Enveloping change: Portugal's different healthcare mall
Cleveland Clinic Abu Dhabi Hospital Abu Dhabi, United Arab Emirates
Client: Sanusquali, SA
Architect: RSO Architecture, Braga, Portugal (http://www.rso.com.pt)
Total Project Area: 334,558 square meters above ground; 473,845 square meters below ground
Total Project Cost: 662,476,930 EUR
At RSO Architecture, we are developing a method that tries to identify and elaborate both the perennial and the transitory in healthcare projects. To illustrate, let's take a look at Casa da Saúde in Portugal, a healthcare mall that will be constructed in 25 different locations (and is a 1,238,000 EUR investment, the largest yet in this country). It will provide surgical and clinical ambulatory services, imaging, a health club, a spa, different health-related shops and a family health center, as well as a 40-bed senior residential area for each location.
During the time of “Form Follows Function” (FFF), architects were taught to give their best effort in puzzling out shapes from detailed technical programs. Elements having differing looks and specs where supposed to be arranged in such a manner that the final outcome would be a perfectly smooth functional diagram in a most pleasant shape. Architects became quite excellent at this, and many masterpieces showcase their genius.
Regretfully, the FFF attitude does depend on a stable function to be pursued—which means that any FFF building would be obsolete as soon as the function it was designed to support became obsolete. Of course in healthcare, premature programmatic aging has always challenged the traditional approaches.
For nearly 50 years, the design community has been paying attention to the cycles of change in buildings, but only a few attempts have been made to create a systematic approach to this. Some of the most accomplished insights address change not as a troublesome inevitability, but as the main programmatic feature that the design should respond to.
Casa da Saúde
Casa da Saúde, literally “House of Health,” is a one-of-a-kind facility. Though a healthcare mall, it provides neither inpatient services nor more generic retail shopping—it is not a hospital and it is not a mall. Sanusquali, the client, briefed RSO that the space should be such that no unhealthy feeling would be experienced. “Healthiness” was stressed as a brand identity.
Of course healthcare malls have been around since 1975, mainly in the United States, but seldom have they been tried in Europe, where state healthcare has long played a major role. It was the architect's task to find an appropriate answer to a program that has never stopped changing from day one, in such a way that it could meet the needs of 25 different locations and provide a consistent and recognizable experience to its costumers.
The building is little more than an envelope. With a rectangular base, it occupies the least possible amount of terrain, according to the program. The open building layout of its interiors evokes silence; the first perception is one of serenity. A modular squared grid structure has been chosen because of its proven flexibility. External service stairs and shafts open up much-needed internal free space, allowing the layouts to change according to evolving market demands. A double basement plan allows for car parking and service areas apart from premium above-ground locations, but taking no more space than the visible footprint. The building will encompass two to three stories above ground. Access to the clinics and other services will be direct from the street and from open balconies overlooking the boulevard.
In fact, the building is but an excuse to create a void. The project is not the open plan, nor even the urban façade. It is a boulevard, featuring public parks and esplanades. The rectangle has been carved out and the public pedestrian flow can freely cross it, with no door preventing entrance and no visible roof hovering over anyone's head. Enhanced public space is the goal of the design. Casa da Saúde has no corridors; all services are street accessible. There are no separate waiting areas, as people will be guided to a central check-in conveniently located under a roofed food court. An electronic tracking device, together with airport plasma information displays, will guide the customer for a “just-in-time” consultation or checkup. In between appointments, people can have a snack, read the newspaper, stroll in the park, and enjoy the sunny Portuguese outdoors.
Basically, Casa da Saúde is an open-ended structure, where the street metaphor has been taken literally. On both sides of the street, open plan layouts accommodate changing programs. What RSO is now trying to figure out from the healthcare programs are the attractor qualities of the different pieces of the programmatic puzzle. That is, if in the diagram each space will be represented by a rectangle or circle, we can say that what concerns us most is the interstices—the “in between” of the pieces—more than the pieces themselves. We also came to realize that, although the services may change, the relationship between services does not change at the same pace—actually, most of these relationships do not change for years. Therefore, our first design intentions are about addressing evolving voids and empty spaces. We allow open architecture strategies for accommodating the program clusters.
The identification of the actual programmatic clusters is the next level of the design. In Casa da Saúde, we have identified four different clusters: anchors, shops, core, and clinics. The clusters are disposed so that the anchors—the family health center and the imaging and analysis spaces—are located at the corners at both main entrances. These anchors are responsible for more than 40% of day visits.
Because shopping in healthcare malls is not compulsive but directed, it is not necessary to create circular flows for visitors. It is much better to allow people to easily enter and access the specific service they need. The street level is then filled with one side of regular shops, and another with amenities, central check-in, and the auditorium—all of which, taken together, is the core.
Behind the core is the first level of a spa/physiotherapy/health club facility on the second level that is hidden behind a food court. The rest of the second level is the clinics. These are accessible through the central food court, which acts as an esplanade overlooking the boulevard.
The senior residence occupies two levels over the shops. With a separate and discrete entrance, this location overlooks the external parks and assures its independence.
The boulevard is itself covered with awnings that allow for natural sunlight to pass through but ensure wind and rain protection. Special features of these, such as very low weight and full recyclability, are part of the very important sustainable strategy—indeed, Casa da Saúde is registered as a Green Guide for Health Care pilot project.
A final benefit of the design: though it is not expected that the building will undergo expansion any time soon, its open-ended approach will easily allow for any unforeseen growth. HD
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