Final DRS Thesis Project

A + R HEALTH C H I T E C T U R Courtney Posel E

A Place of Balance for the Employees of the McGill University Health Centre

McGill University School of Architecture Michael Jemtrud/ Annmarie Adams 2010/2011

architectural context

28% of health care workers report a higher than average degree of stress compared to 18% of the general population. bmj.com

architectural context

INTRODUCTION SITE urban context architectural context site analysis PLACE(S) OF BALANCE colloquium initial proposal conclusion A PLACE OF BALANCE Ivan Illich final project conclusion PRECEDENTS BIBLIOGRAPHY

I N T R O D U C T I O N

Today, health is defined as a state of balance between physical, emotional and spiritual well- being. It is based on one’s desire to live their best life.

This thesis began as an interest in exploring the connection between architecture and the concepts of health and wellness.

Since, by definition, health is a state of balance, the research was rooted in developing an environment, or a series of environments, that could

constitute a place of balance.

More specifically, the study was based on exploring the notion of a place of balance for the health care worker, the group of people who are surrounded daily by illhealth and disease. Since 28% of health care workers report a higher than average degree of stress compared to 18% of the general population, the thesis began by questioning the role of an architectural intervention in affecting this condition and in improving the professional

environment as a whole.

The content of this investigation was applicable to the new McGill University Health Centre. This mega- hospital project is currently under construction in the neighbourhood of Notre- Damede- Grace in Montreal, Quebec.

The structure is scheduled for completion in 2014 and will be replacing several Montreal institutions. The site was related to the proposed topic because the plan for the new hospital

contains no program or specific built environment to address the overall health of its employees.

As a result of the initial interest in the connection between health and architecture and in the selection of a site, it was decided that the final proposition would be the design of a Wellness Center for the employees of the new McGill University megahospital. It would be a place of retreat that would react to, and affect, the professional

experience.

The primary modes of operation were through academic research, collage and 3D- modelling.

S I T E

The new McGill University Health Centre is located at the Glen Yards in the neighbourhood of NDG in Montreal, Quebec. The 43- acre site is a former CP rail yard that required a large amount of rehabilitation and de-contamination when it was purchased by McGill University in 1998 for 23- million dollars.

Because of its massive scale and the infrastructure that surrounds it, the proposed project is sequestered from its surroundings and will be, essentially, a small city onto itself.

The new hospital has

amalgamated five medical institutions into one giant proposal. Once completed, the Montreal Children’s Hospital, the Royal Victoria Hospital, the Montreal Chest Institute, the Research Institute and the Comprehensive Cancer Center will be located on this site. The chosen scheme was selected through a competition process that was won by Quebec engineering and construction firm, SNCLavalin.

The buildings were designed by the architectural offices of IBI Group, HDR, Yelle Maille and NFOE.

Although this project was developed as a response to Montreal’s crumbling medical infrastructure and to the architectural inadequacy of its current hospitals, much controversy and criticism surrounds the design and management of this PPP proposal.

The intervention proposed by this thesis is intended to act as a form of commentary on the new hospital, currently under construction at the Glen Yards site.

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urban context

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A_Children’s Pavilion B_Children’s Pavilion C_Adult Pavilion D_Adult Pavilion E_Research Institute F_Employee Parking

proposed mega- hospital_

architectural context

underground 2 general support services security eco- health waste management vivarium food services staff areas biomedical control center

underground 1 urgent care level

palliative care radiotherapy outdoor terrace admissions and archives teaching offices pediatric ER adult ER cafeteria and commercial space

RDC public entrance

adult/ pediatric day hospitals social services nutrition clinic pharmacy pediatric cardiac diagnosis commerce admissions and archives adult cardiac/ pulmonary commercial space

level 2 diagnostic level

palliative care private offices ambulatory care chapel pediatric neurology patient rooms imaging laboratory support

level 4 translational research clinical research

teaching offices clinical laboratories morgue administration sleep lab speech and hearing clinic center for innovative medicine

level 5 mechanical level private office level teaching offices clinical laboratories dialysis clinic infection control

level 6 women’s health level OB GYN breast centre birthing rooms OB ultrasound ambulatory services nursery neonatal ICU pediatric ICU

level 7-10 inpatient services

adult ICU patient rooms pediatric oncolgy pediatric psychiatry pediatric immuno comp.

