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Tue 18 Mar 2008 04:00 AM

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Clinically designed

The Cleveland Clinic Abu Dhabi has high hopes of creating a more communal healthcare experience. James Boley investigates how American architects HDR are using design to improve overall well-being.


Think of a hospital, and phrases like 'institutional' and 'clinical' come to mind, evoking images of imposing concrete facades and rows of reflective glass windows. People are understandably wary of hospitals, since for many, their only encounters with them are during times of injury or ill health.

Alex Wu, HDR principal and design director for the Cleveland Clinic Abu Dhabi, has a very different view of what a hospital should be like. "An initial meeting with the Cleveland Clinic's CEO, Dr. Cosgrove, and his staff, changed my thinking."

"He described the importance of travel distances and challenges in the verticality of design. Somehow it made me realise how the new Cleveland Clinic Hospital in Abu Dhabi will be infinite; and how we are not," says Wu.

Village life

The daunting scale of institutional structures often contributes to the worrying experience of visiting them. To combat this, Wu redefined the sense of perspective for the clinic, designing a series of small to medium-size buildings, organised around a central space, creating a 'village' feel.

"A village... is a 'safe harbour' where welcoming, comfort and safety are central themes." says Wu. He wants Cleveland Clinic to be an approachable place for visitors. "Villages have a ‘sense of place' that reflects the essence of building a community."

Its ‘feel' is an essential part of how HDR intends to differentiate the Cleveland Clinic from other institutions.

"Historically, hospitals have followed a tradition of institutional design...focused on function and cost, rather than creating a sense of community and innovation," says Wu. "The village concept attempts to reinvent the notion of healthcare design by welcoming its visitors in a communal setting that promotes safety rather than fear."

The main hospital acts as a centrepiece for the village concept. "In successful villages, there is a visual edifice that earmarks a central location to meet and orients users," says Wu.

Less stress

Reducing stress can be an important factor in accelerating a patient's recovery. HDR uses the building itself as a medical tool by designing it to help alleviate the stress associated with a hospital visit.

"Architecture for the most part evokes different human emotions," says Wu. He explains how Elisabeth Kübler-Ross' five stages of grief-denial, anger, bargaining, depression and acceptance-inform the design of the entire building.
Colour, light, sound, texture and nature have been intentionally chosen to create tranquil environments, which combats the stress related to those emotions.

The programme also calls for a 360-bed hospital with a patient tower and administrative building, linked by an indoor public gallery. Glass orthogonal forms are stacked on top of each other, in tribute to classical modern architecture.

"The idea was to create a place that fosters interaction and builds a sense of community," says Wu. "[The tower is] a beacon for state-of-the-art healthcare in the Middle East and the village plan suggests the importance of creating a sense of place."

Sense of direction

The theme of navigation is particularly crucial in defining the function of the clinic. "Wayfinding is one of the most environmentally important issues for large-scale healthcare centres," explains Wu.

Coloured hubs assist navigation, and every 100 feet offers an area for social interaction. LED lighting is also being considered an additional navigation aid.

Perhaps most importantly, the main hospital building uses 'thin building design'. "From almost every area of any of the given structures, there is a focus on creating transparency through the glass wall," explains Wu. "From the glass public can understand where you are by just looking in any direction."

The clinic's design draws heavily on HDR's background in healthcare projects. The company claims to be the top healthcare design firm in the USA and boasts a separate hospital development research department.

"The firm employs a full-time staff of former healthcare practitioners, nurses and healthcare administrators that work together with designers and planners on every hospital project," says Wu.

Lessons from this include the use of environmental effects within the hospital to create a more pleasant environment for staff and patients. "We made a concerted effort to design ‘positive distractions' throughout the hospital to stimulate the five senses," says Wu.

These positive distractions include the use of flowing water and reflective pools to provide soothing white noise and tranquillity throughout the structure. Likewise, green landscaping and natural light is employed to increase productivity and mental alertness.

"The overall design is intended to provide positive distractions, alleviate stress, and to delight one's senses through a variety of different and stimulating experiences," explains Wu.

Respiratory function

As well as creating a more welcoming environment, the clinic's design brief includes elements that will align it with the highest levels of sustainability in a hospital.
Particularly challenging was the harsh climate in the Middle East. In order to reduce the overall energy load required to keep the hospital cool, the team developed a 'building respiratory system'.

"By utilising a dual curtain wall design, we were able to achieve a 'stack effect', which allows for the circulation of air between the glass walls to protect the hospital from the climate," explains Wu.

Warm air naturally to rises through the space between the curtain walls and directed is through the top of the building. This technology allows the building to significantly reduce its required cooling load.

In addition to this, reuse of grey water and storm water will reduce the dependency on desalinated water, and photovoltaics will assist electrical loads during the day.

The sustainable design features in the building help reduce stress, both on the patients and on the area's natural resources.

Roof gardens reduce heat gain and act as 'healing gardens' designed to promote patient recovery.

"[The] views out to the exterior and varied intensities of natural light will raise spirits and encourage a sense of hope in patients," says Wu.

Best practice

Wu is passionate in his belief that both the staff and the building are essential to create a successful hospital, saying the research team helps to create opportunities for architecture to assist in the betterment of patient outcomes.

"Today more than ever, advances in technology, changing demographics, globalisation and novel new drug deliveries are changing the way hospitals are planned," says Wu.

Wu calls for architects and designers to understand the operational model and language of each individual hospital, and then to use the understanding of significant healthcare trends to help inform the design.

"We are committed to delivering innovation through design," he says.

"We have the privilege to be working on the most important building in the world. The number of lives to be saved, and the sick to be treated is infinite. This project symbolises humanity, hope and a stewardship of global community."
