Overseas Observations

Naturally, architecture, sustainability, and culturally driven design vary widely in healthcare facilities around the world; however, a number of commonalities still ring true from Melbourne, Australia, to Beijing to Tel Aviv, Israel, to London.

“As a general theme, we have come to validate the extremely important and universal role of natural illumination and daylight, a connection to the natural environment, openness and the simplicity of design within a successful hospital or healthcare environment,” says Allyn Stellmacher, AIA, LEED AP, and design partner with ZGF Architects in Seattle.

And while, generally speaking, Europe tends to be ahead of the sustainability curve, with the Middle East and China gaining ground, Jean Mah, FAIA, FACHA, LEED AP, and principal of Los Angeles-based Perkins+Will, says green design has become a significantly growing trend across the board. “There is more focus on conservation and reuse of water, less demand for air-conditioning and growing interest in generating less waste and recycling more. In fact, many projects are self-sufficient, with their own sewage treatment plant, water treatment, and/or electrical generation,” she says.

Sustainability aside, before taking a snapshot of healthcare trends in different regions of the world, Mah says it's also important to note the significant and unique role that culture, climate, and locally available resources play in the overseas healthcare design process.

“Cultural issues such as family size, distance to the healthcare facility, separation of sexes, privacy norms, and esteem for nurses and other nonphysician providers can have a significant impact on facility design,” Mah says. Consequently, things like larger waiting areas and gender-segregated wings will affect building configuration, wayfinding, and access.

Middle East

Perhaps the place where culture plays in most significantly is the Middle East. As a result, preferences for privacy, lounging, and visiting must all be accommodated, while, simultaneously, facilities must consider the fast-growing, diverse, and foreigner-based populations of places like Israel and the Persian Gulf states, says Michael Arnold, AIA, and senior principal with Stantec of Philadelphia.

Another interesting trend, Arnold adds, is the explosion of technology in some of these developing countries. The desire to establish world-class medical centers is coupled with an absence of legacy systems, allowing technological change to occur fairly rapidly.

“Unlike their U.S. counterparts, they are not afraid to take aggressive stands on incorporating technology, because they see technology as an avenue that allows them to leapfrog competitors in the U.S. and the U.K. Consequently, the concept of high-tech and high-touch are on full display in hospitals in the Middle East,” says Henry Chao, healthcare practice design principal with HOK of New York City.

However, these hospitals must deal with operational challenges, including the fact that a stable supply of replacement parts and other resources often found in North America and Western Europe is not conveniently available to the Middle East. Similarly, naturally based resources and construction materials-with the exception of concrete and stone-are largely absent in the region. As a result, the vast majority of materials, finishes, and building systems are commonly imported from the Far East and Europe.

At the same time, considering the hot, intense Middle Eastern sun, “most materials are selected for their lifecycle and maintenance, as they are subjected to harsh environments,” says Norman Soto, AIA, MRAIC, principal/director of healthcare for the Middle East/North Africa region for Burt Hill.

Similarly, building orientation, glazing, shading, and insulation materials with a high R-value are critical to keeping solar heat gain in check. “An understanding of severe temperature peaks and the mechanical systems capabilities to condition zones differently throughout the building-as well as the lighting schemes-combined with a design strategy that responds to harsh wind, sand storms, and dust build-up present the project team with design and construction challenges of the highest degrees,” Arnold says.