architectural context

PLACES OF RETREAT_ A planometric study of the proposed megahospital confirmed that there were no specific spaces designated to address the overall health of the employees. Private offices and staff locker rooms will provide the only places for a relative degree of privacy. Furthermore, there are few outdoor spaces incorporated within the building itself. The cafeteria and commercial spaces are completely public, to be used simultaneously by staff, visitors and patients. layered drawing_

private staff areas (offices, locker rooms)

public areas of retreat

(cafeteria, commercial space, chapels, terraces)

THE CENTRAL SPINE_ Like many planned cities, the mega- hospital is organized along a central axis. This axis is a corridor that moves continuously through every pavilion. The spine has secondary arms that connect to it, directing one to the various sub- spaces. This is a large organizational improvement from the current MUHC hospitals, whose various additions and renovations throughout the years have turned them into veritable mazes, confusing to both employees and visitors.

The incorporation of a central spine is standard practice in contemporary hospital design. diagram_the central spine

architectural context

SITE ANALYSIS_ Although the new MUHC mega- hospital will improve the efficacy of the medical system in Montreal, it is an architecturally inward looking proposal.

Though it is located on a unique site with a rich history that straddles three fundamentally different neighbourhoods, the project does not reference any circumstance or idea outside of its immediate physical boundaries. Instead of acting as a bridge to connect to different areas, to move citizens through the site and to be an

active member of the surrounding communities, the building acts as a giant wall. Its massing and placement discourages any sort of movement through the site. Additionally, the proposed architecture does not connect to any historical characteristics of the hospitals that it is replacing, nor does it address any current trends in much admired and successful examples of contemporary architecture in Montreal.

To address the urban and historical issues that arose during

the study of the proposed architecture, a series of drawings was created to provoke discussion and to highlight issues that could be addressed by the future, thesis- driven, design proposal. By exploring these ideas, the intent was to develop an outward looking strategy of intervention. This would fundamentally and conceptually differentiate my scheme from the design of the mega- hospital, thus allowing it to automatically reflect the idea of spatial balance, or the architectural equivalent to health and wellness.

view diagram_

site analysis

MOUNT ROYAL_ When the Royal Victoria Hospital was opened in 1893, one of the main features that defined it was its location on the slopes of Mount Royal. Directly outside of the hospital, one could be enveloped and protected by the natural environment. The height of the trees, the canopies of branches and leaves, and the light qualities of the forest, served to emphasize this sense of safety. The balconies that were incorporated into the design of the building further emphasized the importance of the connection to nature.

WESTMOUNT/NDG_ The Glen Yards lies within the communities of NDG and Westmount. These two neighbourhoods are typically described in terms of the drastic differences between them. In reality, their edge condition is, like most neighbourhoods, completely un- remarkable. It is nothing but an invisible line through backyards and city streets. One can cross back and forth without even being aware of the change in district.

site analysis

ST. JOSEPH’S ORATORY_ From the Glen Yards, the dome of St. Joseph’s Oratory is visible.

The urban importance of this building to the mega- hospital is glorified by the architects renderings, which take care to include, and even exaggerate, its presence.

The unique characteristic of this building is that it acts a symbol. It allows one to orient oneself in Montreal based on what they can see of the building.

THE VIEW SOUTH_ From the site, several mountains to the south are visible in the distance. However, they are partially obstructed by ‘visual clutter’. Buildings and infrastructure affect the visual rhythm of getting to these places, for better or for worse, depending on an individual’s point of view. One must focus their vision to gain access to these views.

site analysis

THE GREEN MOUNTAINS_ It is often repeated in historical documentation that on a clear day, one could see the Green Mountains of Vermont from the Royal Victoria Hospital. This experience was always a surprise; many factors had to cooperate in tandem to make it possible.

A space that was the same day after day was suddenly changed and affected by the appearance of a new condition.

DOWNTOWN MONTREAL_ The connection to downtown Montreal was important to the design of the Royal Victoria Hospital. The long axis up University St. connected the outlying medical buildings to the city as a whole. The materiality of the hospital also associated it to the material pattern of Montreal. The interstitial spaces of a city, a defining feature, are also lacking in the design of the mega- hospital. When moving through the central spine, there is no indication that one is passing from one building to another.

