 | REBUILDING QUEENSLAND HEALTH A ten-year program to rebuild Queensland’s health infrastructure is nearly complete. Michael Keniger outlines the program, the issues and the outcomes, and introduces five representative projects.
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The curved eastern wall of the Princess Alexandra Hospital, by Cox MSJ. Photograph Marc Grimwade.
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Courtyard view of the mental health unit at the Cairns Base Hospital by Hassell. Photograph Robert Gray.
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The extent and seriousness of issues facing the delivery of health services in
Queensland had reached such a chronic state by the beginning of the nineties that it was necessary to take fundamental, comprehensive and decisive action. A complete overhaul and restructuring of medical services and modes of health delivery necessitated an updating of existing health buildings and the construction of new facilities throughout the state to cope with the escalating demands of the present and to meet the needs of the foreseeable future. The factors to be addressed included the pressures of population growth, the increase in the cost and complexity of medical diagnosis and treatment, advances in medical technology, and the dire state of many hospitals which had suffered from an endemic under-investment in maintenance and upkeep. At some hospitals the situation was so serious that medical staff went to the media with the difficulties that they were facing – the broadcast on national television of a video of rats in the corridors of a major urban hospital being just one incident.
The need to upgrade the health care system received widespread support across
political parties and factions, precipitating the largest and most sustained investment in a health-services-led capital works program in Australia. It was decided to completely overhaul the health system and its facilities through an intensive, focused ten-year program of planning, design and construction rather than eking out the necessary changes over a longer period. This ambitious strategy involved significant risks, including a concern that the architectural profession may not have had the capacity or expertise to respond to the demands of such a large scale program within the defined time frame. In 1996 alone, some 250 consultants were commissioned to assist with the delivery of the required facilities. David Jay, the director of the Queensland Health Capital Works Branch, recognises the success achieved by the profession in responding to the needs and expectations of the program. He considers that one of the major outcomes of the program is the acquisition of knowledge and experience that has enabled design consultants to contribute strongly to the debate on health care provision and to challenge the client groups from an expert and authoritative position.
The design of the many projects for new and refurbished facilities was guided by the
primary objective to achieve an improvement in health service rather than just the design and construction of health buildings. In meeting this objective, architectural propositions and solutions were to be considered as furthering the delivery of health services, rather than merely resolving issues of form, function and expression. In the case of the major projects, this entailed contributing to the development of the new healthcare models and evaluating their implications for the planning and servicing of the new facilities. The client agencies were multi-stranded, being comprised of coalitions of managers representing different functional entities. They required special skills of the architects in responding to and resolving competing and occasionally contradictory demands and expectations. The need to overhaul the whole of the health delivery system created a need to design for a broad range of building types, including specialised research facilities, special care units, teaching facilities, mental health hospitals, central energy plants, central laundries, aged
care units and community-specific care facilities such as the Mt Isa Centre for Rural and Regional Health (Woodhead International). Upgrading the quality of the public health system also prompted the upgrade of many private facilities, which further harnessed the growing expertise of the profession. Some of these were co-located with public hospitals, such as the Holy Spirit Northside by Peddle Thorp which is located on the Prince Charles Hospital campus.
Having commenced in 1992, the program is now drawing to a close with the
successful completion of some 50 major projects and over 100 small projects. These
range in scale from the $500 million Herston Hospitals project to the $0.5 million spent on Boigu Island. At its peak, some $600 million was expended annually on capital works with a total expenditure of nearly three billion dollars. Close to 99 percent of all projects were delivered on budget and 95 percent were delivered on time. This represents a significant achievement. That there have been no major disputes signals the effectiveness of the overarching management structure and the value of adopting quasirelationship-based contracting for the construction of most projects. Overall, the program has created a robust and flexible infrastructure that is designed to support health services well into the twenty-first century. Flexibility was an essential requirement of all projects, given the certainty that the demand for healthcare will increase over time and that medical knowledge and practice will continue to develop and change over future years.
A particular challenge of hospital design is that the focus is firmly on functionality
as measured by the efficiency of healthcare delivery. Hospitals are complex entities that incorporate elements requiring high-level technical support and servicing. The quality of finishes required is high, as is the level of environmental control and the stability of the provision of essential services. Efficient circulation is essential as some 50 percent of the annually recurring costs of running a hospital is consumed by the cost of labour. In the case of the $500 million Herston Hospital project, the annual running cost is $380 million, of which the salaries of staff consumes 70 percent. Poor circulation can
dramatically reduce the efficiency of staffing and so reduce healthcare – or increase its cost. The adoption of ambulatory care creates an increase in the throughput of patients which, together with flexible visiting times and open access policies, engenders an active environment in contrast to the closed institutions of the past. Clearly defined orientation and high quality entry spaces are essential to effective wayfinding and to inducing a positive response to the hospital environment.
