 | TAMING ST VINCENT’S The redevelopment of St Vincent’s, Darlinghurst, by Bligh Voller Nield, brings “growth-and-change” ideas to bear on new ambulatory health care models. Elizabeth Farrelly looks at this large project tucked into a tight inner urban site.
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Looking across Green Park to St Vincent’s.
The screened inpatient floors of the new Xavier
Building form a backdrop to the existing hospital
campus.
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Detail of the east elevation, showing the screening to the upper level inpatient floors and an oriel window punching through from the diagnostic and treatment levels below.
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Corner detail of the upper level screening, with the city beyond.
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A typical decentralised staff station in the Public Hospital.
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A typical inpatient unit, with interior design by Rosemary Lucas, in the private hospital.
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View over the city to the east from a patient bedroom.
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The southern end of the redevelopment at the intersection of Barcom Avenue, Oxford Street and Victoria Street, looking along Oxford Street. The photograph shows the building not quite complete, with site huts still in place.
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Western
elevation, seen from Paddington against the
surrounding fine-grain urban fabric. The
screened inpatient floors can be seen above
the line of the existing buildings and trees.
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The north-east corner of the redevelopment, showing the northern termination.
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Aerial view showing the plan location of St Vincent’s within the dense innerurban environment.
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Most of us will never design a hospital. Almost certainly, this is something for which
to be profoundly grateful. Minutely techno-bound, the hospital’s vast corpus must
nevertheless cater to humans at their most vulnerably unshelled. Despite squeezing
architecture’s play-space to near-zero, that is, the hospital needs its healing
ministrations more than ever.
Lawrence Nield, having designed (in whole or part) some 40-odd hospitals over
almost as many years, is as unfazed by the paradox as he is unintimidated by the
imbroglio of fact, theory, pseudofact and politico-feudalism-masquerading-as-theabove that constitutes the brief for such a building. Many architects, faced with such horrors, meekly accept their relegation as packaging consultants. For Nield, however, the best and most innovative hospitals are those – like Richard Llewelyn-Davies 1961 Northwick Park Hospital, near London, or Eberhard Ziedler’s hospital in Hamilton, Ontario – whose architects, declining the decorator’s role, come resolutely to grips with the workings of the organism; forming to function, but building indeterminacy in. Nield’s latest, the deceptively massive Xavier Building at St Vincent’s, Darlinghurst, is a case in point.
Sleek but approachable, typecast without cliché, the building is the combined
result of Nield’s long experience (and some of his favourite architectural motifs) and
project principal Sarita Chand’s intricate grasp of the programs and processes
involved. Nield cut his teeth on hospital design with Yorke Rosenberg & Mardall (YRM)
in late-60s London, where his jobs included St Thomas’, London, and the Radcliffe
Infirmary at Oxford. Nield’s belief in indeterminacy dates from this time, and from a
seminal document produced by Llewelyn-Davies and Weeks for the Nuffield
Foundation and since accorded classic status. Remarking the increasing rate of
techno-obsolescence in hospitals, the report gave rise to the “growth-and-change” catch-cry; embodying principles which, Nield believes, are valid to this day.
At first glance, though, Nield makes an unlikely candidate for the Stephenson &
Turner niche in Australia’s arch-ecology. Stephenson & Turner’s bleakly literal approach to sterility seems an unlikely precursor to Nield’s continuing struggle towards an architecture that is humanistic, ideas-driven and environmentally responsive.
What ideas, though, can plausibly drive hospital design? What kind of idea could even get a look-in, in so highly programmed a building type? What, for that matter, might architecture’s main idea-material – space, light, beauty, even – really contribute to the sick or dying?
Traditionally, hospitals have reflected dominant disease-types, medical paradigms
and service technologies as much as design fashion. Before germ theory, hygiene
was a strictly empirical business; hospitals were as likely to damage health as
enhance it. Filarete’s 1456 Ospedale Maggiore in Milan was the first to incorporate
serious underfloor plumbing. Subsequent hospitals, like St Thomas’s, were often built
over rivers or canals as reticulated disposal systems for human waste. Never mind the
water quality.
