October 1, 2015
by Steve DiPasquale
Modelled after a First Nations bentwood box, the Sechelt Hospital engaged its local community through an extensive consultative process in the design phase. The extension includes emergency facilities on the ground floor, topped by two wings of single-patient rooms.
HEALTH AND HEALING
PROJECT Sechelt Hospital Expansion, Sechelt, British Columbia
ARCHITECTS Farrow Partners in association with Perkins+Will
TEXT Steve DiPasquale
PHOTOS Andrew Latreille
With any luck, the architecture of our public institutions will come to reflect—and help shape—the most progressive social and cultural initiatives of our day. The recent addition to British Columbia’s Sechelt/Shíshálh Hospital (renamed from St. Mary’s) evinces these hopes. It tests its ambitions across a wide spectrum of concerns: espousing meaningful involvement from area First Nations, pursuing the first Lean design process on a new build by Vancouver Coastal Health, providing only single-patient rooms, reaching for net-zero energy targets, and producing a level of delight uncommon in North American health-care facilities.
Home to some 10,000 residents, the District Municipality of Sechelt is located about 50 kilometres northwest of Vancouver. Sechelt is the largest community on the Sunshine Coast, an area that’s part of British Columbia’s mainland but only accessible from Vancouver by ferry or plane. Around 1,200 locals identify as members of the Sechelt Indian Band or Shíshálh. Owing in part to their donation of 11.2 acres of land in 1962 for the purpose of building a local hospital, these First Nations interests are inextricably bound to the site. Before conferring the land, however, the Band first fought and won a court battle to secure legal title to the site, a parcel that was once the learning farm for the local residential school. Narratives from the period are all too familiar: degradation, abuse and malnourishment—particularly egregious in this case since food produced by the students was either sold or consumed by staff. Vancouver Coastal Health and the design team thus aimed to make sure that area First Nations were recognized as important stakeholders in the project, organizing a series of consultations with Shíshálh representatives, and commissioning interior and exterior artworks of substantial scale from native communities.
View of the new entrance.
Architects Farrow Partnership in association with Perkins+Will devised a T-shaped parti for the 5,400-square-metre addition. The volume to the east—a double-height glazed entrance and lobby—is distinguished by its transparency, while two adjoining bars form an L-shaped volume that incorporates inpatient rooms above and the diagnostics and emergency departments below. With all wings terminating at a single nexus, the designers were able to successfully separate out publicly accessible areas, helping to preserve the dignity of gown-wearing patients who invariably find themselves ambling along the corridors at some point during their stay. And where the deep floor plates in conventional hospital designs often result in a sharp falloff of natural light and a disorienting layout, the elegant planning and narrow volumes
of this project make wayfinding refreshingly easy.
A wood mural in the main lobby references traditional motifs from the local First Nations band.
Part of the scheme’s surety is the consequence of a unique, highly participatory design process. The hospital marks the first new build for which Vancouver Coastal Health implemented Lean planning procedures, an efficiency paradigm originally developed by Toyota and since adapted to domains including health care. By organizing rigorous design exercises that included architects and end users, the Lean team—in this case, comprising experienced nursing professionals and a civil engineer—aimed to optimize logistics, clarify staff roles, and ultimately craft a project that would support improved systems of care. To address the problem of conveying to future users the real-world implications of potential layouts, for instance, hospital personnel were invited to an airplane hangar for “live” trials. There, full-scale mockups of entire floor plans allowed staff to test work environments for sight lines, operational flows and task ergonomics. A formidable undertaking to be sure, but superlative in establishing the confidence to make critical design decisions.
Patient rooms are efficiently planned to include zones for family and staff members, as well as having operable windows.
