Danish architect Stig Vesterager Gothelf, senior partner at 3XN is one of the driving forces behind the global studio, which has practices in Sydney, Copenhagen, Stockholm, New York and London. His ability to run complex design projects has resulted in numerous accolades, with some of his most celebrated projects being in healthcare. Ahead of his presentation at the upcoming Health Care Health Design virtual symposium, Adair Winder discusses the influence design can have on the overall healthcare experience with Stig Vesterager Gothelf.
ArchitectureAU: Firstly, I wanted to talk to you about some of the healthcare projects 3XN has worked on, the North Wing and Mary Elizabeth’s Hospital, can you speak on the brief for those two projects?
Stig Vesterager Gothelf: They’re both healthcare projects within the same hospital master plan, but the two differed a lot in terms of the brief. At the North Wing, the client had a very clear idea of what they wanted, both in terms of program and in how the space should be used and operated. Key concepts from the design brief were time and efficiency, the right placement of functions, and of course, the patient’s well-being and needs.
Mary Elizabeth’s Hospital, the children’s hospital, was a different story, because it was an entirely new addition to the hospital’s services, the process was more open-ended. The key focus was to put the patient at the centre, with everything else revolving around that. It’s not that that’s not the case in the North Wing, but in the children’s hospital, it was just emphasized more heavily. That gave us the latitude to push on some more radical ideas and did place play as a key topic to embrace and facilitate in the building.
AAU: When you design a hospital or healthcare space, how does your practice determine what the needs of the patient, staff, community, relatives and visitors are?
SVG: Listening. With these projects, the clients and users know the program, operations, and needs so well, the most important thing is for us to really take in the brief and requirements. Once we’ve established that common foundation, we can start to fold in our own experience and knowledge in behaviour, form-making and so on. From there you can start to have a dialogue and craft the design in collaboration. But if you’re not starting with the same base of knowledge, it’s simply not possible for this process to be generative and successful. It’s an empathetic process.
Incorporating bespoke features was about offering a visual point of difference.
Image: Adam Mørk
AAU: How do you find that balance between functionality and the clinical side with the more playful and creative elements that you’ve incorporated into these designs? Is that a difficult thing to try and find that balance?
SVG: The artistic elements are inherited from the way we work at 3XN. We don’t try to force an aesthetic or formal move. Our priority is to determine optimal and functional logistics, and from there we leverage that to create a story.
With the Children’s Hospital, it’s logistical and functional design first – there is a centre from which wings branch out to create the hospital’s different departments. Functionally, that’s it. Formally, it feels more expressive than that. We think of our designs as stories overlaid upon functional schema. You start to create that narrative when you start treating the building and zones as hands with fingertips.
For the Children’s Hospital, the whole wayfinding strategy was about the fingers, in the sense that this strategy reduces travel distance and complexity for everyone. With that as the formal driver, logistics became an interesting part of the design narrative! The constraints of logistics and function often provide a lot of opportunities for narrative and expression in design.
AAU: What do you achieve by incorporating those narratives, in terms of user group satisfaction?
SVG: If you have a strong identity in healthcare that is easy to read and understand, like the stories of the fingers, it creates a feeling of safety and clarity. Visiting facilities that are super institutional, designed more for efficiency and function than for people’s experience, can feel very overwhelming.
Having that clear design narrative is also a great way for the client to express or emphasise their values. With the Children’s Hospital, that emphasis was on putting patients and their families first: making it easy for them to get around, giving them space to be together, and providing access to nature and natural rhythms.
In the North Wing, the stairs are clear anchor points in the wayfinding.
Image: Adam Mørk
AAU: There are some really playful, bespoke features incorporated in the North Wing. You’ve talked previously about how art can stimulate security. What did you mean by that and what role can artistic elements play in healthcare design?
SVG: It has many roles. In the North Wing, the stairs are clear anchor points in the wayfinding. When you move around, these two vertical elements become your reference points, connecting you between the floors in an otherwise very big building. That’s also why we try to create atriums in our buildings, like in the Children’s Hospital. It allows you to place yourself within this big institution. Art does the same. You remember it and use it as a reference because it’s so strong in its identity.
Adding these features is also about offering a point of difference to provide an escape from the normal routines within the hospital, both for the staff and patients. Most people in hospitals are experiencing atypical situations. Whether these moments are serious and sombre or moments of joy, these features help balance you, giving you something else to focus on, even if only a few seconds of reprieve.
Atriums are a key reference point in the Children’s Hospital.
Image: 3XN
AAU: Healthcare design has evolved, not only in the physical sense but also in the sense of who you are designing for. What lessons do you think architects and designers can learn from the healthcare facilities of the past that they can then bring into the design of future facilities?
