Designing a modern, state-of-the-art hospital on a greenfield site presents sounds like a golden opportunity but also came with challenges, as Ray Philpott reports.
Tasked with creating a district general hospital that provides an uplifting, positive experience for people using it, the architects who designed it have skilfully utilised its attractive semi-rural location.
Conceived as a woodland campus concept, the new Dumfries and Galloway Royal Infirmary is an aesthetically appeal- ing, well-organised, user-friendly, low-rise design that brings ‘the outside in’ while being sympathetic to its surroundings.
The hospital will serve many small, widespread and diverse communities within the 2,400 square miles covered by NHS Dumfries and Galloway in Scotland’s South West and is centrally sited in a semi-rural location off the A75 road.
Architecturally, the facility comprises three core elements. A central diagnostic and treatment ‘bar’ is the primary component, forming the backbone of the campus. Extending out from behind the linear-shaped bar and projecting into the landscape, are three independently linked pavilions of inpatient accommodation. A triple-sided Women and Children’s Unit – featuring a curved outward-facing facade and internal courtyard – adjoins the main building.
The district general hospital has been designed by Ryder Architecture in collaboration with NBBJ, to meet the increasingly sophisticated healthcare needs of the region’s growing and ageing population. The current district hospital in Dumfries itself cannot realistically be expected to meet demand long-term.
Medical facilities in the main building include a combined assessment unit, accident and emergency facility (A&E), a surgical complex with four major operating theatres, oncology and critical care units, and an outpatient centre.
The £212m hospital was procured under the Scottish Government Non-Profit Distributing (NPD) model, with Ryder as the lead architect collaborating with NBBJ and Laing O’Rourke as main contractor.
Designing a greenfield hospital from the ground up sounds like an architect’s dream but the team had to ensure they also met the detailed healthcare requirements and be sympathetic to an earlier ‘reference design’ the board had drawn up to obtain outline planning approval.
Working closely with the board, the practice evolved a series of key objectives into four core themes that informed and underpinned the architecture and interior design, with a strong emphasis on quality.
Firstly, the design needed to be people- centred, attractive and provide uplifting and therapeutic environments with natural views and plenty of good quality daylight. Secondly it had to facilitate efficient operation, good space utilisation, clear wayfinding, innovative use of IT, long-term flexibility and easy analysis of clinical workflows. Creating a safe, welcoming and accessible building and enabling staff to deliver effective care formed the remaining themes.
Bearing these in mind, Ryder and NBBJ looked at the reference design to see where they could improve it, as partner Paul Bell explains.
“The board’s aspiration to have an integrated emergency care centre hadn’t been realised as the combined assessment unit and A&E were quite separate. We redesigned the emergency care area to incorporate the combined assessment unit, which in turn meant we could bring the ward buildings much closer to the diagnostic assessment ‘bar,’ reducing key internal travel distances and improving clinical efficiency.”
The architects also segregated the main internal circulations by floor to avoid creating shared flows or cross-flow clashes. Now, the majority of outpatient and visitor movement happens at ground floor, while the inpatient flow, linking the surgical wards and maternity wards to the operating theatre suites and critical care units, is on the first floor. Facilities management-related traffic happens at lower-ground level. Circulation routes include rest spaces for older users and areas designed to promote interaction between hospital disciplines.
“A key design move was ensuring the main and emergency care centre entrance could both be seen on arrival, so we created a clear ‘decision point’ at the entrance to the campus. In the reference design the position of the Women and Children’s Unit blocked visibility of the emergency care entrance, so we moved it to give a clear route to emergency care.
“Repositioning the Women and Children’s Unit allowed us to locate its entrance immediately adjacent to the main hospital entrance, sharing a canopied entrance plaza to improve wayfinding.”
Nestling in a semi-rural location, the external appearance of the building has been shaped to be sympathetic to its surroundings.
The precast panels on the main building facias are honey-coloured, reflecting the Glasgow Blonde stone frequently used in south west Scotland. A reconstituted stone finish similar to white Galloway granite gives a contrasting, lighter treatment to the inpatient pavilions and Women and Children’s Unit uses.
Pitched-style roofing is used throughout the development to break up the mass of the building, so that it sits comfortably within the hillsides and woodlands stretching from the south west to the north east of the campus.
