Hospitals

The Brief
The client’s express wish, from the beginning, was not to have the new REHAB centre look or feel like a hospital. So, what were we not supposed to do? What is a hospital? Elevators and indoor corridors flanked by countless doors leading to rooms or examination rooms a waiting lounge at the end of the hall or next to the elevator. The same pattern repeated on as many floors as permitted by zoning regulations – an economic solution because it is repetitive to the extreme, and requires no modification of staff behavior.

A rehabilitation centre is a place where people live for up to 18 months, usually after an accident. It is a place where they learn to cope with their changed lives in order to become as independent as possible again. During the day they work with therapists and doctors; they live there and spend their free time there, they meet their families and friends. They have a daily routine just as we do, but with one significant difference: everything happens in one place.

Because the patients are so restricted, because they have to stay at the REHAB centre for such a long time, we have set ourselves the task of designing a multifunctional, diversified building, almost like a small town with streets, plazas, gardens, public facilities, and more secluded residential quarters where people take different paths to move from A to B. We have tried to create surroundings that allow the patients as much autonomy as possible.

The Architecture
The new REHAB centre is a horizontal building on two floors, in which wheelchair users and pedestrians can easily move from one place to another: therapy and medical facilities are on the ground floor; the patients’ rooms on the second floor.

The connection between indoor and outdoor spaces was our primary architectural concern. The complex is conceived from inside out: instead of an arrangement of structures, courtyards are placed in a large rectangle. They serve as orientation and allow daylight to penetrate the entire interior. Only then did we proceed with the development of the individual rooms. In keeping with the analogy of a town plan, we thought in terms of streets and plazas in front of houses. This is still the first impression of the REHAB centre today; you walk in through a large courtyard, the centre of which is a cultivated field. In other words, you enter the complex through an outdoor space. From the main lobby, various inner courtyards provide orientation: one is filled with water, another is clad entirely in wood, the bathhouse is placed in the third, etc. You proceed along them until you reach your destination.

When you have arrived, you realize that the “houses” vary considerably; places like the gym or the workshops, as well as the patients’ rooms are defined by large windowpanes and views of the landscape, with a seamless transition between inside and outside. Other rooms, however, are entirely inwards in orientation; the most obvious example is the bathhouse, placed in one of the central courtyards like an erratic block wrapped in black rubber. Numerous small round holes in the low-slung roof make what looks spectacular from the outside very intimate from within. In the painting workshop and library, both on the roof, the view into the distance is staged: one can look back into the city or out into the expanses of the Alsace.

The diversified design offers patients and their relatives a building that does justice to the complexity of their needs. There are places where one can retreat and be alone and others in which to enjoy company. And there are also non-territorial places that are not assigned to a specific function, small places for the times in between treatments, for conversation with relatives, or for staff members during their breaks. The REHAB is an open, permeable, breathing building.

Wood of different kinds and uses is the predominant material on the façades and inside. One might speak of a kind of pavilion or garden architecture, beginning with the continuous terraces along the rooms on the second floor. Delicate structures of wooden rods, horizontally interwoven in some places, vertically inserted into the ground in others, guide cloth awnings or function as screens to provide privacy. The plexiglas dowels that link these wooden rods glisten like beads when light falls on them.

These beads have a big sister in the patients’ rooms; in the middle of the curved, hollow ceiling, there is a transparent plastic sphere two meters in diameter. Somewhat like the eye of the room, it offers patients laying in bed a view of the sky. And it makes the room, despite its wide veranda, so bright that one almost feels as if one is outside. The veranda has been made wide enough to wheel patients lying in bed outdoors in good weather.

After the existing REHAB centre to the south is demolished, landscape architect August Künzel – with whom we have already collaborated on the design of interior courtyards – will supervise the planting of kitchen and ornamental gardens there and to the west. These gardens aim to integrate the REHAB centre into the surrounding countryside with its family gardens. To the north, a playing field and a training course are available to wheelchair users in the summer.

The new Children’s Hospital lies in Zürich-Lengg, at the foot of a hill known as Burghölzli. It is adjacent to other hospital buildings from several eras and is the largest facility for children and adolescents in Switzerland. It consists of two buildings: the acute-care hospital and the research and teaching facility.

