From Wounded City To Healing Environment (3rd European Healthcare 2017)

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From Wounded City To Healing Environment 3rd European Healthcare 2017 Congress & Exhibition in London, United Kingdom

From Wounded City To Healing Environment - © EGM architects - Erasmus MC

fig. 1: The city of Rotterdam © José M.P. Sanchez

From Wounded City To Healing Environment Liesbeth van Heel, MSc Willemineke Hammer, MSc Wouter Pocornie, MSc, EDAC

Introduction The city of Rotterdam and the Erasmus University Medical Center (Erasmus MC) are composing a duet, which is a reciprocal relationship. Independently, both already demonstrate that it is possible to transform in order to capitalize on economic opportunity while also securing the provision of meaningful places and sustainable, flexible systems. Together they show that it is possible to advance towards coherency.

In recent years Rotterdam is gaining recognition as a tourist destination. The travel guide Lonely Planet considered Rotterdam as one of Europe’s most exhilarating cities of the moment and ranked it at number five of cities to visit.1 The annual Rough Guide Travel Hotlist ranked Rotterdam at number eight amongst all global cities, praising its skyline as being amongst the best in the world.2 The New York Times listed Rotterdam at number ten of places to go worldwide. According to the newspaper, the new architecture, following its post-war reconstruction, is the primary reason for its strong position amongst global metropolitan cities.3 The US news outlet CNN poses the question if Rotterdam is now becoming Europe’s new capital of cool. It lists reasons why this city is flourishing while transforming from a city plagued with urban problems to an internationally renowned metropolis. Once again, its architecture is a major part of the argument.4 In addition, academicians acknowledge the direction the city has taken. At the Urbanism Awards, the city of Rotterdam was named the best city in

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1 (Lonely Planet, 2017; Holland.com, 2015 Oct 29) 2 (Dutch Daily News, 2014 Jan 14) 3 (Mala, 2014 Sep 5) 4 (Forster, 2017 Mar 1)

From Wounded City To Healing Environment - © EGM architects - Erasmus MC

Europe. They also praised the city for its built environment and the appropriation by inhabitants: a “predominantly young, open, tolerant community that is embracing innovative architecture and urban design and new business models”.5

Erasmus MC adds a hospital to the popular skyline of the city. The largest healthcare project in the

Netherlands, concentrated in a building complex, is already a recognizable architectural feature of high-rises and iconic infrastructure that comprises the celebrated portrait of the city. The final phase will be completed in 2018.

Looking towards the near future and building on the momentum of the city’s increasing popularity, where will Rotterdam and Erasmus MC stand in 2018? How do we get there?

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Rotterdam is a veritable open-air gallery of modern, postmodern and contemporary construction. It’s a remarkable feat for a city largely razed to the ground by WWII bombers. Rebuilding has continued unabated ever since with ingenuity and vision.

Lonely Planet

Duet The Second World War seriously wounded Rotterdam. The bombardment left the city in debris by destroying most of the city centre. This tragic event is commemorated through the sculpture De Verwoeste Stad (The Destroyed City), by Ossip Zadkine at Plein 1940: The heart was taken from the city. Over 25,000 homes and thousands of other buildings, including thirteen hospitals, were destroyed. Within days the reconstruction of Rotterdam immediately started. This characterizes the much revered ‘no-nonsense’, proactive attitude of the people.6 The city council appointed Gerrit Witteveen to come up with a plan for a new city centre. A new city implied rigorously departing from the old structure.

Witteveen decided quickly which few buildings were worth preserving. Rotterdam had set out to become a new city, but during the war the reconstruction did not get underway. In 1942, Plan Witteveen was criticized

by Club Rotterdam*. This party considered that the mission of the reconstruction should focus primarily on economics and therefore not prioritize aesthetics.

After Plan Witteveen the reconstruction of Rotterdam proceeded with the Basic Plan by Van Traa.7 In contrast to Witteveen’s three-dimensional way of planning, the Basic Plan can be considered largely two-dimensional.