There is no urban ‘interruption’ on the façade. This creates an ultimate disconnect between the rhythm of the city and that of the mega- hospital. site analysis

P L of BALANCE A C E (S)

Because the design of the proposed mega- hospital is of such an immense scale and is so organizationally complex, developing a strategy of intervention to react to and to affect the institution was quite daunting. Therefore, the first conceptual exercises attempted to impart a degree of distance from the proposal itself and to simply explore the connection between architecture and the ideas of health and wellness.

Since health is a state of balance, the goal was to begin to define

what kind of space could constitute a place of balance for the health care worker. To do so, three prototype characters were developed based on people from works of fiction and nonfiction. This exercise allowed a reaction to the spatial conditions of the medical environment to be developed and to begin to conceive abstract ideas for each of the characters place of balance within their professional experience.

The result of this initial exercise,

a series of spaces that integrate themselves into a typical medical environment, inspired a similar strategy of intervention onto and within the mega- hospital itself. They permitted a certain distance from the architectural complexity of the mega- hospital and the inspiration to delve into the first design proposals of the thesis year.

SETH_nurse

Sometimes, the noise of the hospital is just incessant and overwhelming. From alarms beeping, to telephones ringing, to talking, crying, screaming...

Here is a place of silence within all that sound to still my mind, a cave of quiet and falling water.

The landscape of the patient rooms defines my daily experience.

Though the design of the room remains static, its inhabitants, from patients, to visitors, to doctors, are constantly changing and in motion. Here, I can sit and observe change that occurs slowly, stilling my body and mind.

colloquium

GABRIEL_surgeon

My operating room, no matter where it is located, is always organized in the same way. My instruments are to my right, in their same positions on a tray.

My nurses and assistants take their assigned spots. In these spaces, I am stimulated by the small changes in environment, never quite knowing what I might get.

I concentrate on one part of the body at a time, often working on one small area for hours without looking at the whole. Sometimes, it is a relief to be exposed to the entirety. In this space, I can slowly take it all in.

colloquium

ELLEN_medical student

For the first time, I am surrounded by people stuck in the most confining of spaces: their own sick bodies. It is crucial to not be paralyzed by my empathy, to still know that my body can go anywhere, see anything.

I am always in different places, from the classroom, to all the different parts of the hospital. My mind is seeing and experiencing, it seems, a thousand things at once. This is a place where I am only being pulled, visually and physically, in one direction at a time.

colloquium

3 LEVELS OF INTERVENTION_ Because of the size of the proposed mega- hospital, it was decided to act upon it initially on three different scales.

It was evident that a small intervention would be lost within the complexity of the hospital and that too large of one would threaten to become just as anonymous and intimidating as the building itself. The three scales of operation were defined as the scale of the installation, the scale of the pod and the scale of the pavilion. They

would all be parasitic in nature and would react to and enhance the functioning of their host: the mega- hospital. Like true parasites, all of the interventions would draw services, water, electricity and structural support from the host building. However, the relationship between the parasites and the host would ultimately be one of symbiosis.

The installations would serve to activate the central spine where one pavilion invisibly transitions into another. They would also

aim to orient and to connect the employee to the pods and to the pavilion. The pods would house smaller programs and would attach themselves to the facades of the buildings where natural urban breaks should have been incorporated. The pavilion itself would accommodate the large new programs that would be proposed. The three degrees of intervention would be designed to project a similar language to establish an inherent connection and bridge between them.

to activate

INSTALLATION

to orient to connect

POD

to learn to meditate to breathe

PAVILION

to gather to exercise to eat initial proposal

the installation_a conceptual exercise

initial proposal

THE POD_The design of the pods involved extracting ideas that had developed in the site analysis and in the first spatial exercises and apply them to the hospital itself. Firstly, emphasis was placed on the flow of movement into the pod, the way it attached itself prosthetically to the hospital and the direction to which it was oriented in relation to the urban context.

Then, programs of retreat, such as small places to gather, places to be quiet, and places to be outside, were incorporated into the design.

the pod

to discuss.

to escape.

to learn.

to breathe.

to gather.

to study.

initial proposal

initial proposal

CONCLUSION_ At the December mid- term review, the effectiveness of the ‘momentary episodes’ that had been proposed was called into question. They were understood to be more of an external response to the mega- hospital than the reactive and affective one that was intended. Although the pods were well sited, I was inclined to agree that their effect might have been more formalistic than originally intended.

