of the building shows a clear division between the static nursing units in the ward block and the dynamic depar tments on the lower two (or three) storeys. The external appearance of the ward block is often of an imposing design due to its definitive status.

AccessIn general it may be said that the Breitfuss model produces a compact building with relatively shor t walking distances. However, staff and visitors do have to make frequent use of the lifts.

The number of lifts is par tly determined by the number of storeys of the ward block. In the case of highrise with around 10 floors, a considerable par t of the ward block will be taken up by provisions for ver tical traffic [lifts and (emergency) staircases].

Due to its compact design, this model usually has a clearly recognisable main entrance.

Functional RelationshipsSince the lowrise structure contains all diagnostic and treatment functions, it is possible to create good spatial relationships with this type of building. Where the medical staff is concerned, the stacking of the wards can mean that there is a considerable distance between the outpatient unit and the wards.

The Breitfuss model, originally designed according to functional planning of the care provided (outpatient appointment unit, nursing unit, imaging diagnostics, laboratories, 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 less suitable for planning on the basis of target-groups.

FlexibilityWhere flexibility is concerned, account has only been taken of the possibility of 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.

As a result of these limitations in the design, it is more difficult with this type of building to comply with policy concerning the new style hospital that advocates a shift from inpatient to outpatient.

1. INTRODUCTIONThis chapter gives a few striking examples of hospitals that have either already been built or are in the process of development. Examples are provided of each distinctive type of 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.

The examples show how concepts such as flexibility, functional relationships and design were translated in the relevant period or are currently being translated into the building structure of the hospital.

The following models will be dealt with:- the Breitfuss model- the comb and double comb structure- the arcade model- the linear structure

The building structure of a hospital has undergone a development that shows a decreasing dominance of the ward block. The treatment and outpatient depar tments and the flexibility and design of the main traffic areas have had an increasing impact on the main design of the hospital.

Post-war hospital building in the early decades generated many hospitals with imposing, sometimes monumentally designed ward blocks. In the 1980s, when flexibility became an impor tant concept, more neutrally designed hospital structures evolved.

Subsequent developments show a more internally-oriented design of the buildings, 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 other hand, since hospitals have been increasingly built in an urban context due to land problems, fitting them into the urban environment has become an impor tant concept.

2. BREITFUSS MODELGeneralA typical feature of the Breitfuss model is that a tall building block with nursing functions is placed above a flat building block with treatment and outpatient functions. The structure

Architectural Concepts of Hospital Building Example of Comb Structure (See page 028)Location and Name of Institution:Madrid, Spain - Rey Juan Carlos HospitalDate of Completion: 2011Gross Floor Area: 94,705.49m

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Architects: Rafael de La-Hoz CastanysLocation: Madrid, SpainBuilt total area: 94,705.49m2

Project year: 2011Photographs: Duccio Malagamba

The recent hospitals, as health systems, effectively serve the citizens, but it takes place in a dramatic architectural space unnecessarily and sometimes depressive. Its proven effectiveness is the cause of their repeatability, so that over a quar ter of a century that all are the same, or so perceived.

Architects propose to transform the citizen into a customer, for a new type of hospital, which in addition to assist with the proven effectiveness of our healthcare system, can feel at all times the centre of all care, giving them all attention.

This new hospital model is conf igured in three basic elements: eff iciency, light and silence. The best about hospital

architecture and the best in residential architecture. Conceptually, the new hospital is arranged on base that gives structure to the health care units, outpatient diagnosis and treatment. Structured in three modules or parallel buildings that ref lect the best hospital main structures: f lexibility, expansion, functional clarity and horizontal circulations.

On this structure are arranged two units of hospitalisation, two oval crown with gentle curves drawn give a different view from the depressive sensory residential forms of the rationalist block bar, and draw on the best of recent residential architecture: the elimination of corridors and in consequence the elimination of annoying noise, concentric circulation,

Rey Juan Carlos Hospital

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Example of Breitfuss Model I

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1. Overall view of the hospital in daytime. Two oval crown with gentle curves are arranged on a square base2. Side view of the hospital and surrounding landscape3. Crown and Base form a new architecture offering good environment for the professionals and patients4. Roof detail of Crown5. View to oval architecture from the roof of the base6. Envelope detail

light and silence around a common atrium.

Two functional concepts space: base and crown, which are linked to form a new architecture, a model that offers to the professionals the opportunity to treat and to the citizens to be treated in an environment where the natural light and the silence resulting therapeutics.

The overall concept is based on the architectural proposal for a hospital of this nature: it should allow adaptation to the requirements of the programme needs, and expected f inancial requirements. It has also sought to respond to the complex functional Sketch and Volume Trias

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Example of Breitfuss Model I

7. Atrium with opened roof and skylight, day view8. Atrium with functional areas surrounded at night

programme with contemporary and attractive architecture. It has had par ticular regard to the human scale, solar protection and above all to distinct the patients spaces through the hospital. The build is the result of a different point of view against to the simples and common spaces in hospital architecture.

Architects purpose is also give therapeutics spaces and provide architecture that serves to the rest and recovery of the patient. To use the architecture as a medical treatment. The design is structured on a large base, which encompasses various medical areas of the hospital, holding two volumes of glass where the ward

is developed. This approach develops to a complex system of ar ticulated spaces within three prisms that make up the base, geared to each other as if it were a machine, a healing machine.

