In an area of Singapore that already includes a destination medical center with a public hospital and medical office building nearby, competition among private medical providers to have a presence there is high. Parkway Pantai Ltd. (Singapore), one of Asia’s largest private healthcare providers, was one of six operators bidding on a single piece of land.

Winning that bid, Parkway set out to construct the new Mount Elizabeth Novena Hospital (MNH)— the first greenfield private hospital built in Singapore in more than 30 years—specializing in heart and vascular treatment, neurosciences, orthopedics, and surgery. The hospital houses the latest in surgical and medical equipment; same-handed, canted rooms; and ambient lighting in the ICUs to aid in healing. It’s also the first private hospital in the country to have all single beds for the inpatient wards.

“From an operator point of view, our objective was not only to add to the supply of hospital beds in Singapore, but also to provide patients another option to receive quality medical care,” says Dr. Kelvin Loh, CEO, Mount Elizabeth Novena Hospital. “Having single-bedded suites minimizes risk of cross-infection among patients, and allows for greater privacy and comfort that promote quicker recovery.”

With these approaches in mind, Parkway gave designer HOK a lofty design directive: “Hospital of the future at a Four Seasons,” says Shiva Mendez, senior medical planner, HOK (San Francisco). “That’s how I always saw it.”

Five-star delivery systems
Within this five-star quality setting, a laser-sharp focus was also applied to operations and paths of travel within MNH. But while most hospitals focus on the separation of front-of-house and back-of-house activities, the MNH project took it a step beyond, requiring separate paths for clean and dirty goods, food, and for bodies being transported to the morgue. “It’s a bad omen to cross a dead body ever in a hospital [in Singapore], so that was one of our biggest challenges,” Mendez says. “We had to separate that path as much as possible, even from the staff.”

This complexity of movement means that MNH houses 30 elevators and seven staircases, with some designated specifically to certain pathways while others do double duty (See sidebar below). Local building codes helped with this approach, since they call for designated elevators for evacuation and firefighter access. So the designers utilized three firefighter lifts for certain services, including direct access to the VIP level. Five service/patient elevators in the hospital share handling of patients as well as movement of dirty and clean goods by having separate staging areas for each to keep these paths from overlapping. “So you could wait for a patient to pass by before you entered with a cart,” Mendez says.

The design team says this intricate mapping resulted in nearly double the amount of elevators and corridors at MNH than is typical for a facility this size. Further complicating the layout of the 13-floor, 780,000-square-foot facility were the site’s zoning and occupancy restrictions that dictated specific targets for total square footage. For example, the patient units couldn’t be more than 30 percent of the building’s total square footage. “We were constantly doing math to balance things out,” Mendez says. “You can’t add a square foot to a patient unit without offsetting it somewhere else.”

Designers made some sacrifices, such as fewer and smaller staging areas for linens and materials, while taking advantage of Parkway’s existing resources so that MNH could get supplies delivered from a regional distribution center to go straight to units.

This approach to programming of the patient tower yielded some design opportunities, too, such as the ability to end each corridor with access to views of the surrounding city. A planted light well also brings in daylight to each floor, “so almost at every point as you’re walking through the patient tower, you have access to greenery and natural light, which is so critical to de-institutionalize the building and aid in the healing process,” says Michael Gould, project designer, HOK.

Food for thought
To elevate its food service to a five-star level, the design team was also asked to include a functional kitchen on each patient floor. But why go to such lengths, especially when that effort comes with additional costs for food lifts, butler services, and square footage? “The nutritional value of each meal makes a huge impact on how patients heal and regain their strength,” Loh says. “Having a patient-centric service ethos ensures that we provide the best possible treatment and environment for them to heal.”

The roughly 250-square-foot kitchens house steamers, fryers, washing facilities, and dumbwaiters to deliver raw ingredients. All the prep cooking is done downstairs and all the finish cooking is done upstairs. The attention to detail goes a step further on the VIP floors, which are home to butler pantries and 24-hour, on-demand food service.  “The concept of providing a panty kitchen at every floor and close to the inpatient rooms ensures that foods is not only served warm and fresh, but also plated with a hospitality feel,” says Tham Tuck Cheong, managing director, CIAP Architects Pte. Ltd. (Singapore), who worked with HOK on the project.

Interior aesthetics
While several aspects of the MNH project—from tight spacing to complex paths of travel—provided design challenges, Gould says the interior aesthetic was no less complex. “The owner wanted a hospital that was glistening and gleaming, high-tech, and state-of-the-art, but he also wanted it warm, inviting, and spa-like,” Gould says. “From a design standpoint, ‘high-tech’ and ‘warm and inviting’ don’t always mix.”

Starting with the exterior, designers chose to clad the first three stories of the building in stone. Atop this base rises the patient tower clad in polished aluminum and glass. “It allowed us to have the best of both worlds,” Gould says.

Inside, designers were guided to deliver a setting that carried an international appeal, says Donald Cremers, senior interior designer, HOK. “We wanted something that felt like it was grounded in a bit of Asian history, but would carry forward for many years and still look appropriate.” The entry lobby sets the tone with golden onyx materials. The facility’s three main areas each carry a visual theme based on a species of wood, including the patient tower finished in warm cherry woods and the public areas in native, sustainably harvested teak. “They had the impression that dark wood exuded the feeling of luxury and quality,” Cremers says, “so in the patient tower, the wood and the colors get darker and richer as you move up to the VIP floors.”

Tham calls the layout of the 312 private patient rooms “pro-medical staff and pro-family” because the canted style maximizes patient views to the outside and natural daylight via the floor-to-ceiling windows, while the same-handed layout aids the monitoring of patients with entrance doors that open to a view of the patient’s head. Bathrooms are located at the headwall to allow for the shortest assisted pathway.  Outside in the hallway, there’s a recessed corner for staff to compile notes before and after visiting with a patient.

Rooftop gardens were installed on lev
els three, four, and 11, with private terraces on 13. “The gardens help in the healing process of the patients,” says Tham. “They also functionally support rehabilitation programs for patients.”

Establishing new benchmarks
From a building design perspective, Loh says MNH wanted a marriage of technology and hospitality that “feels, above all else, patient centric.”

With its gardens and gourmet food sitting side-by-side with acuity-adaptable diagnostic and patient rooms, MNH has also created a point of distinction. “People have a choice to come to Parkway or their competitors,” Mendez says. “So they need to marry high hospitality with quality of care in order to attract and sustain their clientele across the region.”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at adinardo@vendomegrp.com.

 

Sidebar:

MNH by the numbers

With its above-average focus on paths of travel, Mount Elizabeth Novena Hospital in Singapore houses an abundance of elevators and stairs. Here’s a breakdown of those systems:

30 elevators:

• 3 firefighter’s lift (MOB: 1, hospital: 2)

• 2 parking shuttle elevators

• 16 public/visitor elevators (MOB: 8, hospital: 8)

• 7 service/patient elevators (MOB: 2, hospital: 5, divided into 2 dirty and 3 clean)

• 2 sterile processing elevators (1 clean, 1 dirty connecting sterile processing to the operating rooms/procedures areas)

Stairs and escalator:

• 7 exit staircases in the building

• 1 escalator connecting lobby and second level

 

Read about MNH's green design intiatives here.

For a detailed source list, including costs, project team, and other vendors on this project, please visit: https://www.healthcaredesignmagazine.com/article/mount-elizabeth-novena-hospital-project-breakdown.