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1. INTRODUCTION of the building shows a clear division between the static nursing units in the ward
This chapter gives a few striking examples of hospitals that have either already been built block and the dynamic depar tments on the lower two (or three) storeys. The external
or are in the process of development. Examples are provided of each distinctive type of appearance of the ward block is often of an imposing design due to its definitive status.
building. However, the fact that these examples have been included here does not mean
that a new hospital necessarily has to be designed on the basis of one of these models. Access
In general it may be said that the Breitfuss model produces a compact building with
The examples show how concepts such as flexibility, functional relationships and design relatively shor t walking distances. However, staff and visitors do have to make frequent
were translated in the relevant period or are currently being translated into the building use of the lifts.
structure of the hospital.
The number of lifts is par tly determined by the number of storeys of the ward block. In
The following models will be dealt with: the case of highrise with around 10 floors, a considerable par t of the ward block will be
- the Breitfuss model taken up by provisions for ver tical traffic [lifts and (emergency) staircases].
- the comb and double comb structure
- the arcade model Due to its compact design, this model usually has a clearly recognisable main entrance.
- the linear structure
Functional Relationships
The building structure of a hospital has undergone a development that shows a Since the lowrise structure contains all diagnostic and treatment functions, it is possible
decreasing dominance of the ward block. The treatment and outpatient depar tments to create good spatial relationships with this type of building. Where the medical staff
and the flexibility and design of the main traffic areas have had an increasing impact on is concerned, the stacking of the wards can mean that there is a considerable distance
the main design of the hospital. between the outpatient unit and the wards.
Post-war hospital building in the early decades generated many hospitals with imposing, The Breitfuss model, originally designed according to functional planning of the care
sometimes monumentally designed ward blocks. In the 1980s, when flexibility became an provided (outpatient appointment unit, nursing unit, imaging diagnostics, laboratories,
impor tant concept, more neutrally designed hospital structures evolved. etc.), offers in principle sufficient possibilities for planning the facilities for care provided
on the basis of patient flows or on the basis of the care process. The Breitfuss model is
Subsequent developments show a more internally-oriented design of the buildings, less suitable for planning on the basis of target-groups.
through the use of covered streets and plazas. Recently developed hospital designs
are characterised on the one hand by more emphasis placed on the design. On the Flexibility
other hand, since hospitals have been increasingly built in an urban context due to land Where flexibility is concerned, account has only been taken of the possibility of
problems, fitting them into the urban environment has become an impor tant concept. adaptation and expansion in relation to functions on the lowest floors. No possibilities
for expansion or adaptation have usually been provided for in the ward block.
2. BREITFUSS MODEL
General As a result of these limitations in the design, it is more difficult with this type of building
A typical feature of the Breitfuss model is that a tall building block with nursing functions is to comply with policy concerning the new style hospital that advocates a shift from
placed above a flat building block with treatment and outpatient functions. The structure inpatient to outpatient.
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Example of Breitfuss Model I
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Example of Breitfuss Model I
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Example of Breitfuss Model I
7 8
programme with contemporary and is developed. This approach develops Achieving a perfect functional 7. Atrium with opened roof and skylight, day view
8. Atrium with functional areas surrounded at night
attractive architecture. It has had to a complex system of ar ticulated relationship between the areas,
par ticular regard to the human scale, spaces within three prisms that make providing maximum flexibility to the
solar protection and above all to up the base, geared to each other as if scheme between the exterior and
distinct the patients spaces through it were a machine, a healing machine. interior spaces. Differentiate between
the hospital. The build is the result of internal and external circulation,
a different point of view against to the In addition to the functional treatment distinguish the accesses and the
simples and common spaces in hospital of the base, a symbolic treatment specificity of ver tical communication
architecture. was essential to remark the towers. cores, allowing clarifying the scheme.
