Emergency Renewal: Renew Sinai – Phase 3A Emergency Department Renovation, Toronto, Ontario

A Toronto emergency department exemplifies how hospitals can help heal through human-centred design.

PROJECT Renew Sinai – Phase 3A Emergency Department Renovation, Toronto, Ontario


TEXT Naomi Kriss

PHOTOS Tom Arban

As my parents’ health slid into serious decline over the past few years, I have become a regular visitor to a handful of downtown Toronto’s hospitals and emergency departments. I’ve built a career immersed in understanding and developing narratives about how design contributes to creating a better world. So during those long visits, I became curious about healthcare environments and their impact on visitors—as well as on the staff for whom these are daily workplaces. Unfortunately, many of Toronto’s hospitals feel less than great. Soaring atriums lack human scale. Infantile colours and inelegant signage make a feeble attempt to deliver warmth. There’s a corporate stiffness. What happened to the idea that hospitals can heal through human-centred design? 

Mount Sinai’s revamped emergency department, developed in tight consultation with hospital staff and clinicians, includes a smaller triage area, increased number of examination rooms, and in-department diagnostics—part of an integrated process of guiding patients more efficiently towards care providers.

But when I took my critically ill father to the new Schwartz/Reisman Emergency Centre at Mount Sinai Hospital, I encountered a highly considered environment. We arrived by ambulance, were swiftly processed through triage, and shown into a spacious private examination room. As we rolled my father’s gurney through the emergency department, I noticed how clean and fresh it was and how the ceilings—an often-overlooked plane, but one a person notices so often in hospitals—was thoughtfully designed with seamlessly integrated lights and vents, and canopies clad with a wood-look laminate. In lieu of standard blue privacy curtains, we entered through an acoustically separating, sliding glass door. An unexpected clerestory window brought in rays of sunlight while still maintaining our sense of shelter and privacy. The room was quietly neutral with more of the wood-like panelling which emitted warmth and reassurance. Equipment offered pops of colour. The room had its own sink. A headwall panel above the bed neatly organized equipment and switches. For the first time in months, I exhaled.

Mount Sinai Hospital plays a vital role in the lives of many Torontonians, while also conducting world-class research and training. To do so effectively, its facilities need to feel fresh and exemplify leading standards. Since 2009, Stantec Architecture’s Gail Hannah and Michael Moxam have been collaborating with a close-knit team of seasoned Mount Sinai administrative and clinical staff on renovations throughout the hospital’s 1953 building. This effort has required nothing short of military-style planning, with over 150 sequenced phases and temporary “decants and relocates” to upgrade the hospital while maintaining ongoing 24/7 operations. According to Dr. David Dushenski, Chief of Emergency Medicine at Sinai Health, following a renovation in 2000, the hospital had exceeded the emergency department’s capabilities within only four years. The new emergency department (ED) is now nearing completion, after seven years of phased construction. 

Touring the ED with representatives from Stantec and Mount Sinai, I learned how this kind of project requires close partnerships, deep listening, and patience to combine clinical and design requirements. The team’s challenges are on par with a complex urban intervention: a deliberately protracted schedule, zero-downtime, multiple experts, stakeholders and sub-consultants, and additional code requirements, especially to meet Infection Prevention and Control Canada (IPAC) standards. This project also involved repurposing functional spaces. To double the ED footprint to 2,230 square metres, they absorbed areas previously occupied by elective surgery and administrative offices. Technological requirements add further complications, particularly when working within an existing floor slab. There’s no room for designers to take experimental risks nor make trendy choices that will quickly age the space. 

Examination rooms include acoustically separating sliding glass doors, providing greater privacy than standard hospital curtains. The rooms are arrayed along the building’s perimeter, allowing for clerestory windows to bring in daylight, while woodgrain ceilings and wall panels deliver 
a sense of warmth.

This is also the kind of project that requires a certain nimbleness. As Dr. Dushenski explained, healthcare design is both linear and non-linear: “We do our planning at a fixed point in time, but the protracted schedule doesn’t slow down for us to incorporate technical innovations and clinical technologies. So midstream during a project, we sometimes need to improve on best practices, add new and important features, or adjust for new requirements.” 

The project began with an exercise in research and development, in which Stantec’s team evaluated design concepts and considered future scenarios, such as evolving technologies. They developed full-scale mock-ups of critical spaces complete with materials and equipment—including the very room that my father and I were waiting in—so that users could experience what it would be like to manage and treat people there. “That exercise greatly informed a lot of the design outcomes,” Gail Hannah explained. “It also helped the clinical staff, who aren’t accustomed to reading architectural drawings, to understand what they were getting.” 

