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© NBRS Architecture 2017


Authors: Alison Huynh, Bernadette Keenan, Brett Sherson


First Published: August 2017

Case Study 01: Sydney Adventist Hospital


Case Study 02: Wilcannia Hospital



Case Study 03: Renwick Centre



Health and the Arts


NBRSARCHITECTURE. Level 3, 4 Glen Street Milsons Point, NSW 2061 Australia

+61 2 9922 2344 Citation: Huynh, A. Keenan, B. & Sherson, B. (2017). Envision Welcoming Spaces in Acute Care. Sydney: NBRS Architecture.

Conclusion10 References11 Approach12


INTRODUCTION “Hospitals have the opportunity to become the community center for health and wellness. The entire healthcare experience could become an inspiration for all who enter the facility to improve their health and wellness” (DeGeeter, 2009)

Previous design studies undertaken by NBRS have explored the cycle of preventative and responsive healthcare and how architectural interventions could support community-based disease prevention. This revealed the important link between hospitals and the community. Local hospitals and health-services should be well-integrated into the community and actively engaged in awareness and education. The hospital must be an open door to the community, socially and culturally inclusive, to promote wellness for all. As designers, we know that first impressions matter. People in the community might consider hospitals to be institutional, uninviting and “sick” places. In this continuing research, we’ve decided to look at how hospitals can redesign and renovate entrances spaces for a more welcoming and encouraging experience for patients and visitors. Furthermore, we’d like to explore how local acute hubs can build their relationships with the community, fostering cultural inclusivity and reducing barriers to care. Local hubs in regional areas are a vital link to healthcare for many in the community,

especially those who are socially and economically disadvantaged, as well as indigenous populations and those in rural and remote areas. Art and design can play a role in fostering social inclusion and intergenerational and cultural exchange. The experiencing, making and performing of art is particularly important for priority populations such as Aboriginal people, culturally and linguistically diverse communities, young people, older people and people with disability (NSW Health, 2016). Isolated or disadvantaged communities tend to experience difficulty accessing health services. A Queensland Health (2012) Literature review on “Best practice multicultural policy implementation” found that language and communication consistently emerged as the main barrier to accessing services. An “Australia’s Health 2014” report conducted by the Institute of Health and Welfare (AIHW, 2014) reported on a range of factors affecting Aboriginal health which included higher rates of mortality and morbidity, as well as greater difficulty accessing health services.

starting point for creating a welcoming space. Salutogenic design principles are increasingly being emphasised to promote wellness and reduce stress within the acute space. Stress is associated with a wide variety of behaviours which adversely affect wellness, such as the suppression of immune system functions which increase susceptibility to disease and work against recovery (Ulrich, 1991). The design of a stress-free place supports patient recovery as well as staff, as job-related stress is associated with low levels of job satisfaction and high rates of burnout (Shumaker and Pequegnat, 1989, as cited in Ulrich, 1991). An uplifting and inspiring space filled with natural light is likely to have a positive psychological impact on patients and visitors (Gander, 2016), and a connection to outside and landscape can help relieve stress as well as reduce potential claustrophobic effects of confined spaces (Joseph, 2006). This is particularly important in changing the perception of the hospital from a place of illness to a place of wellness.

The front of house is an important



CASE STUDY 01: SYDNEY ADVENTIST HOSPITAL Sydney Adventist Hospital, known locally as the San, is a private hospital in Sydney’s north-west and the largest private hospital in NSW. It was established in 1903 and in 2011, it commenced a major redevelopment which encompassed a significant expansion in clinical facilities as well as new entry and arrivals building and new multi-deck car parking. The new entrance hall connects the main hospital buildings to a new car-park as well as integrated access for drop-off, emergencies. In the design, natural light and connection with nature features strongly and the original hospital entrance and green spaces are revitalised. The entrance provides an open and sunlit space for orientation and movement, with views of bushland in the north-east. It is located between three existing buildings and provides vertical circulation and linkages, leading towards a future hospital ‘hub’.



According to architect Cameron Martin “Providing an innovative solution to the entry of the hospital and removing the previous vertical access challenges has resulted in a successful blend of effective access and an amazing aesthetic – all of which has resolved numerous issues the SAH had on site,” (Chua, 2014). The design drew inspiration from the sanatorium that originally stood on the site, focusing on a therapeutic environment which exemplified the notion that the natural environment can impact health and aid recovery. Beyond the entry, views of nature are promoted throughout the new facilities, particularly in the new maternity ward and the cancer clinic. It illustrates architecture’s ability to elevate the hospital as a healthy and inviting environment for patients and visitors. ---


