It was a watershed moment for hospital design in the United Kingdom in 1992 when the British government introduced the Private Finance Initiative (PFI). Under this new system, the National Health Service (NHS) began contracting with private-sector consortia to finance, design, build, deliver, and maintain public healthcare facilities.

The PFI process paved the way for creative architectural firms to enter the market and raise the bar for health facility design. It was an opportunity to change repetitive standards that had encouraged general rather than specific design solutions. Strategically, RTKL saw this as a favorable time to establish a healthcare sector in the firm's London office and offer innovative design solutions to the U.K. healthcare market.

A few years ago, studies showed that there was a shortage of specialist cardiac care in the Midlands region and that the healthcare system could not handle the expected increase in cardiac patients. In such rare instances, the need for a new facility can be so great that the NHS may dispense with the PFI process in favor of an alternative method of procurement in the interest of speed. Such was the case for Wolverhampton Heart and Lung Centre at New Cross Hospital. The NHS Trust (similar to a U.S. hospital board of trustees and charged with overseeing the hospital) prepared a business case for this service to be provided at New Cross. The Department of Health agreed. At the time, the project was the largest capital lump-sum grant healthcare project in the United Kingdom by the Department of Health.

Faster delivery could be achieved with fewer bureaucratic sign-off procedures than with PFI. Another factor in favor of a traditional contract was the expectation of a lower capital cost for the project, although greater cost risk would be borne by the Trust in the construction process. PFI provides a model with a lower initial capital cost, but with rent costs spread over 25 to 30 years.

U.S.-U.K. Collaboration

Using a combination of U.K. and U.S. designers has been a distinct advantage for RTKL. Originally, given their more innovative approach, our U.S. colleagues were best suited to challenge preconceived ideas and openly question historic healthcare standards and procedures. Today, with the majority of large projects complete or in the later stages of planning, greater emphasis is being placed on community and specialist care rather than large general hospitals. A greater level of local understanding is needed, as well as a closer working relationship with each NHS Trust. This requires more U.K. personnel, although the combination of U.K. and U.S. resources remains a definite benefit.

With recent experience designing state-of-the-art cardiac facilities in the United States, RTKL was well positioned to bring new knowledge to bear on this important project for cardiac care in the Midlands. Indeed, Wolverhampton Heart and Lung Centre set a new benchmark for cardiac care in the U.K. It opened its doors in 2004 as the first purpose-built tertiary cardiac center in the country.

The client wanted state-of-the-art technology integrated into a building designed to support advanced clinical methodologies. RTKL came to the project having just designed two of the most advanced heart hospitals in the United States: The Indiana Heart Hospital in Indianapolis and The Texas Heart Institute at St. Luke's Episcopal Hospital-The Denton A. Cooley Building in Houston.

This U.S. heart hospital experience was a valuable resource in designing and procuring the $98.5 million, 161,000-square-foot Wolverhampton Heart and Lung Centre. The Trust Project Team from Wolverhampton visited several completed projects in the United States at an early stage in the design process. These visits created openness to new ideas and appropriate methodologies, which in turn integrated into a more British approach to healthcare.

Consolidated Cardiac Care

Traditionally, hospitals in the United Kingdom have been designed to group functions and facilities by departments. Most general hospitals, for example, designate open-heart operating rooms within their existing surgery department. Other supporting cardiac services are embedded in the various hospital departments.

The Heart and Lung Centre was designed for an integrated approach that supports standardization of clinical procedures and consolidation of cardiac care. All outpatient clinics are on the ground level and easily accessible. The operating theaters are on the second level, with the intensive care unit and inpatient beds for surgery patients immediately adjoining. All cardiac catheterization labs are on the third level, as are the inpatient facilities for those patients, along with daycare facilities. Every effort was made to ensure that each patient stays on the floor where his or her procedure is performed.

Public Areas

In the past, British hospitals have been designed with a “hospital street.” Patients, visitors, staff, physicians, and materials all travel this common conduit and then branch off into the various departments.

Designers of the new heart hospital created separate avenues for private and public flow of activity. Private activities such as material distribution or physician and nurse movement can occur largely outside the public eye. Family members and visitors have freedom to move around and have places to wait without being in the way of clinical and logistical activities. All public and private circulation zones feed into the wards.

Like many of RTKL's most advanced hospital designs in the United States, a public concourse runs the width of the hospital at every level, making wayfinding easy for patients and visitors. On the ground floor, the concourse has been replaced by an external loggia protected by the overhanging building. On the upper levels of the building, areas spaced at intervals along each interior concourse provide places where visitors and family members can relax, as do the coffee shop facilities in the entrance atrium.

The Heart Centre is a landmark building at New Cross Hospital and was intended to be a design exemplar for future development. This goal was achieved in part through the creation of a main entrance marked by an easily identifiable canopy. Light shines through perforated metal on the underside of the canopy, making it particularly dramatic and highly visible at night. Inside, a large and welcoming atrium links directly to the hospital concourse.

Patient Areas

Today, most U.S. hospitals are being built with all private patient rooms. While the United Kingdom is moving in this direction, at the time this scheme was designed, multibed wards were still common. The Wolverhampton Heart and Lung Centre has a combination of both. To ensure flexibility in the future, the multibed wards were designed to be converted easily to two single-bed rooms should that option become desirable. The provision of single rooms is a position that has changed markedly in the United Kingdom in the last two years, and RTKL's current design schemes are providing 100% single rooms.

Internal courtyards and the articulation of the building help to optimize natural light to patient areas. The south corridor on the upper floors is fully glazed, providing a soothing ambiance and excellent views to the outside.

The advent of specialty heart hospitals in the United Kingdom illustrates the country's move toward facilities designed to improve staff efficiency and satisfaction. These new hospitals are designed to improve patient outcomes while being consumer-aware. HD

Alan Morgan, ACIOB, is a Vice-President, and Beau Herr, RIBA, is a Principal with RTKL, a global planning and design firm that serves the healthcare industry worldwide. Mr. Morgan is based in RTKL's London office, where he served as the director responsible for the Wolverhampton Heart and Lung Centre project. Mr. Herr was a member of the project team for the Wolverhampton Heart and Lung Centre.

For more information about RTKL, please visit To send comments to the authors and editors, e-mail

Healthcare Design 2006 October;():38-42