The acute-care hospital to the south consists of a three-story concrete frame with intricate wooden infills that blend into the landscape. The interior functions like a town: the medical specialties are neighborhoods with squares and connecting streets. On each of the three floors, a central main street runs past various green courtyards that provide orientation and bring daylight into the building. The patients’ rooms on the roof are like individual cottages.

Teaching and research are housed in a white cylindrical building to the north, with an open, five-story atrium in the center. The fields of research are arranged around this core of exchange. Underneath, three lecture halls surrounded by seminar rooms and study areas for students are embedded in the topography of the sloping terrain.

The large-scale landscaping includes the planting of over 250 trees. In addition, boulders found underground during construction are placed in and around the buildings, telling of glaciers from the Ice Age. The “inner nature” of the new complex is essential to experiencing the hospital as a place that is conducive to healing.

Both buildings have been awarded the platinum certification of building sustainability as specified by the strict guidelines of the SGNI (Swiss Sustainable Building Council).

The Acute-Care Hospital

The new Children’s Hospital is located in a residential neighborhood dotted with fruit orchards. It is adjacent to the listed building of the University Psychiatric Clinic (PUK), known as the Burghölzli and its entrance, defined by a large open gate, stands directly opposite the entrance to the historic building of 1869. The concave gesture of the façade creates a shared forecourt for both institutions.

The gate opens onto a round courtyard planted with trees, through which the entrance is accessed. The restaurant and access to the therapy facilities below with gardens of their own adjoining the entrance. On the other side, the building’s main street leads to highly frequented types of treatment such as imaging diagnostics, and the surgical day clinic. This central axis, which widens and narrows along the courtyards, terminates at the emergency room, which can also be accessed directly from outside.

In the center of the second floor, additional services are located on both sides of the main street, such as the hospital school, the pharmacy and other shared uses. An officescape oriented towards the outside is wrapped like a wreath around this central zone and provides some 600 workspaces for medical and administrative staff.

The top floor, the quietest area in the hospital, is reserved for children and adolescents, inpatients who are staying overnight or longer. Each of the 114 rooms is designed as a wooden cottage with a roof of its own, providing privacy, a view of the green outdoors and enough room for parents to spend the night with their children. There are four centers along the main street in the immediate vicinity of the cottages, where children and adolescents can receive transdisciplinary treatment.

The façade of the hospital consists of a three-dimensional, loadbearing concrete structure. It combines the first and second floors. The depth of the façade and the infill, which may be wood, glass, fabric or vegetation, varies depending on orientation and the activity inside. Lightweight construction materials have been used consistently throughout the building except for the concrete supports and the circulation cores. In this way, departments can increase or decrease in size: the flat building with its distinctive shape thus ensures the interior flexibility that is so crucial for hospitals.

The top floor with the inpatient rooms is set back and speaks an architectural language of its own. The rooms are staggered and have rooftops with varying inclinations. The individualized, elementary shape of the cottages clearly underscores the singularity of each and every patient.

The Research and Teaching Facility

The rooms of the cylindrical, white building for research and teaching are organized around a central atrium, encouraging exchange and collaboration among researchers. An agora for teaching and study spreads out under this central space and responds directly to the surrounding landscape. Three lecture halls step into the natural slope of the terrain. Daylight streams in from outside, and thanks to movable walls, the lecture halls, lobby and café can be reconfigured into one large space. This creates an agora with a stage in the middle for special events and room for an audience of 670 people. A gallery overfed contains open workplaces for students. Adjoining seminar rooms on the same level complete the spaces available for university teaching.

Laboratories for research and diagnosis with accompanying offices on the five floors above have an unobstructed view of the surrounding landscape. Open workspaces are arranged around the atrium for the use of doctoral students and laboratory staff. From them, one can see several stories at once as well as the agora below, which is in turn connected to the atrium above through an oculus—a small, round hole in the ceiling.

Embedded in an expensively designed landscape, the research and teaching building is a standalone structure in the midst of a fruit orchard similar to those in many Burghölzli gardens. The building itself speaks an abstract, clearly geometric language and makes use of few materials. Cantilevered balconies with tall railings painted white give the building the appearance of being both weighty and airy at once.