CASE STUDY 02: WILCANNIA HOSPITAL The Wilcannia hospital was established in 1878 on the edge of town in Wilcannia, overlooking the Darling River. It has a long history in the community, and was seen as a place of exclusion, sickness and death in the eyes of the Barkinji, the traditional custodians of the land around Wilcannia. In the redevelopment which commenced in 1998 the community were involved in the design facilitated through the Wilcannia Community Working party in conjunction with the Government Architects and Merrima Aboriginal Health Service (Tawa, 2002). The redevelopment began with the removal a series of ad-hoc additions to the original heritage-listed building. Restoration focused on revealing original features and revealing the marks of incremental modification throughout the building’s history. A central spine connects the original building with a new reception area and a new linear wing

facing towards the river. A new mortuary is located at the far end of the new wing and articulated as a separate mass which allowed for dignity and privacy for families to pay their respects. Merrima’s design created a layered and sequenced organisation where internal spaces read as external, allowing for connection with country and views of the river. This approach aligns with academic knowledge that views of nature, as well as images and representations of nature are beneficial to relieving stress, improving mental clarity, and reducing the length of hospital stays (Clay, 2001).


ARCHITECT: Government Architect’s Office & Merrima Aboriginal Design Unit

PROJECT ARCHITECT: Dillon Kombumerri COMPLETED: 1998 - 2002 LOCATION: Wilcannia, NSW PHOTO CREDIT: Brett Boardman

The designers questioned western based architectural design theories and sought to uncover socio-political imperatives important to the indigenous community. This suggested that ‘feeling is more important than seeing’ in the design approach (Kombumerri, 2016).



CASE STUDY 03: RENWICK CENTRE Located on the Royal Institute for Deaf and Blind Children’s main campus in North Rocks, Renwick Centre is a centre for research and professional studies in the field of education for children with sensory disabilities. It houses an auditorium to seat 208, four teaching rooms, specialised research facilities, and a significant library of resources on education for children with sensory impairment. As a new addition at the centre of an existing campus, the design sought to articulate a new entrance portico and pedestrian entrance and linking to other buildings and car parking areas. To create a legible environment it is necessary to mark specific spaces and / or locations. The design of landmarks and “well-structured” paths can assist in navigation and allow users to understand and orientate themselves, especially within a large campus or site (Foltz, 1998, p.59-61). The



streamlined and linear form of the Renwick Centre rises to address the street, but sits low in the landscape from other angles to match existing single-storey buildings. The external corridor forms a campus spine, connecting internal and external spaces. The portico extends an invitation to staff, students and public to enter the campus. In this way, the circulation spine forms an effective urban marker for the campus. Since establishment, the building has become an important feature of the campus and the sheltered portico has hosted events and book fairs for the community. The paved areas and gardens around the building also form informal gathering spaces and overflow for auditorium and teaching spaces, effectively extending the buildings capacity. ---


HEALTH AND THE ARTS Inspiring artworks by local aboriginal artists have been introduced in hospitals especially in regional hospitals and health services. St John of God Geraldton hospital in Western Australia has found art useful for patient care and features artworks including those of local Yamaji artist Barbara Merritt (Lewis, 2016). Traditional arts have been used at Port Pirie Regional Health Service in South Australia to creating a welcoming spaces in inpatient areas for local Aboriginal people attending the hospital. Paintings by artist Ingkama Bobby Brown incorporate his home town around Ingoma Station about 70km from Coober Pedy. Senior Aboriginal health worker Lynore Lawrie highlighted that the traditional arts provide a connection to country and home for Aboriginal people but was also broadly beneficial to all patients staying in the ward (Dulaney, 2015).

The NSW Health and the Arts Framework (NSW Health, 2016) provides guidance for the investment in arts and culture for health services. The Framework identifies the benefit of the Arts in: • • • • • • •

Improving patient, staff and carer experience; Creating a sense of place, enhancing design and wayfinding; Leveraging the Arts for engagement with communities; Promoting health messages; Increasing access to the Arts; Fostering sustainable partnerships with the Arts sectors; and Integrating the Arts into the design of new spaces.

Architecture, spatial design, wayfinding, lighting, signage, landscaping and transport infrastructure are all forms of the built environment that can be engaged to create meaning and coherence in health spaces. Art and design can create welcoming and engaging spaces to elevate hospitals into place of holistic wellbeing for the community. -LEFT: Barbara Merrit and painting (Chris Lewis) RIGHT: NSW Health and the Arts Framework (NSW Health)

The Framework defines the Arts broadly as encompassing all art forms including: Visual Arts; Digital Media; Performing Arts; Literary Arts; and Built Environment.



