Despite significant differences in healthcare delivery models, similar design trends have emerged in the United States and United Kingdom in recent years. In both countries, an increased focus on patient-centered care has led to the design of single-occupancy patient rooms and the growth of specialty and outpatient treatment facilities.

In both markets, healthcare organizations and designers have embraced the concept of the healing environment and its associated design principles, including views of nature, penetration of daylight into interior spaces, convenient departmental adjacencies, and intuitive wayfinding. Similarly, they have recognized that facility design can contribute to staff recruitment, retention, and productivity.

Swanke Hayden Connell Architects (SHCA) has recognized some of these trends in working with the Skanska Innisfree PFI consortium on a project that combines new design and renovation: the King's Mill and the Mansfield Community Hospitals in Nottinghamshire, England. The clients are the Sherwood Forest Hospitals National Health Service Foundation Trust and Mansfield District Primary Care Trust.

At King's Mill Hospital, the project involves extensive renovation to create a unified hospital comprising 28 new nursing units, in which half of the inpatient rooms are single occupancy; a new state-of-the art Diagnostic & Treatment Center; an Emergency Care & Assessment Center with after-hours primary care; and a dedicated Women's & Children's Center.

In general plan, three T-shaped inpatient nursing units, linked together over five floors, will rise above the Diagnostic & Treatment and Women's & Children's Centers (figure 1). Both facilities will enjoy a southern exposure with views of the reservoir and countryside beyond (figure 2). A two-story elliptical building, the Women & Children's Center has its own dedicated entrance and includes outpatient and emergency departments, as well as inpatient facilities.

Three T-shaped inpatient nursing units, linked together over five floors, will rise above the Diagnostic & Treatment and Women's & Children's Centers at King's Mill Hospital

Both King's Mill Hospital and Mansfield Community Hospital will enjoy a southern exposure with views of the reservoir and countryside beyond

Mansfield Community Hospital has been redesigned as a community landmark with improved pedestrian and vehicular access. A new Rehabilitation Center, expanded Therapy Department, and refurbished nursing units will enhance patient care in this facility.

In both cases, the trusts desired design solutions that will improve the communities' perceptions of these hospitals while solving a host of site challenges. Altogether, the $600-million project (£300M) encompasses a site area in excess of 1.5 million square feet, a new building area in excess of 900,000 square feet (85,000 square meters), and 840 beds. Construction began in November 2005; Phase 1 is due for completion in June 2008 and Phase 2 in January 2011.

A Defining Element

The King's Mill site is designed to provide clear orientation for patients and visitors to reduce potential stress on arrival. On entering the site, visitors find the main entrance of the hospital to be clearly visible (figure 3), and the building form facilitates intuitive wayfinding. This simple arrangement is repeated in the main entrance and lobby area, with the reception desk directly on axis with the door. A separate staff entrance is located at the top of the site, collocated with the staff parking.

At King's Mill, visitors find the main entrance of the hospital to be clearly visible

Because of the high percentage of outpatient diagnostic (OPD) accommodations that required natural daylight, the new Diagnostic & Treatment Center (DTC) became a defining element in site orientation, building massing and configuration. The DTC comprises 16,590 square meters of outpatient accommodation over three floors in an innovative new layout at the front of the site. This collocation of the outpatient clinics in one building directly adjacent to the main entrance provides ease of access, while reducing travel distances for both staff and patients.

Moreover, the clinics themselves have been designed with all the consultation and examination rooms located close to the waiting areas. In keeping with the trust's emphasis on creating a healing environment, all waiting areas have views of the landscape outside.

The administration accommodation is located at the ends of the DTC wings directly adjacent to the clinics they serve. This relationship facilitates future expansion space for the all the OPD clinics. Day surgery, endoscopy, and imaging departments are located directly opposite the OPD clinics, affording a faster, more effective service provision.

Clinical efficiency and healing

The main driver behind the new King's Mill Hospital design has been the goal of creating a caring, effective, and safe patient-focused healing environment. Moreover, improving overall clinical adjacencies and staff efficiency were among the key design objectives for the renovation and expansion. Indeed, the design achieves 90% of the desired clinical adjacencies; the design collocates all inpatients in three centralized blocks of nursing units, which affords better proximity to clinical services. A generic ward template has been designed around a 2 × 24 bed module to provide an efficient use of space. The standardization of the ward template has been implemented to facilitate flexibility among service demands.

The design effectively separates patient, visitor, and staff circulation. Dedicated inpatient elevators link the nursing units with all clinical areas on the dedicated inpatient corridor on the ground floor. The main hospital street provides dedicated visitor circulation at each level from the main elevator lobby. In addition, dedicated staff/FM elevators are provided within each nursing unit.

While clinical efficiency is a key requirement, the orientation and design of the nursing units is also intended to create an environment that promotes well-being by providing views of the surrounding environment, including a landscaped entrance, reservoir, and surrounding countryside; introducing daylight and natural ventilation; reducing noise levels; and enhancing privacy.

Nursing units and single-occupancy inpatient rooms (which comprise half of the total number of inpatient rooms) are designed with a window-to-wall ratio of 50%. En-suite bathrooms are placed inboard where patient views and privacy are a priority. The wards have been designed to create quieter environments through the use of single rooms and high-performance sound-absorbing ceiling tiles. All inpatient accommodations have been orientated toward stress-reducing views of nature.

Among other features, improved ventilation and lighting have also been incorporated to improve health outcomes. The ward layout has been optimized to reduce staff walking and fatigue. From the moment of entry to the site to ward entry, the intuitive wayfinding has been designed to reduce stress of patients and visitors.

A unique identity

The design establishes a unique identity for the Women's & Children's Center through various features, including an elliptical form with a dedicated entrance and emergency drop-off. Outpatient and inpatient services are separated to ensure privacy and convenience for these very different patient populations. Privacy screening and discrete exits maintain separation between departments. All maternity services are located on the first floor, with neonatal next to the birth center with its own dedicated theaters. Gynecology services are located with direct links to the main operating rooms. Pediatric services are located on a dedicated floor with an outdoor play area shared with the child therapies unit for rehabilitation.

A Community Landmark

As part of the overall project, Mansfield Community Hospital has been redesigned as a community landmark, in that the scheme integrates existing buildings and helps create a new public realm. The planning creates improved pedestrian and vehicular access, leading to a new main entrance with a resource center offering health information. This will create a much-needed link with the community.

The project is notable for innovation in both design and methodology of collaboration. The unprecedented and high level of interaction between SHCA as the design team leader, consortium leader Skanska Innisfree, and bid manager and clinical advisor HCP, contributed greatly to improved communications, clarity of design response, and thoroughness in the consultation and clinical planning process with the trust. HD

Julian Seward, is Principal, London Office, and Jim Case is Principal, New York Office, Swanke Hayden Connell Architects

For further information, phone 212.226.9696, e-mail case.j@scha.com, or visit http://www.scha.com. To comment on this article, visit http://healthcaredesi.wpengine.com.