Another decision that was called

into question was the choice to parasite a building that did not yet fully exist and that it was unnecessarily complicating to attempt to react to a design about which minimal information was available. Following the review, consideration was given to relocating the project to an existing Montreal hospital, however, this would have changed the basic intent of the thesis, as the largest number of MUHC employees will soon be concentrated at the Glen Yards.

Additionally, an entire entire

semester had been dedicated to investigating this site and to gathering as much information as possible on the proposal.

As a result, there was much determination to see it through.

Transferring the intent to another hospital, such as the Montreal General, would have affected the basic foundation of the thesis.

The most challenging aspect the initial proposal was in representing the symbiotic relationship between the pods, the installations and

the hospital itself. Although hallways and facades infiltrated by new materials and structures could be drawn and it could be insinuated that the whole was being affected by their presence, was that a slightly na誰ve assumption? I do not know if that question can truly be answered by an un- realized project, as the success of a design is mostly understood by its finished, inhabited result. The proposal would have been received differently had it been known that a particular space was used

by a particular nurse at a certain hour, allowing her a moment of escape that corresponded perfectly to where she was and what she was doing at that time in her day. By knowing this information, could a piece of furniture have been designed to alleviate her burden or a light fixture installed that responded to her particular degree of fatigue?

Perhaps I was too focused on realizing a built environment that I could not envision having a project of this detail and scale. I grappled all semester

with trying to provide spaces for everyone that responded equally to individual needs.

At the September Colloquium, Donald Kunze said he felt sorry for architects who cared too much. Although he may have had a point, I cannot see myself designing in any other way.

conclusion

A P L A C E

of BALANCE Following the December review and the questions surrounding the scale of the pods, it was decided to delve immediately into the design of the pavilion, the intervention that would contain the larger programs that would be proposed. The intent for this semester had been originally to begin with the design of the pavilion and work backwards to the smaller scales.

However, the second portion of the thesis became dedicated to the research and realization of this larger- scale intervention.

The proposed employee Wellness Center is sited on the roof of the two –story children’s hospital. In this location, it is highly visible from Decarie Boulevard and maintains a strong sense of connection to the employees’ place of origin. The pavilion can be accessed by a passerelle that connects to the central spine of the hospital at the the fifth story.

It can also be entered from the main core that touches down to the ground, connecting it to the employee parking lot as well as to the surrounding areas.

Finally, the area below the pavilion connects down to the hospital itself, allowing patients, visitors and staff access to the public roof terraces and gardens.

The main goal of this pavilion was to create spaces of retreat for the health care employee that directly related to their professional experience while simultaneously promoting the understanding and maintenance of their own bodies.

In order to ground the design of the intervention within a theoretical discourse, it was decided to incorporate several ideas derived from Ivan Illich in his book, “Limits to Medicine, Medical Nemesis: The Expropriation of Health”. In this text, the author insinuates that health is related to the ability to make a choice and to perform autonomously to heal oneself.

This articulation of the definition of health confirmed an initial belief that health and wellness is specific to the individual. Illich also writes that how a person

“relates to the sweetness and the bitterness of reality and how he acts towards others whom he perceives as suffering, as weakened or as anguished determine each person’s sense of his own body and within it, his health” (Illich 129). This declaration further emphasizes that a health care employees interaction with his professional environment reflects his own state of physical and emotional health.

Based on Illich’s text, two ideas were defined to inspire the architectural manifestation

of this thesis. The architecture must affect autonomous action by propagating choice and the architecture must encourage the employees sense of the their own body.

The Architecture of Autonomous Action_ From the beginning of the year, an understanding of the concept of wellness has been rooted in the individual’s ability to define their own personal state of balance and their desire to create and maintain their own program to achieve it. In traditional cultures, “health

care is always a program for eating, drinking, working, breathing, loving, politicking, exercising, singing, dreaming, warring and suffering� (Illich 130). Therefore, a program of balance can be achieved through the combination of any number of these activities.