The focus was put on allowing more possibilities for future scenarios. It changed into a flexible scheme, a legal framework for the city. The old city triangle that once defined the urban structure was abandoned and replaced by a rigid regular grid of major traffic arteries. In addition, modern, functional buildings were prioritized over traditional architecture: Rotterdam would become the city of the future. This modern city was subdivided into areas for living, working, and recreation.8 At its core, it was considered a tabula

fig. 2: De Verwoeste Stad by Ossip Zadkine at Plein 1940

rasa, where the modernist concept of light, air, and

source image: http://zienenweten.blogspot.nl

space would define the modern, functional city of the future.9 5 (Taylor-Foster, 2014 Nov 17; The Academy of Urbanism, 2014 Nov 14) 6 (Rotterdam Partners, n.d.)

7 (Post-war reconstruction Community Rotterdam, 2017) 8 (Post-war reconstruction Community Rotterdam, 2017; Gemeente Rotterdam, n.d.)

9 (Rotterdam Partners, n.d.; Post-war reconstruction Community Rotterdam, 2017)

* A group of local businessman led by the director of major company (Van Nelle), Cees van der Leeuw, and progressive architects from Opbouw, a society of architects and artists.

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From Wounded City To Healing Environment - Š EGM architects - Erasmus MC

Rotterdam today is a result of a recovery process that followed modern, functional planning and gave way to the possibilities of car use. The plans for various districts displayed a fragmented but new city. The character of Rotterdam is defined by its attitude towards its reconstruction. By radically breaking with the past and going for spacious town planning and exhibiting modern architecture throughout the city, Rotterdam dares to reinvent itself.10. Until recently, this exploration towards something new defined Rotterdam as an incoherent city. People had to be familiar with getting around or else they would be lost amidst wind, sand, traffic, and lack of meaningful places. The road network, prioritizing car use, illustrates the divided city as isolated islands of development.

The collection of unrelated buildings that comprised Erasmus MC in the Hoboken Quarter, north of the

River Maas, could be considered one such isolated island. Geographically, the site is surrounded by two of the city’s traffic arteries. One is an actual dyke, situated next to the busiest junction and providing access to one of the oldest river crossings, the Maas Tunnel, and the other is a canal. The potential of the medical city to be part of the city improved. Bridging the water gave access to the neighbouring Museumpark. Landscaping the connections to the city on the north side of the complex, thereby making use of the height difference between the dyke and the city below, helped connect functions and neighbourhoods.

As the Dutch healthcare infrastructure is currently in a stage of transition, with privatization and

multiple institutions merging, the university medical centre aims to establish a compact building complex that could adapt to future scenarios. How did we get here?

In 1840 the design assignment for a new hospital symbolized the beginning. This Coolsingelziekenhuis

was amongst the thirteen hospitals destroyed by the 1940 bombardment. During the sixties, Dijkzigt Ziekenhuis, a general hospital, became the new facility and shortly after evolved into an academic hospital. In 1971, it became Academisch Ziekenhuis Rotterdam (AZR) after fusing with children’s hospital Sophia Kinderziekenhuis. Twenty years later it fused with Daniel den Hoedkliniek, a cancer clinic. In 1998, an initiative was formulated to combine the AZR with the Erasmus University, and on 1 June 2002 the new organization was born: Erasmus MC.11

Starting in 1998, the design team set out on a course to facilitate the next step in its evolution. Now, as

the first phase is completed and in use, the university medical centre focuses on finalizing the final stage of the project. The process of planning had to follow a critical path in which the old building volumes were gradually replaced by the new. Here, the transformation process of Erasmus MC aims to surpass the character of an isolated island within the city and emphasizes time as the fourth dimension in planning. In search of coherency, Erasmus MC aims to achieve the same as the city. They both improve. The wounds heal.

As stated, the relationship is one of reciprocity and thus aims for synergy. It is through this that a duet between the medical district and the city is composed to transform the whole into more than the sum of its parts.

Qualities of the city and from the process of urban (re)development inspired the process of developing the new Erasmus MC. As such, Erasmus MC is a case study for healthcare planning where the duet with the city influenced decision-making concerning the built environment (physical) as well as the organization (non-physical).

In this case study, we revise the design process, starting in 1998, in order to frame this duet. The medical

centre and the city are introduced through the narrative of recovery, where transitional planning aims for coherency. The factor time, the fourth dimension, is a focal point in this transitional planning. When the process of healthcare planning in a project like Erasmus MC corresponds to the development of the city, the purpose of the project is defined: New and meaningful places of all sizes, for all people, at all times.

10 (Rotterdam Partners, n.d.)

11 (Erasmus MC, n.d.)

