June 2010

Braga’s Private Hospital, one of the first expansion projects of Trofa Saúde in northern Portugal, was an innovator. 
Developed in a pre-financial-crisis period, and built right through its worst, it was developed as a Finance & Design & Build contract, joining together a collection of companies, from a major bank, an important contractor and a plethora of engineering firms plus RSO at the helm of the design. The mandate to the designer was simple yet daunting: to accommodate a demanding medical planning that would challenge the Ministry of Health standards, into a building that would exceed all environmental norms of the day, within a budget that could not vary more than 3%, at the designer’s risk. A process that would take almost for years from inception to the hospital opening.

Sterile Core

Right at the start, the medical surgeon in charge of the hospital medical planning insisted in applying a design principal that although relatively common in the USA, wasn’t yet recognized as good practice in southern Europe: a sterile core instead of a dirty corridor concept for the surgical department. RSO gladly took the task and proceeded with contacting the Ministry of Health projects department, to explain the concept and present the evidence that proved the superior performance in terms of infection control. A commission of architects, engineers and nurses was then created at the Ministry and finally gave us a green light, creating a great precedent for the country.

Evidence Based Design

RSO was also able to introduce to the market another innovative concept yet to be disseminated in Europe at the time. The simple yet remarkably successful principles of EBD were introduced, especially in the design of the bedrooms, where the color scheme, the height of the windows that allow for a clear external view of nature for the patient lying in bed, the introduction of a sleep-in couch in a niche by the window, careful attention to the acoustical properties of the materials, all emphasized the importance of having the patient rest and well being at the center of the design.

Way Finding the Sun

A careful approach was also given to the design of the wayfinding system, that for the first time went above the simple graphic design of the signs maps and symbols, but also introduced notions of spatial orientation tailored for the impaired and the distressed. Navigation in the hospital is therefore made in an intuitive way around landmark gathering points, organized in sequence, always with a multi sensorial experience that is unique to each landmark space so it reinforces easy and instant memorization of where you are within the building, by using different colors and shapes, and by always introducing sunlight and a view of nature facing south, so that the mental map we all create can be automatically readjusted to where you are not only inside the building, but also in relation to the outside. A successful multisensorial wayfinding design such as the one pioneered in this design allows for a smoother and less stressful navigation of the hospital, reducing anxiety and saving time for all visitors and staff alike.

Grand Gestures

The notion of flexible design in healthcare design is an endless quest that deals with the rigidity and permanence of the building forms and materials and how its stands in the way of the ever-changing medical technology and practice. It is said that if a building shell and core life span is usually of 50 years, and if its departmental organization and layout is appropriate up to 25 years, the room layout and the technology and equipment become obsolete in only 5 years. And this disparity baffles most project managers and healthcare developers that face the harsh reality of their building becoming obsolete even before construction is completed.
RSO’s design tried to address this challenge through a series of strategies: first, it used as much as possible a modular grid system, specially out of the inpatient bed and outpatient clinic towers. By not following the detailed architecture layout to place the columns but by designing within a grid, we liberate the design to change and evolve freely, both during the development but also after the construction is terminated; second, large 15.5m spans were introduced on the towers, with no internal columns tampering the layout of bed rooms and consultation rooms, plus freeing the ground floor even further by assembling those perimetral columns into V shaped concrete supports and by hanging in cables the 18m span between both towers, achieving a remarkable space free of structure for the public; third and most importantly, recognizing that change is inevitable, and that by designing a hospital as a city with streets and blocks, and keeping all major infrastructure within the street confines, whenever a renovation or alteration is due, no adjoining department will suffer in the same way that our neighbors don’t have their water supply cut just because we are building anew house on our plot.

Outstanding Performance

And finally in a long list of firsts, HPB was the first hospital ever to be declared a Partner of the European Commission Green Building Initiative, and set new standards in energy performance and efficiency, daylight management, air quality control way above the ones then required for office buildings in a time before such standards existed for hospitals and other healthcare designs.