The two facilities of the Children’s Hospital, though different and distinct, are clearly complementary. Situated on the hill, the circular building for research and teaching guides the gaze towards the lake. The elongated, horizontal shape of the acute-care hospital fits into the flat landscape, providing a view of the mounting rage behind it. The hospital focuses on each patient as an individual, and that means not only the healing process but the well-being of relatives and staff as well. The building for research and teaching highlights exchange and collaboration among scientists and students, which is a prerequisite of forward-looking research.

The hospital is surrounded by nature and contains a garden in its center. The horizontality of the building and its undulating form responds to the location of the hospital in the midst of the wide Danish landscape. A horizontal building is an appropriate building typology for a hospital, because this fosters exchange: across the various departments, the employees work on a shared goal: the healing of the ailing human being. The new hospital shall overcome conventional operational borders. The tall hospitals of the last decades, with their functionalist language, have rarely achieved this goal.

The plan is the marriage of two seemingly contradictory goals: the desire for a large central garden and the necessity for short internal connections. The result is an organic cross shape that permits the interior garden to become a flowing space. A central hall underneath the garden is characterized by four round courtyards. The hospital pulsates from here.

Viewed in section, the arrangement of the functions is simple: two floors for examination and treatment form a pedestal upon which a two-story ribbon of wards is placed along the perimeter, forming the large central garden. In the pedestal, on both levels, connections to the outdoors are created in various ways. Courtyards provide daylight and vistas, and ease orientation. Large connected areas, the repetitive arrangement of the interior courtyards, and uniform room sizes offer a high degree of flexibility. Later changes of functions can be easily realized.

Two basic principles guide the organization of uses within the pedestal:

1. The more frequented a department, the more central its location.
2. The main streams of outpatients and inpatients are separated vertically. Each level of the pedestal serves one primary stream.

The pedestal is mineral with a slender, vertical facade structure, permitting a high degree of flexibility while offering visual protection at the same time. The courtyard facades could be clad in differing materials; they create orientation and variety. The pedestal contains the functions of the hospital that are used by everyone, which is reflected in its continuous facade. The pedestal is an expression of community.

The wards, in contrast, express privacy and small scale. They are made of lightweight prefabricated modules: two by two patient rooms respectively create a small rectangular house of metal or wood. The bathrooms are located in between, set back. They are polygonal and give the ribbon its undulating shape. The plan resembles a spine. The patients’ rooms offer generous views into the treetops or across the wide central garden. From this viewpoint, the hospital looks like a two-story complex.

The landscaping concept consists of two typical Danish landscape typologies. A forest park with clearings for parking lots surrounds the building, while the central garden is Heathland. Circular hedges inhibit views into the pedestal and create the path network of the garden.

This project will be the heart of the new masterplan of Hillerød South.

Basel and the Life Sciences: University and Health City

The Basel University Hospital, situated within the city walls dating from the 13th century, is embedded in the small-scale structure of the Old Town. In contrast to the perimeter city blocks that characterize the surroundings, the hospital campus consists of distinctive, single buildings constructed over many decades around an inner-city garden that has always been a public park. The decision to keep the hospital near the University and to increase its density has attracted other institutions in the fields of teaching, research and healing, such as the ETH Zürich.

The Biozentrum was inaugurated in 2018 and the tower of the hospital’s Klinikum 2 (K2) building will follow; both are large-scale buildings which add conspicuous, erratic notes to the skyline of Basel. These developments are not reversible: the University and Health City is emerging as a city within a city.

A burgeoning Health City of such stature calls for an urban vision that will integrate single and separate, function-oriented buildings into an overarching concept. A cluster of taller buildings is generally preferable to isolated high-rises. We therefore propose another tall building for Perimeter B to complement the ensemble flanking the hospital garden. Over the long-term, we see the potential of densifying the University and Health City by adding more tall structures and simultaneously extending the garden.

The contemporary city with its justified requirements of research, teaching and healing will become manifest behind the veduta of the historical city. An urban quality that has shaped the city of Basel since the 20th century will be accentuated: the natural side-by-side of a small, historic patchwork city and an industrial city of dyes, chemicals, pharmaceuticals and life sciences.