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

Smart Logistics Developing an integral plan to facilitate all flows is essential in healthcare planning. The city handles multiple flows. Rotterdam is a port city and its economic base gains from its dynamic networks and handling logistics. On an annual basis, over 461 million tonnes of cargo are handled.12 In addition, the port continues to expand. The first plan for this expansion towards the sea was already worked on during the war by N.Th. Koomans, the director of the Port of Rotterdam Authority. The Port Authority’s current mission is to make the new port, including the industrial area, the most sustainable and innovative port in the world. Through sustainable management it aims to demonstrate that sustainability and economic growth are perfectly compatible.13

Efficiently organizing flows The Port of Rotterdam ranks tenth in the world and is the largest within Europe with a 30% container throughput. The port extends 40 kilometres out from the city towards the North Sea and is expanding with the Maasvlakte II, which increases the port area by approximately twenty percent.14 The port is essential for creating opportunities for the Dutch economy, employment, and growth. Therefore, as the Netherlands relies on this area for its economic development, the expansion plan, including Maasvlakte II, is another important transformation process in Rotterdam.

fig. 3: Maasvlakte II, Port of Rotterdam © José M.P. Sanchez

Erasmus MC is the largest university medical centre in the Netherlands with over 13,000 employees, over 530,000 out-patient consultations annually, and more than 40,000 patients clinically admitted – most of whom are operated on. Over 4,500 students are educated and trained to become doctors, nurses, paramedics, or researchers. The catchment area of this tertiary care hospital covers the south-west of the Netherlands.

Erasmus MC operates as the main hub in an emerging network of care in the larger region and internationally, by sharing knowledge and treating patients at the appropriate place. Combining all these activities on one site sets high ambitions for patient pathways, planning and logistics.

Overall, Erasmus MC is not expanding its footprint area but instead concentrating more functions

in a compact building volume. Efficient handling of patient visits implies that care pathways are organized in a way that through multidisciplinary collaboration and integrated planning a combination of diagnostic procedures and consultations ensures ‘one-stop shopping’. So, no more unnecessary travelling by ill and frail people. It is a challenging puzzle to organize all the flows in a limited space. The challenge is not only to organize the logistics in a compact volume but also to efficiently organize the flows while keeping the core business operating. Erasmus MC continued its daily operations in healthcare, education and research during eight years 12 (Port of Rotterdam, n.d.)

13 (Port of Rotterdam Authority, n.d.)

14 (Rotterdam Partners, n.d.)

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of building operations. Site limitations asked for ingenuity of the construction firm, with just-in-time delivery of prefabricated construction elements as facades, floors, etc.

fig. 4: Erasmus MC

The factor time is essential regarding smart logistics. This means that ambitions such as smooth wayfinding could not be compromised while developing the different phases of the project. In October 2009, the construction of the first phase started. In February 2013, the hospital started to use the first new parts with diagnostics and research laboratories, central sterilization and the outpatient clinic for rehabilitation. In 2018, the remaining patient-centred functions such as (nursing) wards and all other outpatient clinics, diagnostic and treatment areas will be in use.15 The development process of Erasmus MC was planned to first construct a uniform exterior shell and allow for spatial configuration later on. This would allow for flexibility in structuring program, exchanging facilities and target groups.

The fourth dimension proved to be a ‘friend’ to the project. Because of strong conceptual models and

early investments in flexibility, the design could take full advantage of its infrastructure and incorporate the entire Thorax centre. The strategic construction plan allowed for the integration of innovative technologies at later stages of the design. To illustrate this, when the Thorax centre was incorporated in the plan in 2013, it was also possible to integrate a Pharmafilter in the new hospital. This innovative and sustainable system disruptively alters the work process of care professionals and the logistics of waste handling. The system supports the use of bioplastic (disposable) bedpans and urinals, reducing the number of nurses’ trips to the dirty utility, but also disposing of potentially contaminated materials in a safer way. This sustainable way of working and efficient handling of waste is made possible by strategically planning the building process.

Smooth wayfinding The university medical centre is considered a medical city within the city of Rotterdam. It corresponds to the way the city, especially the port, handles logistics. Similar ambitions regarding smart logistics are evident in Erasmus MC. With over 15,000 people visiting this medical city on a daily basis, smart logistics are needed. The large number of end users in the medical city depend on a clear structure with a plurality of options to move around.