The role of architecture in this case is to provide a habitat for these endeavors to occur and to expose them. Quite simply, different programs and spaces within the pavilion would be linked and exposed visually so that informed choices

could be made autonomously and the employee could take responsibility for their own selfcare.

The Architecture of SelfAwareness_ The hospital is the most humbling place in the world as the patient is constantly under supervision and access to their bodies is publicized for the sake of diagnosis, treatment and hopefully, recovery. Illich suggest that a doctor’s response to someone who is suffering indicates their sense of their own bodies and their own particular

degree of empathy. The intention behind the architecture of the pavilion was to humble the body of the employee, not for the sake of celebrating its disease, but to celebrate its capacity and its existence. By doing this, the pavilion would heighten the employees awareness of their own physical form while providing an understanding of their health and a different ability to empathize with their patients.

Ivan Illich

health care is always a program for eating, drinking, working, breathing, loving, politicking, exercising, singing, dreaming, warring and suffering.

- Ivan Illich

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THE BODY WALL_ To architecturally develop the conceptual framework inspired

by Illich, the idea of the Body Wall was developed. It would be a series of smaller spaces that would permeate the building as a whole and serve as a model for the way that health care could be understood in the 21st century. It was also conceived as a method to mediate between the scales of the programs suggested in the proposal and to connect back to the first series of conceptual spaces that were explored earlier in the year.

final project

final project

WEST ELEVATION_

SECTION A_

fitness center. fitness center.

aquatic center.

roof top garden.

final project

EXTERIOR STAIR_

ENTRANCE CORE_

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from surrounding pavilions

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ROOF GARDEN LEVEL_

children’s area.

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vegetable garden.

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gathering space.

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LEVEL 1_

passerelle from hospital. leisure pool. to wash. to sweat.

to eat.

lobby.

lap pool. reception.

A

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terrace.

final project

LEVEL 2_

to breathe. to escape.

fitness center.

terrace.

LEVEL 3_

to wash.

to reflect.

to gather.

fitness center.

final project

TO STUDY_section_level 2

The following images explore spaces within the Body Wall itself.

TO STUDY_ Is a space that permeates the southern facade of the pavilion and allows panoramic views to the St. Lawrence River and the mountains in the distance.

TO REFLECT_ Is a private changing room on the third level that offers a small space to nap or work quietly.

TO REFLECT_ceiling plan_level 3

day.

night.

final project

TO ESCAPE_section_level 2

TO ESCAPE_ Is a series of small rooms that are modelled on the idea of the capsule hotel. Composed of a large shower and bed, they are places that can be used for many hours at a time.

TO REFLECT_ Is a studio space to be used for yoga or other aerobics classes.

Its floor- to- ceiling windows provide panoramic views north to Westmount and to Mount Royal.

TO BREATHE_elevation_level 2 panels closed.

panels opened.

final project

from the ramp leading to the Hospital.

The following three images explore the relationship between the Body Wall and other spaces within the pavilion. Emphasis has been placed on the visual connections between people and program.

from the passerelle.

final project

from level 1.

it’s the idea that a building, a work of architecture, can directly catalyze a transformation, so that the society that finishes something is not the same society that set out to build in the first place. the building changes them.

- Lebbeus Woods

FINAL REVIEW_ The final thesis reviews at the McGill University School of Architecture took place between April 26 and April 28, 2011. This thesis was presented on April 27 to invited critics Lily Chi, from Cornell University and Vassilis Ganiatsas from National Technical University of Athens.

The members of the advisory committee and faculty present were Michael Jemtrud, Annmarie Adams, Aaron Sprecher and Torben Berns.

In general, the project was well received and the commentary and questions posed by the panel

were compelling and entirely appropriate. Interestingly, the first question that was asked was how the hospital could have been redesigned as a whole; this is not the first time that question has been directed towards this project. Although I do have an architectural response to that query, the intent behind this thesis project was never to design a hospital, though some may argue that it may have been a more appropriate response to the topic at hand. Obviously, the mega- hospital could have been designed in a more sensitive manner to reduce the wall- like

effect of its form and scale and to connect it to its surroundings.

It was also suggested that it could have been re- designed following a more de-centralized approach that would have truly emphasized the conceptual framework suggested by the thesis. Although smaller- scale clinics do reflect how the majority of care should be received today, they are not an adequate alternative to the mega- hospital.