A key criterion for evaluating an ED is speed of service. When the final phase of the project is complete, ambulance and drop-off patients will arrive through a newly constructed emergency driveway, and enter through dedicated doors to help alleviate congestion. The triage waiting room is intentionally smaller than it was previously, part of an integrated process of guiding patients more quickly towards providers.
An overhead monitor outlines the check-in process—in which patients are registered in the hospital’s system, enabling care such as bloodwork or an intravenous drip to be ordered right away—and indicates where patients are in the queue. 

To help expedite service, Mount Sinai increased its examination rooms from 37 to 52, and there are now dedicated rooms for specialized services within the department such as ophthalmology and dentistry, and even CT scans and X-rays so that patients do not need to be transported elsewhere within the hospital, nor interrupt regularly scheduled services. I was told that with this renovation, Mount Sinai is Canada’s first ED to have dedicated in-house diagnostic services. Standardized examination rooms accelerate both service and safety, as staff are always familiar with the placement of equipment and other elements. And Mount Sinai’s “nobody owns a bed” philosophy means that between examinations or consultations, patients are directed to internal waiting areas, freeing rooms for other patients.

Another critical indicator of success is an ED’s ability to induce calm. With the new design, instead of being told to go to the perhaps stress-inducing “acute care waiting area,” patients wait in the “yellow zone”—indicated by yellow lines on the floor and a supersized photograph with yellow hues. These photographs, superimposed onto fibre-reinforced laminate (a durable material only recently approved by IPAC), multitask as wayfinding and stress-relieving distractions. 

Interestingly, the ED is not as laden with technology as I expected. Monitors similar to those in an airport indicate where everybody in the department is located, when a room needs to be cleaned, or if a patient needs assistance. The examination rooms are outfitted with computers, enabling a full-scale switch to digital charting. In some cases, there was a deliberate effort to reduce the presence of technology: for example, high-security staff phones substitute for overhead intercom pages to minimize extraneous noise pollution.

Over the past few years, mental health care has become an increasingly important aspect of emergency health. The final phase of Mount Sinai’s ED will reveal a dedicated pod for patients experiencing behavioural and substance issues. This contained unit is designed to help keep both patients and staff safe, and incorporates more soothing design elements. 

When I asked the team what they were particularly proud of, I was ushered into the resuscitation room—the most critical space within the ED. This operating room was almost completed when the Covid pandemic struck, and the team needed to reverse its approach. Previously, patient, clinicians and equipment were all within the room. But the IPAC requirements switched to allowing only essential people and equipment. It was challenging to quickly design a response that met the needs of both the clinicians and IPAC. The solution features an operating room with an anteroom and equipment room divided by glass partitions, so that a supporting team can feed the necessary equipment into the operating room as needed. The teams communicate via intercom, as well as via a whiteboard—the latter proved to offer the quickest and clearest form of communication when one is dressed in full PPE. According to Dr. Dushenski, “This space has fundamentally changed the way that we do critical care in emergency medicine.”

As my visits to the hospitals increased, I came to realize that when it comes to design, the primary users are the physicians, nurses, and allied health professionals for whom they are a regular workplace. While patient care is top of mind, in the hospital, design excellence is determined by how the space can support medical services to be delivered quickly, safely, and effectively, under what are often the most intense and life-changing circumstances. A clinician’s ability to cope, respond and perform effectively under pressure is deeply dependant on the design. So much is determined by clinical and code requirements that investment in more nuanced design details might otherwise fall to the wayside. However, the thoughtfulness applied to these areas has a subtle yet important impact on everyone’s wellbeing. This is why the Mount Sinai ED excels—much of its design is exceptional for both staff and patients.

Naomi Kriss is the founder of Kriss Communications, a consultancy that aims to broaden national and global awareness of contemporary Canadian architecture and design. Since 2020, Naomi has also been exploring ways to leverage her skills to improve the design of healthcare and wellness environments.

CLIENT Sinai Health System | ARCHITECT TEAM John Steven FRAIC, Michael Moxam, FRAIC, Gail Hannah MRAIC, Mark Pitman, Sylvia Kim MRAIC, Brian Moeller MRAIC, Norma Angel MRAIC, Nicolas Correa-Corrilla, Steve Moore, Arshad Siddiqui MRAIC, Anthony Lue, Baria Abu Ghoush, Damir Kusec, Ena Kenny, Jane Wigle, Jim McCullam, Ko Van Klaveren, Laurena Clark, Lloyd Hilgers, Nancy Lindsay, Richard Eaves, Sarah O’Connor-Hassan, Sylvina Jones-Noel | STRUCTURAL Entuitive | MECHANICAL/ELECTRICAL H.H.Angus & Associates | LANDSCAPE Stantec | INTERIORS Stantec | CONTRACTOR Ellis Don | AREA 2,468 m2 | BUDGET Withheld | COMPLETION Summer 2024

As appeared in the June 2024 issue of Canadian Architect magazine