Projects | Words Michael Keniger
6 October 2014
A flagship facility for Western Australia’s health reform program, the Fiona Stanley Hospital employs evidence-based design principles to make tangible contributions to patients’ wellbeing and recovery.
The acceleration in the upgrading and renewal of healthcare systems and services
in Australia has substantially increased investment in large-scale, integrated health
facilities. These facilities advance healthcare capabilities, achieve efficiencies of scale and benefit from the rapid pace of innovation in medical technology. The Fiona Stanley Hospital in Perth is one of the latest and among the very largest of the nation’s comprehensive health and hospital projects. With a budget of $2 billion, it is Western Australia’s largest single building project and the flagship of the state’s health reform program. The range of design and medical planning services required by the size, nature and location of the project led to the selection and appointment of architecture firms Hassell, Hames Sharley and Silver Thomas Hanley working jointly as the Fiona Stanley Hospital Design Collaboration (FSHDC). Construction commenced in 2009 and practical completion was achieved on schedule in December 2013. Subsequently, however, the complexities of commissioning such a large entity and enterprise have caused the opening of the hospital to be rescheduled as a series of stages commencing in October 2014. By necessity, those major hospitals that provide comprehensive tertiary and quaternary care rely on a broad spectrum of clinical and health-related disciplines.
Further, they increasingly stand to benefit from the rapid take-up of proven medical and technical advances through translational research partnerships and from the integrated education of clinicians, nurses and medical support staff. They are large, complex organizations governed and managed with a focus on the effective and efficient delivery of healthcare. As hospitals have become larger and more centralized, there has been some concern that operational management and clinical systems would subordinate the patients’ needs to those of the institution – a concern that has stimulated an increased focus on the patient experience.
As the current generation of hospitals and healthcare facilities has evolved, so too the
delivery of healthcare services has been recast to embrace patient-centric practices
that position the patient as an active participant in the healthcare journey. This is
strongly aligned with the adoption of team-based healthcare tailored to the
individual needs and situation of each patient. Evidence-based design has further
enhanced traditional, hospital-based medicine and clinical care: essentially, research
into the moderating effects of the physical environment has found that the nature
and quality of the environmental experience make tangible contributions to patients’
wellbeing and to their rate of recovery. Such factors as the quality of light, privacy
within ward settings, views of green space, access to outdoor space, the ease of
wayfinding and clear orientation, among others, have been demonstrated to improve
recovery. Evidence-based design strongly influenced the development and design of
the Fiona Stanley Hospital through a sharpened focus on the relationship with the
natural environment, the generation of comprehensive strategies for effective
wayfinding and a significant increase in the number of inpatient beds provided in
sole-occupancy rooms to over 80 percent of the total.
Located on a 32-hectare, greenfield site at Murdoch to the south of Perth’s CBD, the
Fiona Stanley Hospital is the location of not just core healthcare services but also
medical research, medical education and a range of allied specialist entities including
the state centre for rehabilitation services and a major mental health unit. Colocation
with neighbouring institutions including Murdoch University, the private St
John of God Murdoch Hospital and the Harry Perkins Institute of Medical Research
offers potential synergies for the further enhancement of Western Australia’s
healthcare program. It is envisaged that the increase in the critical mass of health
resources will foster a step change in the urban growth and development of the
precinct and the region.
The primary physical arrangement of the hospital and its supporting units is as a low
plateau or plinth of functional entities ordered by a grid that integrates the main
circulation spaces and the linking courts, terraces and public parks. The flexibility of
the underlying planning strategies provides for future growth and for future developments in the delivery of healthcare. The planning approach also enables colocated services to articulate their separate identities within a unifying framework
and to draw from shared planning principles and a common palette of materials.
Differences in expression of the various service units and disciplines are governed by
a vocabulary of colour, materials, finishes and ordering rhythms drawn from a detailed analysis and abstraction of the colours, textures and forms of the adjacent native bushland, including spatial analogies to clearings, density, canopy and growth.