Multiple entries to the building complex, public facilities in its vicinity, meaningful public spaces inside, and clear points for orientation via overview, art and nature enable the end users to find their way. Clear directions and signage help patients and visitors to find their destination, and volunteers help pilot them through the site as an extra service.

15 (Erasmus MC, 2016, p.16-23)

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

The ambition to conceive a healing environment in a highly urbanized site demands strategizing. Part

of the vision was to create an environment with plenty of natural daylight. Daylight is channelled throughout the building complex. At the same time a visual relationship with the surroundings and the city is established – complementing the orientation and wayfinding. These atria are meaningful places. Public spaces such as the square near the children’s hospital (Plein Sophia), illustrate the advantages of daylight and nature. Children can run around like they would do in a forest or park, hence forgetting for a brief moment the healthcare facilities. In every public space, such as the atrium or square, a specific theme establishes a meaningful place while benefiting the functional qualities of handling logistics, i.e. orientation, wayfinding and efficient movements. It enables the user to (self-)identify this place. The architecture and landscaping are the visible parts of the smart logistics.

fig. 5: Structure collage

In the earliest stages of the project, a master

plan was developed, similar to the Basic Plan, which geographically distinguished yet unified the functions of patient care, education and research. A logistical backbone, most notably through the Passage, connects these sectors in new and existing buildings and stimulates collaboration between them. It is from this meaningful place that all end users come together and via art, concentrated natural daylight and clear lines of sight recognize their respective places inside the hospital. The structural scheme separates excitement from serenity vertically. The split between city and dyke level organizes the hectic logistics of materials and equipment on the ground

fig. 6: The Basic Plan: ‘Bestemmingen Herbouw Binnenstad Rotterdam’

floor and leaves room and enjoyable public spaces

source image: http://www.wederopbouwrotterdam.nl

on level 1. Functions with a high turnover of patients and visitors – outpatient clinics, diagnostics and day care treatment – use the lower part of the building, while the clinical wards use the calmness on the higher levels. There they can fully enjoy the view of the city’s skyline and sunlight, and they are not bothered by the many movements below. Separate lifts ensure that people and goods have a minimal number of unnecessary encounters.

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

Natural sense of calm A prerequisite for smart logistics in this project is a natural sense of calm, which is the result of a successfully created healing environment. The hectic processes inside the hospital should not affect the overall experience for end users, which is impacted by the efforts made regarding safety, well-being and efficiency. For example, at any stage the design offers clear orientation, smooth wayfinding, and provide possibilities for implementing sustainable technologies that facilitate and promote the health and well-being of all end users of Erasmus MC.

fig. 7: Passage, Erasmus MC

In addition to the port area, the city of Rotterdam knows how to manage flows of people. For example, commercial hubs like the shopping area, locally dubbed as the Koopgoot, organize flows both horizontally as well as vertically. It separates slow groups, destination traffic, from those who want to pass through the area quickly. The infrastructural nodes such as Central Station, Blaak Station and the nearby markets such as the Markthal and Binnenrotte organize logistics while providing quality spaces for leisure on multiple levels. These infrastructural arteries of the city are now becoming a gateway in establishing a natural sense of calm instead of isolated islands. They separate necessary hectic, commercial processes from the quality and comfort of experiencing the city without being rushed. The planning of this infrastructure places emphasis on experience in addition to handling logistics.

Erasmus MC is structured along its backbone, its main structural artery. It is essential in handling

logistics while creating places. Some provisions that are conventionally found throughout the city or in the vicinity of hospitals are situated inside the complex in the Passage, Square, Arcade, various atria and coffee corner.

This publicly accessible domain houses a supermarket, bookstore, pharmacy, restaurants, and many different places where all end users could claim their space, as they would do in the city. Users enjoy positive distractions and possibilities for leisure in rest areas. The design team also applied a salutogenic perspective to configure the layout. The hospital is designed to be manageable by the use of front and back offices (or ‘on-stage and off-stage areas’ with regard to interaction with patients), a layout that channels natural daylight, create short travelling distances in nursing wards, and emphasizes direction throughout the building’s circulation area. The bed-accessible roof gardens, attractive staircases and Passage improve meaningfulness, stimulating the sense of coherence of all end users.16

16 (Antonovsky, 1996; Eriksson & Lindström, 2008)

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

The logistics of the Erasmus MC project are recognized as a challenge. The principles, established in 1998, were delivered in the completed first phase and are currently being implemented in the second and final 120,000 square metres. It is about finding ways to facilitate meaningful places during a transformation. It is a process of transition in which hectic activities, both in healthcare and in design and construction, are structured to allow for new, innovative systems and models to be implemented at a later stage.

