Canadian Builders Quarterly

How to Design for the Healthcare Sector

with André Ibghy Architectes

By

A thesis on the design of healthcare facilities at the University of British Columbia has shaped the career of Montréal architect André Ibghy. For almost 30 years, Ibghy has endeavoured to translate medical officers’ clinical vision into a spatial plan. Ibghy and his design team at André Ibghy Architectes have developed an intimate understanding of how hospitals function, and the firm specializes in healthcare projects throughout Canada and beyond.

1. Develop a vision
A healthcare design project is preempted by the development of a clinical vision that specifies the nature of the service, its clinical objectives, and the operational model that will deliver the service. This process is driven by hospital management and clinical directors, but the designer is often involved in order to facilitate transition to design.

2. Refine the vision to a functional program
The functional program identifies the services required and provides an inventory of all the spaces within the services. “With the functional program, master plan, and concept for the Montréal Children’s Hospital, part of a $1.5 billion project that relocates five facilities on two sites for the McGill University Health Centre, we started with the design criteria for a patient room,” Ibghy says.

The firm looked at the nurse-to-patient ratios that would be most effective and efficient. It turned out that an efficient patient cluster was 12 patients per nursing team, so the team considered various ways to cluster 12 rooms around a support core.

Ibghy and his team evaluated the organization of patient beds according to “U,” “L,” and parallel clusters facing one another, and considered various criteria—including the accessibility to the patient bed by staff and family, travel distance for nurses, patient privacy, and natural light.

“We even considered the design of the ceiling, because patients are often lying on their back looking at the ceiling,” Ibghy adds.

3. Design an environment focused on healing
“The design process in healthcare is distinguished from others in that it is focused on the creation of an environment specifically directed towards healing and minimizing stress on patients,” Ibghy says.

This perception of what constitutes a healing environment may be very different for each of the stakeholders of the healthcare institution. With the Shriners Hospital for Children, André Ibghy Architectes developed a consensus with the client as to the image of the institution and how it wished to project itself—both to the com-
munity and to its various visitors and patients.

“As this is to be the Shriners’ only hospital in Canada, we developed a thematic for each floor that corresponds to a geographic area of Canada,” Ibghy says. “Each floor’s theme affected the pallet of colours and images, and seeks to create a soothing environment for the patient that he or she may identify with.”

4. Control infection transmission
Controlling infection is a vital factor in everything André Ibghy Architectes does. “What distinguishes healthcare projects from others is the expectation that a healthcare environment will be a healing one—and with that comes a responsibility,” Ibghy says. “When you walk into a hospital, you expect that you will be protected from getting sick or getting transmitted a disease or infection that will aggravate a condition.”

André Ibghy Architectes has to facilitate this responsibility. And because risk management has become a huge part of the operational concerns of a healthcare institution, it has also become a huge concern for the firm. All decisions—down to where to locate a sink—have an impact on infection-control strategies. “Whether [placing the sink] just inside or outside of a patient room will have an impact on the frequency with which a clinical professional washes his or her hands,” Ibghy says.

5. Design facilities that are flexible and adaptable
Treatment modalities are constantly changing, and so are the technologies to deliver those treatments. Therefore, designers of healthcare facilities must anticipate that spaces will need to respond to such changes over time.

“For instance, the challenge for residences for the elderly is that the condition of the individual living within the residence devolves overtime as autonomy is challenged, yet the nature of the architecture does not,” Ibghy explains. “There is tension between the two. We have to think of ways the residence can respond to changing levels of its residents’ levels of autonomy.”