CONCLUSION A large body of research now supports the positive impact of both natural light and views of nature from the bedside on reducing the length of hospitalisation (Ulrich, Zimring, Quan, Joseph & Choudhary, 2004, p25). Natural light can be utilised as an effective design feature, creating aspirational and welcoming spaces which respond to the outside lighting conditions, movements of the sun and changes of the seasons. Natural light is strongly featured in the case studies and should be incorporated in healthcare centres as adequate light is critical for health and wellbeing of patients and staff and is generally preferred over artificial light, not to mentioned cheaper to provide. In particular, adequate light enables the performance of visual tasks; helps



to control the body’s circadian system and affects mood and perception (Joseph, 2006, p1-3).

dialogue with users, designers can weave a legible narrative of health, community and history.

The architectural typology of the hospital has grown from a civic and spiritual place of healing to an industrial megastructure which tends to resist and architecture of atmosphere and emotion (Pert, 2014). The case studies show that designers must consider the human scale when designing entrances. Double-height spaces can help create a lofty and grand experience, while single-height spaces can encourage more personable and individual interactions.

A clear visual connection with country is a feature highly valued by indigenous communities. This also helps to ground the hospital in the land and connect the acute environment with the home environment beyond (Kombumerri, 2006).

Through consultation, we know that the institutional nature of hospitals is intimidating to members of society who have felt discrimination and underprivilege in the past (Vesey, 2017). By maintaining a

The principles outlined in this study can be applied to all acute health projects of all scales. Lighting and landscaping can improve the quality of hospital spaces without significant outlay and by investing in the design of front-of-house areas, hospitals and health services can reinstate and strengthen their role as community hubs and landmarks.

REFERENCES AIHW. (2014). Australia’s Health 2014, Chapter 7: Indigenous Health. Canberra: Australian Government. Retrieved from http://www.aihw.gov.au/ australias-health/2014/indigenous-health/  Chua, G. (2014). MBMO combines nature and nurture in design of Sydney Adventist Hospital. Architecture And Design. Retrieved from http:// www.architectureanddesign.com.au/news/mbmo-combines-nature-and-nurture-in-design-of-sydn  Clay, R. (2001). Green is good for you. American Psychological Association, 32(4), 40. Retrieved from http://www.apa.org/monitor/apr01/greengood.aspx DeGeeter, M. (2009). Changing perception: Hospital brand as a design strategy. Healthcare Design Magazine, 9(12), 10-15. Retrieved from  http://www.healthcaredesignmagazine.com/architecture/changing-perception-hospital-brand-design-strategy/  Dulaney, M. (2015) Aboriginal elder paints ehaling art for regional hospital. ABC News. Retrieved from http://www.abc.net.au/local/stories/2015/07/21/4277858.htm Foltz, M. (1998). Designing Navigable Information Spaces (MSci). Cambridge: Massachusetts Institute of Technology. Retrieved from http:// www.ai.mit.edu/projects/infoarch/publications/mfoltz-thesis/ Gander, K. (2016). How architecture uses space light and material to affect your mood. The Independent. Retrieved from http://www. independent.co.uk/life-style/design/how-architecture-uses-space-light-and-material-to-affect-your-mood-american-institute-architects-a6985986.html  Joseph, A. (2006). The Impact of Light on Outcomes in Healthcare Settings. The Center for Health Design. Retrieved from https://www.healthdesign.org/chd/research/impact-light-outcomes-healthcare-settings  Kanyini Qualitative Study. (2014). To your door: Factors that influence Aboriginal and Torres Strait Islander peoples seeking care. Kanyini Vascular Collaboration. Retrieved from http://www.kvc.org.au/wp-content/uploads/2014/12/Paper-Mono-1-CD-20130624-v42-Submitted.pdf  Kombumerri, D. (2016). Merrima indigenous design unit GAO (1995-2016): The time has come. Architecture Bulletin, Autumn 2016. Retrieved from http://architecturebulletin.com.au/autumn-2016/the-time-has-come/  Lewis, C. (2016). Indigenous art lifts spirits at Western Australian hospital. ABC News. Retrieved from http://www.abc.net.au/news/201603-01/indigenous-art-raises-spirits-of-geraldton-hospital/7208896 NSW Health. (2016). NSW Health and the Arts Framework. North Sydney: NSW Ministry of Health. Pert, A. (2014). Build me up: how architecture can affect emotions. The Conversation. Retrieved from https://theconversation.com/build-meup-how-architecture-can-affect-emotions-22950  Queensland Health. (2012). Literature Review: Best practice multicultural policy implementation. Brisbane: Queensland Government. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0030/372954/qh-gdl-080-att-b.pdf Tawa, M. (2002). Wilcannia Health Service. Architecture Australia, 91(4). Retrieved from http://architectureau.com/articles/wilcannia-health-service/  Ulrich, R. (1991). Effects of Interior Design on Wellness: Theory and Recent Scientific Research. Journal of Health Care Interior Design, 3, p.97109. Retrieved from https://www.researchgate.net/publication/13173950_Effects_of_interior_design_on_wellness_Theory_and_recent_scientific_research Ulrich, R., Zimring, C., Quan, X., Joseph, A., & Choudhary, R. (2004). The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. The Center for Health Design. Retrieved from https://www.healthdesign.org/chd/knowledge-repository/ role-physical-environment-hospital-21st-century-once-lifetime-opportunity-0 