Despite the focus on operational and technical demands, the program emphasised
that the quality of the physical environment for patients, visitors and staff should enhance the health care service. Furthermore, it eschewed the adoption of standardised designs in favour of designs that best suited their particular locations and the needs defined by the client/user teams in each case. Some of the largest facilities, such as those at the Royal Brisbane Hospital, had to be fitted into closely packed and densely built-out hospital sites, whereas others occupied greenfield sites. All projects required integrated project planning that linked service delivery with physical requirements prior to the commencement of design. Response to climate was a primary factor with a view to reducing energy costs, although most facilities are air conditioned if only to ensure a stable and hygienic environment and a reduction in the risk of cross infection. The formation of management teams for each project aided the process of designing to suit each location. Jay emphasises that one of the most important skills required of the design management was that of communication. The task of being briefed by so many specialist disciplines and
obtaining productive design input was at times hampered by the poor communication skills of some consultants who failed to convey their ideas to clinicians who, though expert in their own fields, were not necessarily able to fully understand design drawings.
The breadth of the Queensland Health capital works program prevents a
comprehensive review at this time and a more detailed analysis is warranted when the program is finally complete and when the various facilities have been in use for a
sufficient time to allow teething problems to be resolved. In particular, a review of those projects involving the refurbishment and enhancement of existing buildings, such as the Cairns Hospital A&B Blocks by Hassell, would draw attention to Queensland Health’s achievement in retaining and enhancing existing buildings where they can meet the needs of contemporary health services. The following projects illustrate the range of project types undertaken in terms of size, function and location.
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| Project Credits |
Princess Alexandra Hospital
Architect Cox MSJ. Mechanical/Electrical/Fire
Engineer WBM Bassett Joint Venture. Structure
and Facade Engineer Ove Arup & Partners.
Hydraulic Engineer McKendry Rein Petersen. Lifts
WBM Bassett Joint Venture. Acoustics Ron
Rumble. Kitchen Food Services Design. Quantity
Surveyor Rider Hunt. Contractor (Structure) John
Holland Constructions. Contractor (Fabric & Fitout)
Baulderstone Hornibrook. Client Queensland
Health. Project Director Higgs & Associates.
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| Townsville Hospital, Woods Bagot |
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Aerial view. Photograph Cameron Laird.
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South elevation of the ward building, seen from the university ring road.
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The courtyard between the acute building, on the left, and the ward building on the right.
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The main entrance porte cochere on the northern side.
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Looking west along the north elevation, with its dramatic external stairs, towards the emergency entrance.
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The internal atrium, looking west alone the level 2 corridor.
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Night view of the main entrance porte cochere. Photographs David Sandison.
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The new Townsville Hospital, one of the
largest outside Brisbane, provides 425
beds and offers a general acute level of
medical support. It is a freestanding
development replacing the original facility
in the centre of the city. The model of care
developed for the hospital clusters clinical
services with the co-location of inpatient
and outpatient functions. This increases
flexibility by bringing the clinical services
into a direct relationship with the related
bed spaces. The interconnection of the
four key buildings creates a deep plan,
given a strong order by the clarity of the
circulation patterns. The four-storey,
naturally lit, atrium-cum-arcade, running
from east to west through the length of
the main building, anchors the horizontal
and vertical circulation and gives an order
to the overall pattern of circulation. The
designation of this space as “open space” assists with fire evacuation and
considerably increases the potential
flexibility of planning to accommodate
future changes. The ambition to create a
welcoming and enjoyable environment is
sustained by the emphasising the
locations of the entry and main stairways
by strongly pronounced, super-scaled,
blade walls and by the use of bright colour
to punctuate the spaces.
A simplicity of construction is
suggested by the extruded shed-like
forms, which are enlivened by glancing
intersections in plan and by deeply
projecting roofs and sun shading. These
serve to assist with the control of solar
penetration and heat gain and to evoke an
association with regional building
traditions. The generous, shaded portico
and the lively composition of the principal
elements provide a lively and engaging
character in complete contrast to the
original Townsville Hospital. The design
signals the changes made to healthcare
and offers an open and accessible centre
that overcomes the overwhelming
presence that could have resulted from a
facility of this size if governed by less
thoughtful design.
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| Project Credits |
Townsville Hospital
Architect/Lead Consultant Woods Bagot.
Architectural Subconsultant Ralph Power
Associates. Quantity Surveyor Rawlinsons.
Structural Engineer Bonacci Group, Halliburton
KBR. Civil Engineer Halliburton KBR. Services
Engineer Lincolne Scott Australia. Hydraulic
Engineer Steve Paul and Partners. Project Director
Burns Bridge Australia. Building Surveyor, Risk
Manager Project Services. Programmer Tracey
Brunstrom and Hammond. Managing Contractor
John Holland Group.
