A Case Study from the UK

A Case Study from the UK

By Doug Olson, AIA, RIBA

Stevenage Independent Sector Treatment Centre (ISTC) 
Hertfordshire, UK (Campus of Lister Hospital) 
FaulknerBrowns | Chong Partners LLP 
60,000 square feet 
Scheduled for completion in October 2007

The design for this new surgical/diagnostic facility responds to private financing initiatives (PFI) recently introduced to serve the United Kingdom (UK)’s public healthcare system. Working as a part of a larger UK business consortium chosen to develop, staff and operate the facility, the design team tested and implemented an innovative modular design with a flexible skin.

The National Health Service (NHS) launched this latest PFI program to create a new class of small surgical centers where doctors can perform minor procedures that may require overnight stays. The PFI program is part of the NHS’s transition to decentralization, and the Independent Sector Treatment Centre (ISTC) at Stevenage is a program forerunner. The well-received design approach is potentially applicable to multiple ISTCs proposed throughout the UK.

Healthcare is an environment of change. Programs fluctuate. If a medical planner or healthcare provider makes a late request for a room or wing to be moved, the change disrupts design. To meet this challenge, the team developed an exterior kit of parts that accommodates plan adjustments during design and construction, and throughout the life of the treatment center.

The select group of fixed external envelope components works with an internal partition modular system (approximately 3.3 m x 12 m x 3.8 m). A palette of high-quality materials was carefully composed on a regular modular steel framework, and includes color-coated metal panels, cedar boarding, fixed and center-pivot windows, and double-glazed curtain-wall.

Materials and window treatments were chosen that would suit site context and retain aesthetic appeal in multiple configurations. Two types of panel materials are provided: metal to correspond with exterior service areas, and cedar slats for exterior areas with pedestrian traffic. Four window/ treatment types are each codified with a room type. Thus, the exterior cladding acts as a “flexible skin.” Program components can be shifted along a 600 mm grid; when a room or wing is moved, the appropriate exterior has the ability to move with it. This approach has been likened to an improvisational jazz ensemble over that of an orchestrated symphony.

While using the modular design did not reduce the cost of the facility, it did reduce the construction schedule by six weeks, allowing the operation to begin producing important revenues earlier.

Located on the southern edge of the Lister Hospital campus, the Stevenage ISTC is situated behind mature trees that line a thoroughfare between the hospital campus and the residential community. By testing and developing off-site modular techniques, the design team addressed the needs of a constricted brown field site while also delivering high-quality finishes for rapid assembly.

A corridor directly connects the ground hospital floor to Level 2 of the new building and enables pedestrian access from a nearby bus stop. The building mass synthesizes the internal program with the site by providing a covered loggia at the drop-off area. The loggia wraps around the building, connecting to covered ground-level parking. The top level is set back in response to the facing residential neighborhood and creates a dynamic south-facing frontage.

The 60,000-square-foot facility is located on the south edge of the Lister Hospital campus and includes space for recovery, pre-op, five operating rooms (ORs), 20 inpatient beds, and an endoscopy suite. It will be operated by the East and North Hertfordshire National Health Service Trust. The UK consortium, Clinicenta, developed the PFI package and will later staff and operate the facility in a lease-back financing arrangement, enabling the NHS to take over the facility at the end of their lease.

The team also chose from adjacency models reflecting a blend of UK and US clinical standards. For example, anesthesiology functions in the UK are typically placed within ORs. Designers determined that dedicated anesthesiology bays away from the OR would support better staff work flow. Using the latest 3D design medium, planners explored these design possibilities in real time along with clients.

Level 1 provides delivery access and houses main reception and initial consultation areas. Level 2 accommodates ORs, adult and pediatric pre-op and recovery areas, and the endoscopy suite. With three distinct departments performing invasive procedures, Level 2 presented the most complex challenges for planning and circulation flow to move patients through procedures.

Harmony of circulation was achieved in each department at Level 2. The patient moves in a clockwise fashion from pre-op/anesthesia component to surgery and recovery, and returns the way they came, avoiding back tracking and cross over.

One-way, separated circulation is also provided. Endoscopy procedure and recovery areas are adjacent to maximize patient privacy. Patients check in at ground level and take an elevator to grade level sub-waiting. They then move to a pre-procedure consultation room and prep/recovery bay to change into a gown before being escorted to the endoscopy procedure.

Level 3 includes 20 inpatient beds, support areas, and the main mechanical room, which is primarily segregated from the inpatient areas by an external mechanical deck/roof area and deliberately situated above the OR block for more efficient service distribution.

Through the use of solar reflective glass, building setbacks and by making best use of natural ventilation, the building is cooled and ventilated naturally (except where mechanical ventilation is required, such as in procedure and treatment rooms). Natural light and ventilation also infuse the main corridors as well as rooms on the perimeter.

Like the exterior, the interior relies on a kit of parts. For example, reception desk identifiers incorporate a thickened medium-density fiberboard wall and an overlapping glass panel that connects to a thin linear soffit punctuated with a single pendant light fixture. Branding walls with graphics and logo announce nearby treatment rooms. If a room is moved, it remains well-oriented and clearly identifiable from reception.

To establish a natural way of way-finding, designers suppressed their urge to add elements not contributing to clarity. Wall surfaces are set back to make treatment room entries more prominent.

The pediatric waiting area was designed with special sensitivity. Outdoor play space is provided on Level 2 adjacent to the waiting area and play room. Tall glass panels and wood screening create a safe environment, while soft colors offer a calming atmosphere appropriate for children facing or recovering from surgery.

This project proves that modular design can be used to create flexible, functional healthcare facilities. As one of the first ISTCs to enter the pipeline, this project introduces an innovative design approach that supports the continued success of PFIs in the UK. The project also takes advantage of the best medical planning efficiencies from North America and the United Kingdom, suggesting new healthcare models for both sides of the Atlantic.