SVG: If you go back to the 1900s, hospitals were like small pavilions with easy access to fresh air. There was an attention to the exterior, to natural light and the circadian rhythm. Then in the 70s, healthcare architecture became industrialized. Healthcare spaces from this time onwards tended to follow the same results-driven approach, repeating architectural orthodoxies and resulting in functional buildings with pre-determined outcomes. It was pragmatic but came at the cost of the human experience and general well-being.
Now it’s more widely understood that the whole process around the surgery or treatment is just as important in terms of stimulating and creating wellbeing. We have ample evidence demonstrating how critical it is for patients to be able to look out at some greenery and stimulate their brains. Also, for the staff, if you’re spending your shifts inside and away from natural light, you veer towards circadian dysfunction. Circadian rhythms help dictate the inner workings of our bodies and mind; their imbalance can have massive effects on individual health and wellness.
Today, everyone is striving to bring forth more diversity in the design through daylight, calm zones and so forth. I think it’s safe to say this will become an even greater priority in the future.
AAU: So, design has moved on from being solely focused on treatment to being more about the entire experience, from when you walk into when you leave.
SVG: Absolutely. Today there’s even a new layer to what that experience is. In a traditional model, architects’ work starts with the arrival, but with the Children’s Hospital, it starts at home, in a digital form. By using an app, patients learn what area of the hospital they will interact with, how they can prepare for their visit and how to get there. The patient experience starts before arrival to remove some of the fear and mystery.
AAU: You’ve spoken about when you were designing the two hospitals, it quickly became clear that it wasn’t just about individual comfort, but also about social structure and cultural identity. Could you talk a bit about that?
SVG: There is, correctly, a lot of emphasis on creating a healthy environment for the patient. But that also includes their families. It’s so important that there is also space for them to be with their loved ones outside of the hospital room. This is especially true in the Children’s Hospital where parent and child are so linked.
In the Children’s Hospital, we designed the rooms so that a family member can sleep next to the patient or so that they can create an environment that mimics the feeling of home. It was important for us to create as much normality as we could. By allowing the family to move a table over to the child, the family can sit next to them while they lay in bed and have dinner or play a game in the way they would at home. It makes an abnormal situation feel more familiar and comfortable.
We also applied that framework to the corridors of the wards. Outside each room, there is a small seating area embedded into the curvature of the wall. In that nook, there’s a window back into the room, so you can keep an eye on what’s happening without having to physically be there. It can be a space for a rest, a difficult phone call, to give someone privacy without sacrificing visibility or safety. Another key design element is the winter garden terraces located at each ‘fingertip’. Here, staff, relatives and patients can go out and rest exercise or just get some fresh air.
AAU: It seems like you’ve incorporated design aspects that allow users to navigate and regulate their own environment based on their own comfort level and needs at the time.
SVG: We tried to think about it as though the hospital were a home. In terms of function, you don’t want the hospital to be like a home, but you do want the sense of comfort and safety you have at home. Differentiated zones provide the ability to be in your room on your own, or to go out to the garden and get some air, just as you would at home. There is also the living room where all the fingers meet, and this is where the big family kitchens are located - you can go there to interact with other people and socialise.
The Children’s Hospital has been designed in the shape of two hands.
Image: 3XN
AAU: About the shape of the Children’s Hospital, where did the idea for the hands come from?
SVG: It came again from a functional requirement of how many beds and departments we needed to create and orient them within the limits of the site. From there, we layered on the key design concept: reducing travel distance and making space for children and their families to be together outside of the rooms. The ‘fingers’ idea arrives from a dialogue with the functional and the narrative elements of the brief.
The idea arrives from and fits very well with patient requirements. When it comes down to the treatment areas on the lower floors, two fingers suddenly start to connect into a U shape to house diagnostics. To the north, it connects again into a triangle where all the operation theatres and maternity departments are located. In the lower part, we needed to have more flexibility than in the bedward areas above.
AAU: Both facilities were designed prior to the pandemic. Do you think the pandemic has or will alter the way future healthcare facilities are designed?
SVG: Yes, certainly. I think it will drive a focus on ability and capacity. Something that we incorporated into our design was the ability to transform the room to cater for two patients. While one patient is the ideal situation, it can accommodate two patients in a crisis. The way the Children’s Hospital has been designed makes it functionally simple to isolate each section into a hygienic contained cell.
The human-centric design approach is important when thinking about crises, isolations, and pandemics. You don’t want to have these big, long halls with just doors and rooms full of patients. You want to be able to isolate areas into smaller groups so that people feel safe within that group.
Stig Vesterager Gothelf is one of several experts to discuss how innovative design can improve the quality and user experience of healthcare systems at the Health Care Health Design forum. Gothel will feature in session three Hospitals for the Future: Designing for Innovative Healthcare. The session is available to be streamed from October 17, 2023 until November 17, 2023. Tickets can be purchased here.
Health Care Health Design is a program of Design Speaks, organized by Architecture Media.