Functionality and Urban Planning: A Three-part Composition

The new building must meet the exacting needs of a complex brief. The outpatient tumor center, laboratories and outpatient nephrology are permanent functions but during construction on K2, it will also provide temporary quarters for other departments (phase 1). The permanent uses will be installed later (phase 2).

In collaboration with the hospital planner Teamplan, Rapp and Herzog & de Meuron have devised a three-part composition to achieve the flexibility required to meet these complex needs: an elongated base on a slope that accommodates three to four stories with two objects hovering above it, a 12-story cube and a one-story, kidney-shaped pavilion. This division of the large volume into several parts ensures a trouble-free side-by-side of permanent uses and temporary quarters.

The subdivision also makes it possible to establish a precise spatial and atmospheric rapport with the urban environment and the hospital garden. The three-story base responds to the height and scale of the landmarked neighborhood along Hebelstrasse. It is four stories high at the other end and flanks the hospital garden, thus establishing a relationship to K1 that is similar to the current nurses’ residence built by Hans Schmidt. The axially positioned high-rise will transform the unattractive Schanzen-/Klingelbergstrasse junction of the ring road into a prominent urban Plaza of Research with access to the new building and the hospital garden. It is clearly juxtaposed with the new K2. As integral to the urban vision, the cube lends the growing University and Hospital City an identity and a center.

Permanent Uses in the Base: Tumor Center and Laboratories

On the Plaza of Research, a canopy marks the main entrance to the hospital lobby from Klingelbergstrasse. Placed under the cube hovering above, it divides the gently curved base into two halves and, as in K1, it links the street and the garden, but on a more intimate scale. It also provides direct access to all of the departments located in the base (and in the cube): the outpatient tumor center on the three lower floors and laboratories on the two floors above them. Inner courtyards provide orientation and daylight; waiting zones adjoin them. The corridors provide intermittent views of the city and the garden; small terraces allow staff and patients to enjoy the fresh air. The base is connected to K1 above and below ground along Schanzenstrasse. The existing, complex infrastructure underground must remain operative during and after construction, which is an additional functional and structural challenge.

Pavilion: Nephrology

Nephrology and the dialysis station will be housed in the pavilion on top of the base. The proximity to Holsteinerhof and a separate entrance on Hebelstrasse ensure an inviting atmosphere and privacy for patients returning for regular treatment.

Cube: Flexible Spaces for Two Phases of Use

Temporary quarters for K2 are located in the cube, a flexible building with an efficient floorplan. Conversion for phase 2 is restricted to this high-rise component and will make only a marginal impact on daily routine in the base. In phase 1, the cube will temporarily accommodate the outpatient units, such as Surgical Polyclinic, Dermatology, the Medical Polyclinic and Functional Diagnostics. These areas of high patient frequency are accessed directly from the main entrance. As the plans now stand, pathology, genetic medicine, research and teaching will be housed in the cube during phase 2. It is also conceivable that the Eye Clinic, which is now outside the Health Campus, will be relocated to the new building.

Form and Facade: Finely Structured, Curved Contours

The architecture is characterized by sweeping, convex and concave contours. Their origin is indebted to the shape of the plot; it follows the former city walls, which are now the ring road. This sweeping gesture resonates on a smaller scale in biomorphic shapes, such as the roof of the nephrology pavilion, the main lobby and smaller elements of the building like stairs, ramps and the brise-soleils of the facade.

Cantilevered concrete floors, setback glazing, brise-soleils of lightweight concrete, awnings and natural stone cladding lend the new complex depth as well as an open, breathing character and a mineral quality. A kinship with other buildings on the hospital campus is intentional, especially with K1 as a superb example of modernist hospital architecture; we have taken the building’s detailing and material idiom a step further. The brise-soleils – “mineral parasols” for a highly transparent facade – direct daylight deep into the building. Conversely, they minimize the sunlight reflected back onto the city and reduce light pollution at night. The bright, finely structured elements of the facade are human in scale and treat sun and light in different ways.

Hospital Garden: Heart of the University Hospital

The new building emphasizes the qualities of the inner-city hospital and reinforces them as part of the overall vision. The hospital garden with its trees still constitutes the heart of the entire complex. The base that flanks it is relatively low, ensuring ample space, air and sun while the greened roof terrace on the base affords a view of the Baroque garden of Holsteinerhof and the hospital garden.