BUILDING FOR MORE THAN HEALTHCARE

As a Dane, you should occasionally tear yourself away from the plain and seek out mountains, train yourself to have vision and dizziness 1

These words of the well-known Danish poet Benny Andersen (1929–2018) formed a framework for the way my close working relationship with Herzog & de Meuron began. In them, Andersen both captures the soul of the Danish people and challenges the ‘Laws of Jante’ – a set of unwritten, egalitarian principles ingrained in Danish and Nordic society that frown upon non-conformity and personal ambition.

When I was appointed in late 2011 to establish a body to plan a new super-hospital north of Copenhagen, I found the Laws of Jante weighing me down and pushing me to conform. Hospitals today are some of the strongest markers of our welfare society. They exemplify civilisation and cohesion. At that time fifteen other hospital projects were already underway in Denmark as part of a €6 billion project to modernise the country’s national healthcare system; our New North Zealand Hospital (NNZ) at Hillerød was to be the sixteenth and last of these. The new hospital site was a pristine meadow and wetland that was beautiful but also challenging. The area is known for its protected species, of which more than 1,500 were transferred to a safe location.

Intuition told me that Hillerød was a unique opportunity to be curious, and to create a new sort of hospital. So I assembled a team consisting primarily of people with backgrounds in behavioural and human sciences. This instantly set thoughts and dialogues in motion. Architects, anthropologists and sociologists talked to doctors, nurses and patients, and pretty quickly we involved thought-leaders and leaders from other fields. If we were to understand the health needs of the future, we would have to seek out mountains. It would not be enough just to build a new hospital or sygehus (literally ‘sick-house’: the word’s pejorative connotations alone left it far from our transformative vision).

It was clear from our first field studies and from visits to hospitals built in the late 1990s and early 2000s in neighbouring countries and across the Atlantic that distinct typologies existed with an institutional understanding, both in terms of the way hospitals were organised, and in their architecture, décor and mindset. I was not a qualified health professional, let alone a ‘system native’, and my humility perhaps enabled me to challenge the system and the experts who represent it. Healthcare is of course scientifically driven, with treatments and care based on evidence and constantly developing research. But when it comes to hospital architecture, perhaps surprisingly, such an approach is less prevalent: certified health architects say there is a certain way to do it but the evidence to support this is often missing.

When we started our planning as the client, we immediately questioned this institutional understanding of what a hospital is. We needed a new definition of a hospital as a welfare building. A place that understands and respects humanity and dignity. Professionals. Patients. Relatives. Citizens. We formulated various taglines to emphasise the project’s ambitions: ‘beyond bricks’, ‘a blank canvas’, ‘a hospital that doesn’t feel like a hospital’.

Our ambition was thus to reinvent the hospital typology. We moved back in time and looked at hospital gardens and Le Corbusier ’s unrealised 1965 plan for a hospital in Venice, with its horizontal focus and four levels. We wanted to escape the prevailing verticality of healthcare, with its emphasis on isolated departments, and to promote a more horizontal model, very adaptable, in which care would be integrated and focused on the patient. And we wanted to take an even more radical step: our hospital would be a gathering place for the local community, a place where you might meet to go for a walk. We engaged the founding director of Tate Modern in London, Lars Nittve, to lead the art programme of the project, to make it relevant. Lars shortlisted artists of the highest international calibre – Roman Signer, James Turrell, Maya Lin, Pipilotti Rist, Susan Philipsz – to develop works to complement the hospital and invite visitors who had no ‘hospital purpose’, to be inspired, illuminated, distracted and to be together. This foresight is part of a broader vision in which the hospital building itself is seen as a bridge to a better healthcare approach. The challenge is to build for the role that hospitals will have in the future, while simultaneously bringing that future into the present. We envisioned a model in which the hospital is one node in a larger continuum of care. This model emphasises outpatient therapy over inpatient care, mental health, healing as a process that is most effective at home, virtual consultations, and opportunities for communities to become partners in caring for the sick. In a sense, the goal was to deinstitutionalise and transform the hospital from a place where the ill come and stay, into a place where care