It is no surprise that for many years building sites in the city were enclosed by boarding emblazoned

with the words “Hear these construction sounds: This is where Rotterdam builds its new heart”. Could it occur anywhere else in the country? Rotterdam as a city understands that investing in the process allows for experimental, fragmented plans to potentially mature towards a coherent, new reality. A challenge is therefore perceived to be an opportunity instead. A chance to pioneer.

Space for body and mind The municipality of Rotterdam and the Port of Rotterdam are the main employers in the city. Where the port has become a for-profit corporation, with the municipality as a major shareholder, the municipality itself is a fairly bureaucratic organization. It consists out of both central and decentralized decision-making bodies and its civil servants answer to elected officials. With quadrennial elections for the city’s Council of Mayor and Alderman, transformation processes are at risk of being influenced by a change in economic climate or political colour. Just as happened when the Club of Rotterdam influenced town planning in 1942, local stakeholders in the Hoboken Quarter joined forces in 2007 to develop a vision. The ambition was to provide ‘space for body and mind’. All twenty-two parties were involved in a covenant. They established the ‘Rules of Hoboken’ in order to create an attractive neighbourhood with Erasmus MC as the economic ‘powerhouse’ at the centre.17 It now has about as many employees as the port and municipality combined.

The decision made by the university medical centre to invest over a billion euros in its transformation

with new buildings and renovation of its main functions – patient care, education and research – was at the heart of this initiative. It showed that the inner-city location was a strategic asset for Erasmus MC. On the other hand, knowing that this large employer would renew and continue its development within Rotterdam allowed the city to upgrade public and outdoor spaces. By doing so, this quarter was marked as a focal point for new economic development – stimulating a new supply of housing that appeals to students, guest lecturers and employees, in addition to further promoting the stream of visitors to the various cultural institutions.

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fig. 8: Hoboken in the vision

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Erasmus MC - Hoboken (number 6) is designated as one of thirteen very important project areas in the vision of the city of Rotterdam.

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About Hoboken Quarter:

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The neighbourhood not only hosts medical students and research graduates,

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but the Rotterdam University of Applied Sciences (Hogeschool Rotterdam)

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offers education in nursing, facility management, architecture, real estate management, etc. While Erasmus MC ranks within the top twenty worldwide in clinical research, the Quarter also hosts several world renowned museums, like ‘Museum Boijmans van Beuningen’, ‘the Kunsthal’, and two of Rotterdam’s major green lungs: ‘Museumpark’ and ‘The Park’ that includes the ‘Euromast’ as an touristic icon.

10 17 (van der Mast, 2011; van der Mast & Hoogendoorn, 2009; Gemeente Rotterdam, 2007 Nov 29, p.154-156)

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

Developing the plans for the transformation of the Hoboken Quarter bears a strong parallel to the way the transformation of Erasmus MC’s real estate took place, starting as early as the late 1990s. Therefore, we would like to state that a knowledge and healthcare institution like Erasmus MC is the ultimate example of the careful creation of a space for body and mind – a healing environment.

Rotterdam and Erasmus MC: a reciprocal relationship A clear conceptual framework, for both city and medical centre transformation, is helpful in convincing board members, city aldermen and other parties to continue on a set course. Strong leadership and expertise is needed to support guardianship throughout the process. It helps when parties invest in understanding each other’s ambitions, challenges and possibilities, and are able to find common ground. This was done in the Hoboken process with clear leadership provided by the municipality and also by operating independently for all Hoboken partners. Examples where partners benefitted from this approach are manifold but a few are described here to illustrate the reciprocal relationship between Rotterdam and Erasmus MC. For instance, the hospital was connected to the healing environments of the adjacent parks and canal, which also functions as a border to delimit the medical complex in its use of additional space. In addition, the expansion needed for parking facilities for all hospital functions – including the Daniel den Hoed Cancer Institute – was developed beneath Museumpark’s festival ground by the city of Rotterdam. This saved construction time for the hospital and also ensured that additional parking for construction crews was available in time, helping the smooth logistics for hundreds of temporary workers in the Hoboken Quarter.