The idea behind the new hospital is to offer critical care and to direct other patients to smaller, community based clinics. For example, the birthing center

at the Glen Yards is meant to receive higher- risk pregnancies.

The decentralization of such a large facility negates the logistical convenience of the project. Although I have presented criticism about the design of the new hospital, I do support the idea behind its conception; this is why the thesis was never centered around it redesign. The realization of the mega- hospital was understood as a given and I simply wanted the opportunity improve and to affect the inevitable.

Lily Chi had positive comments

about the project and truly understood the larger architectural decisions that it reflected, from the siting of the proposal, to its orientation. It was gratifying that these ideas were transmitted without having to articulate them. She did suggest that another, perhaps more aggressive, iteration of the project would have had a more ‘plug-in’ nature. This was an interesting comment as it reflected the operational methodology that had been explored, presented and abandoned. To have progressed with that type of methodology

would have necessitated a larger degree of assumption to have been formulated about the mega- hospital. Although it was considered, it was not an appealing process, as the thesis required a certain grounding in reality. To create such an imaginary framework would have been an endless task that did not have any boundaries through which to define the project. A parasitic approach would have been ultimately successful and perhaps more conceptually reflective had it been applied to a building that already existed. It is an idea that

conclusion

continues to interest me.

FINAL REFLECTION_ The initial goal of this project, as stated in the proposal, was to provide places of balance and retreat within Montreal’s new megahospital and to address the physical, mental and spiritual health of the employee. It was to infiltrate the system and to affect change. It was also to complete the year with a defined architectural proposal. Although I do think that my proposed building does begin to explore and to achieve the initial goals, it is perhaps too detached from

the ‘system’, or to the reality and functioning of the hospital itself.

To have altered this mechanism would truly have necessitated the re- design of the proposed mega-hospital and to have addressed the fundamental issues through a new approach and iteration. This direction was resisted throughout the year because its scale threatened the realization of an actual project.

Although the most effective way to have approached this thesis is an ongoing discussion, I am pleased with the final proposal. It architecturally, programmatically

and logistically reflects my main goals. Its scale is appropriate for its location and it projects a strong contrast to its host.

The less typical programs incorporated into the project, the components of the Body Wall, reflect the individualized notion of health; they are personalized by the activities of their user.

Finally, the points of connection to the hospital reflect the desire to create a place that can be used and accessed easily at any point of the day. Ideally, these design principles could be used to conceive other appendages and infiltrations within the

hospital itself.

To conclude, the thesis year was a successful and positive experience. The topic of the project encouraged me to ‘live the thesis’ and to project its ideology onto myself, allowing me to mindfully engage with the process and to remain reflective.

I would like to thank my advisors Michael and Annmarie for their guidance and support. I would also like to thank my family, whose love and patience has been crucial during my time at the McGill School of Architecture.

Namaste!

conclusion

P R E C E D E N T S

LAS PALMAS PARASITE_

korteknic stuhlmacher architecten The integration of new programs within with old.

PARASITE PREFAB_

HAVANA, RAIN_ Lebbeus Woods The occupation of architectural infrastructure.

WATER_

Lara Calder Architects

Herzog and de Meuron

The occupation of infrastructure.

The occupation of architectural infrastructure.

MULTIVERSE_

de YOUNG MUSEUM_

Leo Villareal

The activation of a transition between buildings.

Herzog and de Meuron The control and manipulation of views to the surroundings and to the city.

VITUS BERING INNOVATION PARK_ C. F. Møller Architects The visual connection between people and program.

KRAANSPOOR_

OTH, Ontwerpgroep Trude Hooykaas bv The occupation of infrastructure.

KM-QRO_ casaPública The visual connection between people and program.

NOVO FACTORIES_ Arne Jacobson The activation of the body through an unusual experience.

SLEEPBOX_ Arch Group The new capsule hotel.

NATIONAL BALLET SCHOOL OF CANADA_ KPMB The material palette.

B I B L I O G R A P H Y

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de Botton, Alain. “The Architecture of Happiness.”

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Stichler, Jaynelle F. DNSc, RN, FACHE, FAAN. “Healthy, Healthful, and Healing Environments: A Nursing Imperative.” U. 32(3). (July/September 2009): 178-188.

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thank you.