APPROACH NBRSARCHITECTURE is a multidisciplinary practice offering services in architecture, landscape architecture, urban design, interior design, heritage and compliance. We believe in creating life-changing environments for patients, families, carers, staff and communities. We are particularly interested in helping our clients deliver best-practice, person-centred care. Our experience across a wide range of spaces for living, gathering and working supplements our interest in health care delivery. We develop creative partnerships with our clients to ensure high quality design outcomes, and regularly engage in public discourse on architecture and design. In order to ensure the relevance of the spaces we design, we conduct research into current and projected trends in the way people live and interact with the built environment. Up-to-date knowledge is vital in ensuring a high quality of design as well as



an understanding of the social, cultural and political context within which we operate. Envision papers incorporate case study, literature review, desktop analysis and other research. Case studies are useful as they focus on individual projects rather than sweeping statistical or data-analysis based study. By analysing built projects, it is possible to gain an understanding of the effectiveness of design in achieving its desired results. While a case study may not directly answer to a research question, they provide a real-world example with site and context to test theories and ideas. Literature review is conducted across a range of local, interstate and international sources to ensure our designs are responding to international best practice as well as regional issues and trends that directly affect our clients. This provides us with the knowledge to provide strategic advice and guidance to our clients.

The Envision Student Partnership Program engages architectural students to work in conjunction with mentors within the practice to do further in-depth research and design around key topics relevant to our work. If you are interesting in knowing more about a topic covered in our research, please feel free to contact us. We are also interested in engaging in new research with current and future clients to support business case development, feasibility and concept design.

architects@nbrsarchitecture.com nbrsarchitecture.com +61 2 9922 2344

360° INTEGRATED TEAM. As a multi-disciplinary design practice, we are able to work as one 360° integrated team, with expertise in Architecture, Heritage, Landscape Architecture, Interior Design, Urban Design, Graphic Design, Sustainability, Compliance, Strategy and Research. Our ‘One Team’ approach allows the best possible design outcome to be achieved, with seamless collaboration between our range of service studios throughout the design process. The resulting designs are cohesive and considered from all angles. This consolidation of specialists also allows for increased efficiency for the client in the management of the project team.




Our creative team of architects work to produce award winning design solutions for each unique site and condition.

Our heritage studio has specialist expertise in providing conservation and heritage planning advice, in addition to adaptivereuse design. We have experience in the identification and management of built heritage items of all types and periods and in design documentation and project administration of projects for both government and private sectors.

Landscape Architecture is an amalgam of art and science. As designers, Landscape Architects are required to be careful interpreters of the natural and cultural conditions of a site. Our Landscape Studio seeks to create attractive, meaningful, usable, connected and equitable spaces that embody sustainable design principles. Places that bring joy to users, and connections between and to the landscape.

With a commitment to cutting-edge design and a uniquely client focused approach, we work continually at achieving an outstanding aesthetic result that meets the functional needs of the end-users. We are committed to delivering inn ovative projects of all types and scale which can only be achieved through extensive client consultation, meeting the project objectives, having sound technical expertise and competent management. Situated within a full-service firm, our team of architects is able to work closely in creative partnerships, considering all facets of a project from its earliest stages.

COMPLIANCE We provide consultancy services in BCA, Fire Safety and Access. Strategic advice is provided throughout the design process, with a focus on the integration of design and functionality, to provide a complete package that meets the needs of the users and stands the test of time.

INTERIORS Our Interiors Studio is passionate about achieving a connection between interior design and the whole architectural concept. We think deeply about how interior spaces are used and create innovative design solutions. Our Interior services include space planning, detailed fixture design and the selection of furnishings.

URBAN DESIGN Our cross-disciplinary team is well equipped to design urban spaces. Paying careful attention to positive and negative spaces in the urban landscape and the juxtaposition of built form and open space. Our experience has provided an understanding high volume pedestrian and vehicular movement.



We are continually improving strategies for the implementation of ESD principles into all aspects of the design processes, designing buildings to maximise efficiency with the use the latest technologies and concepts.

We engage in research to ensure the relevance of the spaces we design. We have authored several publications & hosted conferences in a wide array of sectors including education, health, worship, community spaces, the workplace and affordable habitats. ENVISION WELLNESS Acute Health Design






Sydney: +61 2 9922 2344 nbrsarchitecture.com


Welcoming Spaces in Acute Care