The gables formed by the pitched roofs are clad with angled concrete panels reflecting the woodland campus idea, with three different designs for the wards, diagnostic and treatment building and Women and Children’s Unit.
“Our intention has always been that each of the three ‘fingers’ of ward buildings projecting south west from the diagnostic and treatment centre, should create an impression of a series of pavilions,” says Bell.
“Ward accommodation comprises a series of single, en-suite bedrooms in low-height structures naturally dictating a long, linear shape for the ward buildings. We broke up this linearity by incorporating vertical dormer features along the sides of each finger. These are public circulation areas – day space – with large oriel windows allowing extensive daylight penetration.
“Additionally, each ward room features large, tall windows running from the ceiling almost to the floors to punctuate the linearity, while giving patients attractive landscape views from their beds and a good source of daylight.”
Natural light streams through two large, unglazed rectangular openings in the roof of each ward building roof, creating light wells inside. The well walls are glazed, forming open courtyards in the wards, giving staff views across from one corridor to another to help them observe patients or see if colleagues need support.
“Integration of the internal environment with the natural landscape is a crucial component of the project, as is the landscaping on the campus in general,” says Bell. “We liaised extensively with landscape architects Fira, to meet the requirement.”
“Between each ward building are spacious accessible gardens where patients can experience various garden environment spaces, paths and glades, some used for therapy purposes, others for walking. The relatively loose grouping of the buildings also permits landscape views for people inside. The central courtyard of the women and children’s unit also has a planting area.
“Palliative care rooms have their own garden terrace, and beds can be taken onto them so patients can experience the external environment,” says Bell. “The courtyard at the centre of the Women and Children’s unit is generously proportioned and attractively landscaped to include children’s play spaces and quieter areas.
Car parking is in curved lines on the site’s eastern side, softened with extensive planting that extends beyond the perimeter to form a green barrier to the light commercial buildings beyond.
The main entrance reception has a suspended wooden ceiling and is lit from above by a long row of skylights and aluminium-framed curtain wall glazing with countryside views. Bell points out: “This creates a pleasant welcome to the hospital, and from there the obvious primary circulation routes make it is easy to find the wards and other inpatient and outpatient services. The many attractive gardens and landscaped spaces across the campus also act as memory points for navigation.”
A ground floor cafe with views over the landscaping features decorative glass partitioning featuring artwork by Scottish artist Liz Myhill, whose designs also appear on glazing elsewhere in the main building. Like the wards, the main building features a number of light wells to bring additional daylight in.
Gas and combined heat and power generators provide electricity and hot water, with excess heat recycled via underfloor heating in the larger ground floor spaces.
A mixture of opening windows and mechanical ventilation control the interior environment, and there is a plan to
supply much of the water from a natural aquifer under the site. These features, combined with excellent insulation, LED lighting and appropriate solar-controlled glazing, have resulted in a BREEAM Very Good rating.
All structures have piled foundations and are concrete-framed with high- quality precast concrete panels with architectural finishes on the facades. Steel frames create the pavilion shapes, topped with grey aluminium or zinc standing seam metal roofing.
The building extensively uses offsite-manufactured, precast components – a speciality of Laing O’Rourke – bringing the benefits of quick, accurate and cost- effective construction.
A ‘hospital without compromise’
With the building now firmly on target for completion in September, Bell says: “We set out to deliver a hospital without compro- mise to provide excellent healthcare for people in the region. A hospital that maximises the potential of its wonderful location by bringing the qualities of the surrounding landscape into the site and capturing the healing properties of light and views to nature, to provide excellent health- care for people in the region.
“The successful delivery of a project on this scale within such a demanding programme, will be a significant achievement only made possible by a great team effort.
“We hope we’ve created an uplifting, healing campus environment offering an attractive and highly effective setting for patients, staff and visitors – a truly person-centred hospital.”
Client: NHS Dumfries and Galloway
Architect: Ryder Architecture in collaboration with NBBJ
Main contractor: Laing O’Rourke
Structural engineer: WSP
MEP engineer: Hoare Lea
Campus size: 50 acres
Total building area: 65,000 m²
Number of beds: 344
Staff on site: 2,000 (approximately)
Population served: 148,000
Overall project value: £212m
Car parking spaces: almost 1,000
Work commenced: February 2015