There are instances of spatial drama, including the void of the main pedestrian spine as it cuts through the Education and Pathology Buildings and the atrium that links the various levels of the cancer treatment centre, but otherwise the architectural resolution is one of discreet composition with changes in function and purpose revealed by relatively subtle changes in expressive treatment. The five levels of the principal inpatient, acute care wards stand above the podium of the main hospital building and provide a crowning expression of the patient-centric approach to healthcare. The pleated planes of the diamond-patterned wall panels and their intersection with the undulating chevrons of the window hoods to the east, north and west provide a series of dynamic forms and surfaces further articulated by shade and shadow. Influenced by a study of native banksia seed pods, the strength of the elevation treatment is in its articulation of the primacy of the care of individual patients. Locating the wards at these higher levels provides all inpatients with views across the landscaped roofs of the podium and beyond to the wider landscape.
For any large hospital, clear orientation and lucid wayfinding are essential to minimize confusion and stress and to reduce delays, especially for those in need of immediate care. On approach to the Fiona Stanley Hospital, large beacons integrated with the facade and form of the podium signal the key arrival points. Most pedestrian movement will be channelled from the principal entry forecourt and plaza into and through the Main Building via the pedestrian spine of the main concourse. This ground-level, double-height space provides an open-ended, continuous, linear armature with primary access to most of the key functions, including the various reception areas, retails outlets, pharmacy and cafes. To the west it stretches across the entry plaza and connects, via an upper-level bridge, to the Education and Pathology Building and to the Harry Perkins Institute of Medical Research. Natural light filters in from above and the length of the concourse is broken by rest points and by shifts in colour and material treatment. The location of the primary public stair and lifts is signalled by the serpentine coils of a major artwork by Stuart Green incorporating timber harvested from the hospital’s site. Fittingly titled Around and in Between , the work also marks the entry to the Main Court and to the adjacent public and staff cafes. The Main Court provides an inviting and sustaining public space and landscaped garden at the heart of the hospital. It is generous enough to be both an active space with open terraces for the main cafes and a place of retreat and reflection for patients and visitors seeking privacy and solace. The landscape planting, though yet to mature, employs species native to the immediate region, with much of the plant stock generated from seeds and plants collected from the site prior to construction. Gardens and external courtyards help provide a variety of outlooks and breakout spaces throughout the hospital. A linked series of courtyards and terraces at different levels forms a green “valley” running parallel to the main concourse through the podium levels. These valley spaces provide external light and views of an exterior setting to enliven the internal spaces of the deep plan of the podium levels.
Green roofs are used across the complex for a further extension of the hospital’s natural setting, giving additional visual relief – where visible – from internal spaces. Continuity with the landscape beyond the hospital is reinforced by a series of linked public parks integral to the hospital precinct and open to public and patients alike. The principal linear park aligned north –south from the north-east corner of the precinct provides a green lung and parkway route separating the State Rehabilitation Service unit and the Mental Health unit from the main hospital building. To the south, across Robin Warren Drive, is the public Lake Park formed as part of the remediation of the wetlands and
adjacent conservation area. Planting extends out and across the various surface car parks to further strengthen landscape continuity.
The Fiona Stanley Hospital has yet to receive its first patients and to be tested by the intense activity that it has been designed to support. Even so, it is already clear that the stage is set for what promises to be a new benchmark for hospital-based healthcare in Australia.
The complex politics and the machinations of the funding and delivery of major capital projects such as hospitals often suppress or weaken the architectural resolution of the design. The vision framed in the masterplan for the Fiona Stanley Hospital included an objective to create “a distinguished work of architecture that contributes positively to its surroundings, the environment and the community.”
Although such a review as this – conducted well before the hospital has welcomed its first patients – may be premature, it is apparent that the integration of evidence based design principles in the planning and design of the hospital has ensured that the patient experience will be enhanced through clearly ordered planning, welldefined
circulation and wayfinding and thorough provision of physical and visual amenity. It is to the credit of all involved that the initial ambition for the architectural quality and effectiveness of the overall project has been sustained and answered with distinction and without compromise.