.”

The pool is a great example of an element ever-present in the project–a simple, natural palette of colours and materials like wood, brick and glass aimed at soothing the patients and keeping them rooted. It also creates a timeless aesthetic that won’t go out of style in a few years. Montgomery and Farrow also saw intangibles like natural light and the natural surroundings as part of the aesthetic palette and played with the way light and views would change during different times of day and through the seasons. Energy-efficient elements like LED lighting, energy recovery wheels in the air-handling units, and a building automation system that monitors energy usage throughout the wing–along with recycled steel, concrete, carpet, drywall and linoleum–also helped to keep costs down during and after construction.

It’s a complex design in a number of ways. It’s no surprise that Montgomery and Farrow spent months exploring every inch of the existing space and educating themselves on the needs of the patients. While there were few–if any–envelope-pushing rehab hospitals they could visit to develop their design concept (particularly for such specific areas as the therapy pool), they did have one lucky break. Due to the slow timeline of the project–they began discussing the project in 2001 but didn’
t start construction until 2010–they actually designed and built the Holland Bloorview Kids Rehabilitation Hospital in the meantime, which afforded them some experience in the building type and helped them to further develop their approach to architecture in the health-care realm.

“Architecture is that third element in the equation of healing,” says Farrow. “There’s what happens to you, the medical staff, and then what the environment can do to help as a healer. It’s part of the process.” Though it’s rarely in the brief that architecture can or should help evoke a sense of wellness, Montgomery and Farrow see it as a driver for the design. While the health-care industry is often focused on the pathogenic side of things, where the central concern is the cause of the problem, Farrow sees merit in flipping that focus around to zone in on salutogenics, which concerns the causes of health. “You begin to really look and see how the building can actively cause health,” he says. “The environment has a massive impact on what makes you feel good or not. What can we as a design team do to enhance the ability of people to perform better than what they might do otherwise?” In the case of St. John’s, it’s in the details: moving the staircase into a conspicuous spot, developing ample green space for people to spill outdoors, and flooding the indoors with natural light. This approach to health-care architecture is still in its earliest phases–evidence-based design that focuses on more traditional notions of healing is far more prevalent at the moment–but projects like St John’s are starting to generate irrefutable proof of the impact architecture can have on a patient’s recovery. And it doesn’t take much, says Montgomery: the wing was completed on time and under budget.

“Making a more pleasant setting doesn’t necessarily cost more. The most important room in this whole space is that one,” he says, pointing out the window at the tree-lined courtyard below. “And we got it for free.” CA

Paige Magarrey is a Toronto-based architecture and design writer.

Client St. John’s Rehab Hospital
Architect Team Terry Montgomery, Tye Farrow, Geordon Green, John Archondakis, James Mallinson, Marta Belcourt, Hong Kim, Laureen Wint, Ingrid Wimenta, Sebastian Spataro, Rosalie Dawson
Structural Halcrow Yolles
Mechanical/Electrical MMM Group
Landscape Vertechs Design
Interiors Montgomery Sisam Architects in joint venture with Farrow Partnership Architects
Contractor Buttcon Ltd.
Area 48,300 ft2
Budget $26 M
Completion November 2011