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| Project Credits |
Comprehensive Cancer Research Centre
Architect Bligh Voller Nield Wilson Architects joint
venture—project team Phil Tate, Chris Clarke, Mark
Grimmer, Anthony Ogden, Geoff Hehir, John Thong,
Robert McAdam, Hamilton Que, Warwick Allen,
Richard Sale, Michael Hartwich, Michael Tanner,
Michael Rogers, Michael Obrien. Project Manager
Project Strategies and Solutions. Quantity Surveyor
WT Partnership. Structural/Civil Engineer
Robert Bird & Partners. Mechanical Engineer WBM
Consulting Engineers. Electrical Comms Barry Webb
& Associates. Hydraulics McKendry Rein Petersen.
BCA Consultants TASPM. Managing Contractor
Baulderstone Hornibrook. Artist Eugine Carchesio.
Client Queensland Institute of Medical Research.
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| Thursday Island Hospital and Community Health Centre, Cox MSJ. |
One of the most remote projects within
the program is the Thursday Island
Hospital, way up in the Torres Strait. In
part, the impetus for the project came
from the disaffection shown by the
Islander community for the earlier
hospital that had failed to address the
cultural needs of the community. The
new hospital is comprised of
interconnected, verandah pavilions, linear
in plan and with gently curved roofs that
offer openness to both view and breeze.
This openness, matched by a flexible
policy for visiting hours, offers a less
intimidating and less institutionalised
resource that invites the community to
regard the hospital as a social focus as
well a place of medical care.
This invitation is further emphasised
by the design of the main entrance foyer
which is an open breezeway framing
views to the aqua-blue of the sea beyond.
Although a small hospital with some 34
beds, it is a significant resource for the
island community and offers a structure of
healthcare and a physical environment
that is more relevant and accessible than
the previous, more conventional and
prescribed model.
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| Project Credits |
Thursday Island Hospital and Community Health Centre
Architect and Planner Cox MSJ. Client
Queensland Health. Project Director Higgs &
Associates. Project Manager Q Build Project
Services. Contractor Barclay Mowlem. Civil
Structural, and Hydraulic Engineer Connell
Wagner. Mechanical and Electrical Engineer
Gutteridge Haskins & Davies. Kitchen Food
Services Design.
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| Clermont Hospital, Fulton Trotter and Partners |
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Entrance to the Clermont Hospital.
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The admissions counter.
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Courtyard space between the old and new blocks. Photographs Richard Stringer.
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The interest in the Queensland Health
program has inevitably focused on major
projects in the urban centres. Yet, a key
feature of the program has been its
encompassing of all scales and forms of
healthcare across Queensland. The
practice of Fulton Trotter and Partners has
specialised in the design of public
buildings in many of the smaller and far
flung regional centres and country towns.
They have returned to some of the
hospitals designed in the fifties by a
previous generation of the practice, to add
new facilities and refurbish the existing
buildings as part of the health services
program. These projects include hospitals
at Barcaldine, Emerald and Clermont.
The most remote of these townships
is Clermont, which has been resuscitated
by the re-opening and modernisation of
the nearby Blair Athol open-cut coal mine.
The project involved the stripping out of
miscellaneous additions to the original
buildings, refurbishing the 1950s core
building, extending the operating theatre
and constructing an aged care cottage
with a treatment similar to the original
buildings. A new inpatient wing has been
added parallel to, and to the north of, the
existing hospital, creating a series of
sheltered gardens and courtyards
between the two. They are linked by a
new main entry, by the administration
offices and by connecting passageways.
The existing building was restructured to
house emergency, outpatients, medical
imaging, dental and allied health facilities.
A generous verandah along the length of
the new wing offers sheltered outdoor
seating while shading the inpatient
accommodation. Further shading protects
the western elevation and these two
measures help to reduce the air
conditioning load.
The new wing emulates something of
the scale of the original while employing
mono-pitched roofs and a mixed palette of
masonry veneer and metal cladding that
clearly distinguish it from the original. The
construction system of a simple steel
frame and suspended concrete floors
offers flexibility both of layout and of
service distribution. Although one of the
smaller projects in the program, this
hospital provides the primary healthcare
for the town and its region. It now offers a
high standard of medical services in a
hospital that is both welcoming and
relatively informal. The care taken to
design a range of open and enclosed
social and waiting spaces increases the
sense that this facility is in itself
hospitable and intended to serve and
sustain its community
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| Project Credits |
Clermont Hospital
Architect Fulton Trotter and Partners—design
architect Mark Trotter; project architects Robert
Wesener, Nicole Thomas; health planners Roger
and Jane Carthey; design team Winfried Sitte,
Kylie Forbes, Greg Isaac, Justine Ebzery;
specification Stephen Trotter; interior design Clare
Bennett. Structural Engineer Connell Wagner.
Services Engineer Bassett. Hydraulic Engineer
McKendry Rein Petersen. Landscape Architect Belt
Collins. Quantity Surveyor Mitchell Brandtman.
Builder Evans Harch. Project Director Burns
Bridge. Procurement Manager Project Services.
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