In addition to the functional treatment of the base, a symbolic treatment was essential to remark the towers. The space of the patients is planned only thinking in the needs and in the best way to them to feel better with harmony and light. From the first moment, it was determinate to have different spaces between the area of the patients and the other functional areas of the hospital, allowing in this area the relation between the green roof garden and the views from each room.

Achieving a perfect functional relationship between the areas, providing maximum f lexibility to the scheme between the exterior and interior spaces. Differentiate between internal and external circulation, distinguish the accesses and the specif icity of ver tical communication cores, allowing clarifying the scheme.

The position of the two towers, responds to the functional need to have an immediate access to the operating rooms, delivery rooms, emergency and diagnostic. The functionality of the building lays in the way of life the patients and their relatives have during the time they have to be inside. The strategy of the implementation is the

Section

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Example of Breitfuss Model I

9. Entrance lobby of the base10. View to the roof of connection part between Crown and Base

organisation between all the elements that are involved in the project. The three prisms of the basement organise the circulation in an exemplary manner. In the two prisms of the edges are arranged for one to be used externally and the other internally, the block in the middle shares uses when internal and external circulations are necessary, but always without inter ference. The architects systematise the building by structural modulation with the subsequent pre-industrialisation process linked with a technological innovation in the materials and systems used; give a unique result with the last

technology making the difference with the traditional hospital buildings. One of the architects main points in the building is the sustainability; considering the conditions of solar orientation, topography, built environment and the greenery nearby, without forgetting the urban conditions of application. They incorporate in the system green materials and renewable energy technology, with the objective to save resources and optimize operating costs, providing through the green roof, natural light and ventilation to the inside of the building.

Typical Floor Plan of Inpatient Unit

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Example of Breitfuss Model I

12. Operating room with shared hand-washing station outside13. Wall decoration and softy light in the patient bedroom

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Example of Breitfuss Model I

14-15. Sunlight provide bright but soft light for the patient room16. Ensuite/bathroom and opened window

Diagram of Window Installation Typical Floor Plan of Single Patient Bedroom

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Example of Breitfuss Model I

3. COMB OR DOUBLE COMB STRUCTUREGeneralThe comb or double comb structure is characterised by a traffic zone in the centre from which different building wings protrude like the teeth of a comb. The building structure is designed like a uniform grid. It comprises many end walls, the so-called open ends, which make it simple to add extensions.

AccessDue to the many open ends, the external architecture gives the impression of being unfinished. In contrast with the Breitfuss model, for example, an overall picture of the hospital is not 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 design.

Functional RelationshipsFunctions which have to comply with the same requirements are grouped in one wing. 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 services 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.

FlexibilityThe 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.

Example of Comb Structure A(See page 042)Location and Name of Institution:Barcelona, Spain - Sant Joan De Reus HospitalDate of Completion: 2011Gross Floor Area: 92,037m

Example A of Double Comb Structure B (See page 054)Location and Name of Institution:Murcia, Spain - New Santa Luca University General HospitalDate of Completion: 2010Gross Floor Area: 114,369m

Example B of Double Comb Structure C (See page 064)Location and Name of Institution:Murcia, Spain - New Los Arcos del Mar Menor HospitallDate of Completion: 2010Gross Floor Area: 61,352m

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Architectural Concepts of Hospital Building I

A B C

This project is presented according to the urban requirements of the plot and the guidelines established by the functional programme. It must be taken into account that the building, due to its public use and size, is a very important benchmark for the new technological park and the city of Reus. At the same time, the architects consider that the facilities are going to give an emblematic and modern image so as to achieve a high architectural quality and eff iciency as new hospital.

The objective of the new hospital building project is to take the most of the site features by improving the functional programme and its link between the

different areas and their surroundings, and also optimising the vehicular traff ic and f low of people. All this is accomplished in the f inal project organisation. After evaluating different alternatives, the project is presented as a major horizontal unit with light wells on which six two-storey hospitalisation volumes rest as if they were f loating. These volumes are linked to a large public circulation area (rambla); the slanting faade and the project of some smaller annex buildings give the hospital a more pleasant appearance along with the city, the technological park and the new university campus. The project is organised into two circulation axis or streets. The medical circulation axis, the par t that is more in

Architects: Corea Moran Arquitectura S.L. and Pich-Aguilera ArchitectsLocation: Barcelona, SpainBuilding area: 92,073m2

Project year: 2011Photographs: Cour tesy of Architects

Examples of Double Comb Structure I

Sant Joan De Reus Hospital

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1. Dusk, street side view of the hospital2. Aerial view of the hospital in comb structure3. Front view of hospital 4. Front square and main entrance

contact with the dual carriageway of Bellisens, is in the north par t of the site where the entrances and exits of the parking lot and the technical logistics sector will be built.

The public circulation axis, located in the south of the site, opens onto a new pedestrian walk. In this large circulation area, called rambla, all public entrances to the hospital emerge from a square. The idea of this hospital design is to control its size and make it similar to

the urban dimensions, controlling and balancing the landscape impact of such a building in the city.

The project consists in building a low height hospital, with changes in the existing topography, a big well-lit unit where the general public and the physicians can communicate, with green spaces, evoking nature in the building area. In the faade, where pedestrian accesses are located, the large scale building is softened with two project strategies.

On the one hand, the faade plane that covers the whole building is bent over, optically reducing the physical presence of the building and increasing its perspective effect. On the other hand, on the ground f loor there are rounded pavilions at a lower scale that receive people, helping to organise the different entrances. In the big area of the public rambla, the personnel, patients and visitors encounter a public square which enters into the building as if it were par t of it. Elevations and Sections

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Examples of Double Comb Structure I