The economic crisis was an influence as well as the challenges in public-private partnership. In designing the connections between the city and the new hospital, the aim was to make them as smooth as possible. The landscape design for outdoor public areas corresponds to indoor spaces – the main entrances and the Emergency Department’s walk-in entrance. The pledge to the investment level and quality of materials used posed a challenge during the recent economic crisis but was met by joint project responsibility and a common aim, founded in the Hoboken vision for 2030. An example of synergy between city and Erasmus MC was the exchange settlement of ground positions. It smoothened the maintenance and control phase of the joint project. Also, the phased construction of the PPP part of the outdoor spatial development enabled the municipality to combine major maintenance on its underground infrastructure with new surfaces that also gave an impetus to the use of trees, grass and plants. They offer more space and a better environment to employees, students, patients and visitors. These connections enable the city to play its part in offering easy access to nature and art in a similar way to how Erasmus MC creates a healing environment in its new hospital building.

Rotterdam and Erasmus MC: partnership in process When setting out the framework for the new buildings’ qualities, early in the development process, the hospital and design team joined forces with experts on public health and healthy living environments from the municipality. Ambitions were formulated and agreed upon, both on the level of the built environment as well as on the level of town planning and landscaping.18 Not surprisingly, these ambitions covered the fields of sustainability, safety and healing environment. A Quality Plan19 offered a framework for the spatial expansion of Erasmus MC. By formulating these kinds of frameworks, the team established commonalities for the duration of the development and construction period. Establishing them at the right level – i.e. Executive Board of Erasmus MC and College of Mayor and Alderman of Rotterdam – in addition to having long-term committed project leaders on both sides, helped in keeping them as key performance indicators throughout the project. In this way, the ambitions for the project and its surrounding quarter survived several changes in political leadership in Rotterdam as well as in changing strategic plans at Erasmus MC – where the executive leadership of the university medical centre is more or less synchronized with changes.

Again, time is the fourth dimension in this partnership. It offers opportunities at various stages. Decisions taken can close off paths that appear interesting to pursue later on. It is essential to engage in joint planning of construction works on the site as well as on the routes and public spaces around it. Just as the project team 18 (Dicke et al., 2002) 19 (dS+V Rotterdam & Xaveer de Geyter Architecten, 2003 Jun)

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

had to ensure that operations in patient care, education and research could continue as normal, the city had to ensure that all logistics on the site are safeguarded. The industrial complex is comparable in size to a town of 18,000 inhabitants if you consider the amount of people flowing through the site, the use of electricity, etc. It needs to be fed with materials, food, linen, equipment, gasses, drugs and so on. Its trauma centre status obliges the city to safeguard smooth access at all times, often with the help of a police escort through congested traffic arteries. Again, good communication, collaboration and respect for each other’s priorities and timing is essential in making Rotterdam a better city. It offers a space for body and mind, or, as an early Erasmus MC project motto proclaimed: ‘Rotterdam is getting better!’.

Conclusion: Rotterdam and Erasmus MC Rotterdam is transforming from a city plagued by urban problems into a city filled with revered architecture, a ‘make-it-happen’ spirit, and rising (economic) opportunities that are creating a coherent metropolitan city.

Erasmus MC is part of the heart of the city and contributes to the city’s future opportunities.

Although rooted in tragedy, the city of Rotterdam holds a strong narrative. The narrative of recovery:

Rotterdam was wounded. In order to interpret where we are going as a project, as a city, reflecting on redevelopment processes offers perspective. The character of the city conveys the will to recover, depart from old structures, and even dare to experiment and strive for a new, modern and functional medical city. Over time the city developed into an incoherent, car-based city with great individual qualities and pockets, but it became fragmented as a whole. Recent years indicate a search towards coherency. Great potential is being fulfilled by partnerships that bring qualities of the city and the built environment closer together.

The duet between the city and Erasmus MC describes its reciprocal relationship. The development process of Erasmus MC is inspired by the recovery of Rotterdam. It embodies the character necessary to handle smart logistics and planning, with a specific focus on timing, towards a healing environment. It is part of the further planning of the city to be an economic engine and contributing partner at the decision-making table. When the process of healthcare planning in a project like Erasmus MC corresponds in a reciprocal manner with the development of the city, the purpose of the project is defined: new and meaningful places of all sizes, for all people, at all times.

