In 1997, North Bay architect Brian Bertrand sat down with his colleague Glenn Scanlan and a blank piece of paper. They set out to design a different kind of hospital. The place Bertrand envisaged would focus less on sickness, and more on healing.
His vision became a reality in 2011, with the opening of North Bay’s Regional Health Centre, now recognized as a pioneering step forward in hospital design. It introduced a number of firsts for Canadian hospitals, including circulating fresh air in every room and the use of timber as a prominent material throughout the building. It was one of the first Canadian hospitals to achieve LEED certification.
Other healthcare facilities are now following North Bay’s lead. Since the opening of NBRHC, the wellness-oriented approach to design has become the standard for new hospitals in Ontario. Instead of the dreary wards and dark corridors typically associated with a hospital, the emphasis is increasingly on natural light, communal spaces, fresh air and imaginative materials. Recent projects that exhibit the current thinking include Toronto’s Bridgepoint Active Healthcare hospital, opened in 2013; the Niagara Health Systems St. Catharines site (also opened in 2013); and the new Providence Care hospital in Kingston.
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Ontario now requires hospital redevelopment projects to conduct a “post-occupancy evaluation,” which assesses how a building has performed and interacts with people. Similarly, Infrastructure Ontario, the provincial agency that oversees public infrastructure projects including the construction of hospitals, directs applicants to include a user experience component in proposals for new buildings.
As hospitals enhance their built environments, they’re also gathering data about how the changes affect patient outcomes, according to the Toronto-based research firm that conducted the post-occupancy evaluation of Bridgepoint. “We are now embedded on design teams, with the architectural firms that bid on projects,” says Celeste Alvaro, principal and founder of Methologica, which works with healthcare facilities to evaluate the effects of design. “Each hospital presents a new opportunity to study some of the same measures over time, but also to develop new ones that make sense for each site.”
Methologica’s post-occupancy report of Bridgepoint in 2015 marked the first time that the user experience was included in the evaluation of a new hospital. Instead of just measuring obvious medical outcomes as they relate to design — infection rates and numbers of slips and falls, for example — Alvaro and her team asked patients and staff how they felt about being in the hospital. They studied patients’ sense of connection to nature, whether the hospital’s occupants were proud of their environment, and how they felt it affected their mental health. They also quietly observed how patients and staff responded to various design elements, such as the rooftop terrace, and how people interacted in communal gathering spots such as the cafeteria.
Alvaro’s team found that windows were important to patients’ well-being, for example. When they were able to enjoy views of nature and city life, patients became more comfortable in their hospital surroundings and more optimistic about their prospects for recovery.
Bridgepoint’s imaginative rooftop terrace, with its steps, ramps and walking paths, served as a good rehab space for patients, encouraging them to take more exercise and other forms of physical therapy on their own time. “It was an unintended outcome,” says Deyan Kostovski, communication strategist for Methologica. “Nobody expected that the patients would be out on the rooftop extending their therapy.”
Staff burnout also decreased.
Methologica’s post-occupancy evaluation of Bridgepoint has become a rubric for others. The next step, according to the firm, is to standardize how hospitals evaluate design and to share the data in an accessible way. Methologica is now working with the Canadian Standards Association to develop a common framework and standardized tools for studying hospitals across the country. Lessons learned from a rural hospital in Saskatchewan for example, could be transferable to an urban hospital in another province, and vice versa.
Back in North Bay, the design task was especially challenging because the facility was the first in Canada to combine an advanced specialized mental health facility and an acute care hospital. “That brought a whole set of unique challenges in terms of various population types living under one roof,” Bertrand says. Some patients are in hospital by court order, so NBRHC had to figure out how to apply different security levels in different areas while still allowing for co-mingling in communal spaces.
The mental health area of the hospital demonstrates the potential of design to reduce stigma. According to Bertrand, the floor plan for the old Northeast Mental Health Centre had been copied from a jail in New Brunswick. “It was very austere, and if you weren’t sick when you went in there you were certainly sick once you [were admitted],” he says. For the new hospital, Bertrand and his colleagues used evidence-based research to build a mental health facility that fostered independence and privacy, but also engagement with other people. Patients have their own apartment-like rooms, but there are also public spaces where they can engage in normal activities of daily life, like going to the bank or getting a haircut. Thanks to these design elements, Bertrand says, a growing number of patients have been able to move out of the hospital and back into the community.
The integrative design philosophy applied in North Bay was similarly applied in the construction of the Providence Care Hospital in Kingston. As in North Bay, the new Kingston facility combines a mix of patient services, including mental health care, physical rehabilitation, complex care and palliative care.
The concept of architecture as treatment is not new. During the Crimean war, Florence Nightingale, a 19th-century British nursing pioneer, observed that overcrowded army barracks, with poor air circulation became breeding grounds for infection and disease. She advocated for adequate ventilation and reducing overcrowding. Mortality rates dropped sharply as her ideas were implemented. Another medical pioneer, Jonas Salk, credited the architecture of Assisi, Italy with helping to inspire him when developing the polio vaccine.
By thinking of themselves as places of well-being rather than sickness, Ontario hospitals are re-learning an old lesson. As Bertrand says, “A well-designed environment has a radical impact on people’s health.”
Kylie Gionet is a Munk Fellow in Global Journalism.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.