Reorganisation reaps benefits in Canada

In the late 1990s St. Mary’s General Hospital in Kitchener, Ontario reviewed its role within the community and the Ontario Government’s Health Services Restructuring Commission. Via this process, the hospital realised it needed to undertake a significant redevelopment of its facilities to enable it to keep pace with its transforming role in the community. The existing building was in significant need of upgrades, as the majority of the facilities dated from between 1923 and 1965. Over time the organisation and layout of the clinical spaces had been configured within existing accommodation on an “as needed basis”. The hospital spent considerable time and energy in visioning its ongoing role and developing programming parameters for the new facility. St. Mary’s hired an architectural firm (Parkin Architects) to assist it in realising a redevelopment of the full facility. The major programmes addressed in the functional plan were: ambulatory care, day surgery, surgery, emergency, nuclear medicine, and diagnostic imaging. The hospital also worked closely with the Canadian Ministry of Health and, part way through the process, was designated as a provincial Cardiac Care Centre. This mandate, to build a cardiac programme from the ground up, added a fascinating new perspective to the whole project. The resulting design for the new facility required the addition of 100,000 ft2 of new space to the existing building to bring the total area of the hospital to 250,000 ft2. Also included in the project were some 100,000 ft2 of renovations. The hospital has a capacity of 190 beds. The cost of the entire multi-phased project was C$100 m.

Guiding principles

The guiding principles for the redeveloped facility included consolidation of services into appropriate clinical groupings and relationships, logically organising clinical programs to ease access for patients and staff, and upgrading infrastructure to provide the technical framework upon which the hospital could expand over time. It was important to create a hospital environment that would be pleasing and supportive of patients, visitors and staff. One of the main architectural goals was to re-orient the main entrance away from its existing location at the front, to the side, of the building. The main entrance’s original location was no longer suitable, since space there was limited and there was no adjacent visitor parking once drivers had dropped patients off at the door. The main entrance corridor also cut between the emergency and diagnostic imaging departments, requiring patients to be moved through the main lobby when going for an X-ray. The project saw the new entrance, adjacent to a large parking lot, fitted out with clear signage to direct visitors efficiently to the hospital’s main access point. Inside this entrance is a beautiful two-storey lobby space suffused with natural daylight, providing a calming experience for those entering the hospital. The main public access departments are adjacent to the lobby, providing easy wayfinding and patient access to the clinical programme spaces. The hospital’s new surgical suite is located on the second level directly off the main lobby. The original surgical suite and day surgery were located four floors apart, leading to real inefficiencies in delivery of the surgical programme, not least of which was the need to transfer every “pre-op” surgical patient from level four to level eight. The redevelopment solution was to group all surgical and minor procedures on level two of the hospital addition, next to the supporting day surgery and recovery spaces. This location, off the lobby, is easy for patients to find, and means they have less distance to travel. The operating rooms, day surgery and recovery area all benefit from natural light, resulting in a more comforting space and reduced stress for both patients and staff.