The space of the patients is planned
Architects purpose is also give only thinking in the needs and in the The position of the two towers,
therapeutics spaces and provide best way to them to feel better with responds to the functional need to have
architecture that serves to the rest and harmony and light. From the first an immediate access to the operating
recovery of the patient. To use the moment, it was determinate to have rooms, delivery rooms, emergency
architecture as a medical treatment. different spaces between the area of the and diagnostic. The functionality of
The design is structured on a large patients and the other functional areas the building lays in the way of life the
base, which encompasses various of the hospital, allowing in this area the patients and their relatives have during
medical areas of the hospital, holding relation between the green roof garden the time they have to be inside. The Section
two volumes of glass where the ward and the views from each room. strategy of the implementation is the
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Example of Breitfuss Model I
9 10
organisation between all the elements technology making the difference with 9. Entrance lobby of the base
10. View to the roof of connection
that are involved in the project. The the traditional hospital buildings. One part between Crown and Base
three prisms of the basement organise of the architects main points in the
the circulation in an exemplary manner. building is the sustainability; considering
In the two prisms of the edges are the conditions of solar orientation,
arranged for one to be used externally topography, built environment and the
and the other internally, the block in greenery nearby, without forgetting
the middle shares uses when internal the urban conditions of application.
and external circulations are necessary, They incorporate in the system green
but always without interference. The materials and renewable energy
architects systematise the building technology, with the objective to save
by structural modulation with the resources and optimize operating
subsequent pre-industrialisation costs, providing through the green
process linked with a technological roof, natural light and ventilation to the
innovation in the materials and systems inside of the building.
used; give a unique result with the last
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Example of Breitfuss Model I
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Example of Breitfuss Model I
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Architectural Concepts of Hospital Building I
A B C
3. COMB OR DOUBLE COMB STRUCTURE Example of Comb Structure A(See page 042)
General Location and Name of Institution:
The comb or double comb structure is characterised by a traffic zone in the centre from Barcelona, Spain - Sant Joan De Reus Hospital
which different building wings protrude like the teeth of a comb. The building structure Date of Completion: 2011
is designed like a uniform grid. It comprises many end walls, the so-called open ends, Gross Floor Area: 92,037m
which make it simple to add extensions.
Example A of Double Comb Structure B (See page 054)
Location and Name of Institution:
Access
Murcia, Spain - New Santa Luca University General Hospital
Due to the many open ends, the external architecture gives the impression of being unfinished.
Date of Completion: 2010
In contrast with the Breitfuss model, for example, an overall picture of the hospital is not Gross Floor Area: 114,369m
visible. If located in the heart of the traffic zone, the main entrance may be hidden between
the teeth of the comb. In the case of large hospitals, this structure can lead to a sprawling Example B of Double Comb Structure C (See page 064)
design. Location and Name of Institution:
Murcia, Spain - New Los Arcos del Mar Menor Hospitall
Functional Relationships Date of Completion: 2010
Functions which have to comply with the same requirements are grouped in one wing. Gross Floor Area: 61,352m
From the point of view of size and technical requirements, the teeth of the comb are
geared to the functions to be housed there. Practical experience has shown that stacking
spatially related functions with specific requirements regarding installations can also be
successfully done in one wing. For example, the emergency depar tment is located on
the ground floor, intensive care on the first floor and the operating unit on the second
floor. Other designs may include all laboratories in one wing, plus the pharmacy and the
central sterile supply ser vices unit, or wings with only nursing functions.
The comb or double comb structure is in principle fittable for all three models described
in 3.3 with regard to accommodating the care organisation.
Flexibility
The double comb structure was developed at a period when flexibility had become one
of the most impor tant design criteria. Flexibility is guaranteed by extending the teeth of
the comb or by extending the traffic structure by adding a new wing. The basis structure
of the hospital remains unchanged after these extensions.
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Examples of Double Comb Structure I
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Examples of Double Comb Structure I
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Sections
contact with the dual carriageway of the urban dimensions, controlling and On the one hand, the faade plane
Bellisens, is in the nor th par t of the site balancing the landscape impact of such that covers the whole building is bent
where the entrances and exits of the a building in the city. over, optically reducing the physical
parking lot and the technical logistics presence of the building and increasing
sector will be built. The project consists in building a low its perspective effect. On the other
height hospital, with changes in the existing hand, on the ground floor there are
The public circulation axis, located in topography, a big well-lit unit where the rounded pavilions at a lower scale that
the south of the site, opens onto a new general public and the physicians can receive people, helping to organise
pedestrian walk. In this large circulation communicate, with green spaces, evoking the different entrances. In the big area
area, called rambla, all public entrances nature in the building area. In the faade, of the public rambla, the personnel,
to the hospital emerge from a square. where pedestrian accesses are located, patients and visitors encounter a public
The idea of this hospital design is to the large scale building is softened with square which enters into the building as
control its size and make it similar to two project strategies. if it were par t of it. Elevations and Sections
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