It wasn’t until the nineteenth century that Florence Nightingale, accused of wanting
hospitals “built out of air”, began to insist on the importance of daylight and ventilation in the healing process. As tuberculosis became disease-of-the-moment, her chill and spartan wards found their apotheosis in the sanatorium, with its characteristic alconystreamlining – Aalto’s 1929-33 Paimio Sanitorium becoming the permanent archetype.
But International Modernism, ably assisted by Taylorism, air-con and the fluoro
tube, quickly dispensed with all that windows and courtyards nonsense; not only were
fresh air and daylight replicable, they were – like mothers milk – better synthesised.
This unquestioned belief in innovation, combined with economy-of-scale precepts,
ballooned hospitals into today’s gargantua. Even here, though, Llewelyn-Davies and
Weeks’s contribution was crucial. However gargantuan, the hospitals that heeded their
growth-and-change warnings are alive today (Sydney’s Westmead, originally designed by Llewelyn-Davies and Weeks, is one such). Others, like London’s Charing Cross Hospital, are as dodos: governments having found it cheaper to walk away from even so vast an investment and start over, than to refit the existing.
St Vincent’s too has been under pressure to move out, although for different
reasons. An ageing motley of buildings crammed onto three hyper-valuable hectares of central Darlinghurst makes for nightmarish construction logistics and a reasonable
temptation to flog it and go. But the Sisters of Charity have occupied this site since
1870 and now, when half the other hospitals around – Paddo, St Margarets,
Camperdown – have disappeared under the relentless roll-out of residential latte-land, St Vincent’s is defiantly consolidating at the pink and pulsing heart of the continent’s densest quarter.
By the late 1990s there were nine major buildings on the site (including three
since demolished to make way for the Xavier). Together these constituted the St
Vincent’s Healthcare Campus, including a smallish private hospital to the south, and a large and very serious public hospital to the north. The public institution, one of
Sydney’s “big seven” teaching hospitals, offered all major specialisms except obstetrics, with particular emphasis (it is, after all, home to the Victor Chang Cardiac Research Unit) on cardiology. But change was once again in the air.
Greater emphasis on preventative and “ambulatory” care, for example, means that
patients who would once have needed hospitalisation are now, through keyhole surgery and other miracles, treated as outpatients. Almost thirty percent of all operations are now undertaken as day-surgery, average patient-stay has halved, and preventative care means that heart disease lands less often on the operating table. Such changes shift the spatial balance between a hospital’s three main parts – wards (“inpatient units” or IPUs), treatment and diagnostic, and the “hotel” (kitchen/laundry) component.
Whereas the traditional hospital was mostly ward (so that institution size could
usefully be measured in bed numbers), treatment-and-diagnostic is now by far the
most space-hungry function. “Procedure rooms” have proliferated, along with their
ancillary waiting and servicing spaces, while operating theatres have doubled in size in a few years (36 square metres to 80 square metres) due to their huge technological
requirements.Wards, meanwhile, have reduced in both number and occupation-levels (although, as hospitalisation now implies more serious illness, this shrinkage is
somewhat offset by the concomitant increase in volume of bedside equipment).
So technical a building type inevitably turns design into something of a power
struggle, but Bligh Voller Nield were committed to a more hands-on understanding of
hospital praxis than the usual public-service expectation of fitting the architecture to
given health planning diagrams. Bringing Llewelyn-Davies’ growth-and-change
analysis to this new, ambulatory health care model in a tight inner-urban area was a
challenge indeed, requiring ingenuity, diplomacy and near-impeccable contextual
manners.
For at eleven storeys and 44,000 square metres the Xavier is no miniature. And,
unsurprisingly, it generated its share of controversy amongst the Paddington streetsoviets,
who wanted a hospital but didn’t want to see it. In fact, they’ve just about got
their way, so neatly does the Xavier embed itself between existing trees and buildings. Even the 275-place car-park nestles sweetly beneath existing gardens at the hospital’s font door, all but undetectable.