Collaborative engagement, however, does not mean easy consensus. The designers found themselves lobbying for contentious positions—most significantly, a commitment to the merits of private inpatient rooms, which are comparatively expensive to construct. The architects argued that single-occupancy rooms reduced the number of disruptions during sleeping hours, reduced the likelihood of patients receiving medications in error, and reduced spread of infection. In the end, the design team was successful in their bid for single-patient rooms—all of which are unusually bright, well-sized, and feature operable windows. Apart from the quantifiable benefits, the inclusion of private facilities has also helped catalyze more systemic advantages. If single-patient rooms discourage the spread of contagion, they also discourage the spread of an agitated mood: one staff member contends that nurses working the night shift see a much calmer environment overall, and thus administer fewer sedatives to help settle patients. Another staff member goes further still, suggesting that the new addition has sparked a wholesale improvement in worker morale where “everyone is more accommodating with one another.”
Corridors are flooded with natural light.
In touring the facility and talking with its architects, it’s apparent that they’ve brought a level of sensitivity—and courage—achievable only with a strong sense of purpose. One of the project leads, Tye Farrow FRAIC, has thought a good deal about subtly reframing the aspirations of hospital design, pledging that the litmus test of any viable strategy is its capacity to “cause health.” If this seems a strange formulation, it’s because it is. This neologism and its cognate “salutogenic”—literally health-causing—work, in part, by provoking some rumination. The odd reversal asks that we replace the negative question embedded in codified systems of harm avoidance—“But how might this affect our health?”—with a much more ambitious, positive challenge—“Are we doing everything we can to effect health?” This is the more restless and possibly productive question, and could be rightly folded into popular practice as yet another layer of concern.
The lofty entry volume certainly bears the impress of this directive, offering an attractive alternative to the default appeal of the standard elevator lobby. Warm-toned wood plays through a sprawling sculpture, the curtain-wall backup system, and the straight-run stair. This binds the lobby space together and draws people in. One can watch as visitors of all ages enter the building, then gravitate toward the stair and climb its steps, likely never realizing they might have taken the lift.
Diagnostic and treatment rooms throughout the facility include clerestory windows.
Continuing on through its myriad departments, the most striking aspect of the project is that, at every turn, spaces are bathed in daylight. This is certainly the case in anticipated areas like public corridors, patient rooms, and the family gathering room—but sunlight also beams into less likely spaces. Where the designers actively reshape health care’s reigning gestalt is in their brave insistence on making places out of what are often a hospital’s most utilitarian zones. The elevator area becomes an inviting, even contemplative refuge by way of a well-placed skylight and a radius-edge wood bench. Two more skylights in the emergency room (one immediately outside the psych room) proffer an atmosphere more conducive to coping. A ribbon of tall clerestory windows illuminates the usually dim recesses of imaging, CT scans and ER alike.
The architects battled for these features, fighting not only a tangle of mechanical runs, but more impressively, facing off with entrenched cultures of work disposed to prefer conventional environments. (Project designers also pushed for a planted atrium in the ER, but were unable to win acceptance.) As one of the team’s architects, Kirsten Meissner, puts it, “We’re pushing to design hospitals that don’t look like hospitals.” Which is to say they’re aiming to realize a new institution shaped by a fuller empathy for patients, staff, visitors and community stakeholders.
Totem poles crafted by local artisans greet patients and visitors at the entrance to the new hospital addition.
Impressively, given the breadth of their aspirations, they have largely succeeded. Perhaps in only one instance, the design falls short. In landing on an exterior design language to countenance their hopes, the architects might have resisted abstracting the wood tones of their inspirational form driver—the bent cedar box of the Coast Salish peoples. This design decision does set off an intended dialogue between the earth tones of the cladding and the feathery grasses of the adjacent landscaping. However, somewhat to its detriment, the cladding also competes with the wood elements of the lobby space. Leaving the warmth of the entry volume to itself might have allowed it to speak even more clearly of the propitious changes taking place in contemporary health care, exemplified here in Sechelt.
Steve DiPasquale is an intern architect at HCMA Architecture + Design in Vancouver. He is currently working on an essay for the next Twenty + Change publication.