Both Rotterdam and Erasmus MC demonstrate that it is possible to transform in order to capitalize on economic opportunity while securing the provision of meaningful places and sustainable, flexible systems. Erasmus MC, as a medical city within a city, corresponds to the qualities of Rotterdam in terms of smart logistics. The medical centre is structured to separate excitement from serenity and promote smooth wayfinding and efficient organization. Time as the fourth dimension in healthcare planning is imperative. Erasmus MC, just like the city, plans for a transition while still securing its key operations. It is an ongoing concern. Therefore, special attention is put on experience in order to create a healing environment during and after the final phase of development. In short, the planning of this infrastructure places emphasis on experience in addition to handling logistics: Smart logistics and a natural sense of calm add up to meaningful places.

Both Erasmus MC and Rotterdam benefit from their productive relationship. Erasmus MC is an economic powerhouse for future developments in the city’s Quarter of Hoboken. On the other hand, the hospital needs the city to be aware of its needs in connections, accessibility and future spatial development. Joint ambitions guide the transformation of the hospital site as well as its neighbourhood. Public-private partnership is not easy and cannot be taken for granted, but with the right leadership and guardianship it will contribute to healing the wounded city. It offers a healing environment for all to enjoy: Rotterdam continues to get better!

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From Wounded City To Healing Environment - Š EGM architects - Erasmus MC

fig. 9: Erasmus MC in 2018 - an artist impression

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From Wounded City To Healing Environment - © EGM architects - Erasmus MC

Authors Liesbeth van Heel, MSc

Willemineke Hammer, MSc

Wouter Pocornie, MSc, EDAC

Program Secretary ONE

Partner/Architect

R&D/Architect

Our New Erasmus MC

EGM architects

EGM architects

Senior Policy Advisor Program Integrated Buildings

Biography of the authors: Liesbeth van Heel MSc (1964) was trained in Facility Management and Business Economics before joining Erasmus MC as a management trainee. Since the late ’90, she has been involved in the Erasmus MC redevelopment project as project secretary, and manager within the directorate of Corporate Real Estate. She has gained expert knowledge on the cutting edge of developing a good new university hospital and an innovative, sound and robust new building. Recently she focuses on a safe transition to the new facility, but is still involved in national and international orientation and knowledge sharing. She is also responsible for PR on the Erasmus MC project.

Since joining EGM architects in 1998, Willemineke Hammer MSc (1971) has been involved in the development of large academic institutions, general hospitals, residential care projects and initiatives in which living as normally as possible and welfare are central themes. In the overall spectrum of Cure & Care she searches, in dialogue with clients and (end)users, the appropriate connection between people, processes and physical environment.

Willemineke is also responsible for scientific architectural research, which is considered part of EGM’s core activities. Before joining EGM architects, she worked on retail, private housing and small business buildings.

Willemineke Hammer studied Architecture at Delft University of Technology and Art History at Leiden University.

Wouter Pocornie MSc EDAC (1986) studied Architecture at Delft University of Technology and graduated in the directions Architecture as well as Urbanism. In 2014 he joined EGM architects to help set up the R&D department.

He explores new approaches to healthcare design, ways of contextualizing themes and innovations, and integrating multiple perspectives in a narrative of healthcare design. Adjacent he holds a strategic position at two platforms in Amsterdam and works on various business initiatives between The Netherlands and Suriname.

During his studies, he worked on multiple research projects abroad. Here, he explored urbanization processes in Haiti, China, Nigeria, and El Salvador.

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Dicke, D., Lindeman, L., van der Meer, L., & Weterings, M. (2000). Hoboken/Erasmus MC: een healing environment (intentiedocument duurzaam en gezond ontwikkelen). Rotterdam: Taakgroep Duurzaam en Gezond Bouwen Hoboken. dS+V Rotterdam & Xaveer de Geyter Architecten (2003, Jun). Kwaliteitsplan Rotterdam Hoboken (Presentatie).

Dutch Daily News (2014, Jan 14). Rotterdam rated must-visit destination for 2014. Retrieved on April 13, 2017, from http://www.dutchdailynews.com.

Erasmus MC (2016). Our New Erasmus MC: Future-proof buildings. Retrieved on March 30, 2017, from Erasmus MC website: http://www.erasmusmc.nl.

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From Wounded City To Healing Environment - Š EGM architects - Erasmus MC

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