Inside, growth-and-change principles surface in a number of ways: the openended
corridors, allowing extension but also inviting light and street-views; the thirtypercent
over-sized ducts and risers; the fully-accessible interstitial floors, where
possible, to provide universal wall-less cabling and servicing; the non-specific room
types. Most of this lies at the non-visible end of the architectural spectrum, but BVN’s
determined exertion of humanism over habit and reason over expedience has
empowered such principles significantly to tame the blind tangle of formalin-andgravy-flavoured corridors typically meant by the word “hospital”.
The analysis story begins way back, with Nield’s study of in-hospital travel
patterns and his realisation that excessive in-hospital pedestrian movement was not
only wasting vast amounts of time and money but, worse, endangering patients. At St
Vincent’s, therefore, BVN have rationalised the model, collecting day-procedure
facilities – normally scattered with their respective departments – onto the Xavier’s
lower, street-side levels. Operating theatres are similarly concentrated, with wards
occupying levels six and seven.
This rationalisation strategy has the side-benefit of allowing quasi-public areas
such as reception and waiting to be more generous, often with floor-to-ceiling glazing
and reassuring street-views over higgledy-Darlo housetops. To maximise normality
without losing the comfort of efficient organisational presence, the entrance lobby is
garnished with espresso bars, ATMs, flower stalls and escalators. Views, crossings and
width-changes punctuate the building’s principal internal “street” – some 140 metres
long – at every opportunity. Rationalisation also means that the elevations can be
organised to reflect with some humanising clarity the functions within; horizontal sunshading signifies wards, solid precast spandrels present treatment and diagnostic
areas, and Nield’s signature, glazed orioles break the grid to offer limited two-way
transparency at each major common space.
Such rethinking is already widely applied in office design; healthcare, for Nield,
has a deal of catching up to do. Vast floorplates are probably inevitable, given the
insuperable inefficiency of vertical transportation in a healthcare context, but for the
hospital of the future Nield anticipates a fully-computerised system to monitor patient
progress through the various departments, all-but-eliminating wait times. Such an
institution might boast not only the healthcare equivalent of hot-desking (which, to
some extent, already happens) but also, for instance, operating theatres without walls.
Scoff you may, but in a sterile world, the wall is just one more thing to scrub down. With demountable screens and laminar-air germ-brooms, maybe it’s possible; just need to relieve the medics of their territorial affliction, and Flo Nightingale may have her hospitals “built of air”, after all.
Elizabeth Farrelly is a Sydney-based architectural critic and urban consultant
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| Project Credits |
Architect Bligh Voller Nield—principals Lawrence
Nield, Sarita Chand; project director Tim Brook;
project architect Jim Russell (major works), Ian
Goodbury (early works); project team Craig Burns,
Victor Burysek, Lara Calder, Nicholas Christo, John
Dermatis, Ton Jaucian, David Kidston, Leny Lembo,
Catherine Linton, Tracy Lord, Christine McLean,
Darren Paul, David Pond, Danny Villaneuva, Julie
Wong. Interior Design Bligh Voller Nield—Andrea
Nield (Public Hospital), Rosemary Lucas (Private
Hospital). Arts co-ordinator (Public Hospital) Andrea
Nield. Structural/Civil Engineer Taylor Thomson
Whitting. Mechanical/Electrical/Medical Gases/
Communications/Lifts Engineer Steensen Varming
Australia. Hydraulic Engineer Ledingham Hensby
Oxley & Partners. Cost Planner Rider Hunt.
Programmer Tracy Brunstrom Hammond. Acoustics
Peter R. Knowland. Laboratory Consultant Brian C.
Griffin. Landscape Architect Oculus Landscaping.
Project Management The Capworks Group. Builder
Leighton Contractors. Client St Vincent’s Hospital
Sydney, South Eastern Sydney Area Health Service.
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