Architectural Concepts of Hospital Building

1. INTRODUCTION
This chapter gives a few striking examples of hospitals that have either already been built
or are in the process of development. Examples are provided of each distinctive type of
building. However, the fact that these examples have been included here does not mean
that a new hospital necessarily has to be designed on the basis of one of these models.
The examples show how concepts such as flexibility, functional relationships and design
were translated in the relevant period or are currently being translated into the building
structure of the hospital.
The following models will be dealt with:
- the Breitfuss model
- the comb and double comb structure
- the arcade model
- the linear structure
The building structure of a hospital has undergone a development that shows a
decreasing dominance of the ward block. The treatment and outpatient depar tments
and the flexibility and design of the main traffic areas have had an increasing impact on
the main design of the hospital.
Post-war hospital building in the early decades generated many hospitals with imposing,
sometimes monumentally designed ward blocks. In the 1980s, when flexibility became an
impor tant concept, more neutrally designed hospital structures evolved.
Subsequent developments show a more internally-oriented design of the buildings,
through the use of covered streets and plazas. Recently developed hospital designs
are characterised on the one hand by more emphasis placed on the design. On the
other hand, since hospitals have been increasingly built in an urban context due to land
problems, fitting them into the urban environment has become an impor tant concept.
2. BREITFUSS MODEL
General
A typical feature of the Breitfuss model is that a tall building block with nursing functions is
placed above a flat building block with treatment and outpatient functions. The structure

026

Example of Comb Structure (See page 028)

Location and Name of Institution:
Madrid, Spain - Rey Juan Carlos Hospital
Date of Completion: 2011
Gross Floor Area: 94,705.49m

of the building shows a clear division between the static nursing units in the ward
block and the dynamic depar tments on the lower two (or three) storeys. The external
appearance of the ward block is often of an imposing design due to its definitive status.
Access
In general it may be said that the Breitfuss model produces a compact building with
relatively shor t walking distances. However, staff and visitors do have to make frequent
use of the lifts.
The number of lifts is par tly determined by the number of storeys of the ward block. In
the case of highrise with around 10 floors, a considerable par t of the ward block will be
taken up by provisions for ver tical traffic [lifts and (emergency) staircases].
Due to its compact design, this model usually has a clearly recognisable main entrance.
Functional Relationships
Since the lowrise structure contains all diagnostic and treatment functions, it is possible
to create good spatial relationships with this type of building. Where the medical staff
is concerned, the stacking of the wards can mean that there is a considerable distance
between the outpatient unit and the wards.
The Breitfuss model, originally designed according to functional planning of the care
provided (outpatient appointment unit, nursing unit, imaging diagnostics, laboratories,
etc.), offers in principle sufficient possibilities for planning the facilities for care provided
on the basis of patient flows or on the basis of the care process. The Breitfuss model is
less suitable for planning on the basis of target-groups.
Flexibility
Where flexibility is concerned, account has only been taken of the possibility of
adaptation and expansion in relation to functions on the lowest floors. No possibilities
for expansion or adaptation have usually been provided for in the ward block.
As a result of these limitations in the design, it is more difficult with this type of building
to comply with policy concerning the new style hospital that advocates a shift from
inpatient to outpatient.

027

Example of Breitfuss Model I

Rey Juan Carlos Hospital

The recent hospitals, as health systems,
effectively serve the citizens, but it takes
place in a dramatic architectural space
unnecessarily and sometimes depressive.
Its proven effectiveness is the cause of
their repeatability, so that over a quar ter
of a century that all are the same, or so
perceived.

028

Architects:
Rafael de La-Hoz Castanys
Location:
Madrid, Spain
Built total area:
94,705.49m 2
Project year:
2011
Photographs:
Duccio Malagamba

Architects propose to transform the

citizen into a customer, for a new type of
hospital, which in addition to assist with
the proven effectiveness of our healthcare
system, can feel at all times the centre of
all care, giving them all attention.
This new hospital model is configured
in three basic elements: efficiency, light
and silence. The best about hospital

architecture and the best in residential

architecture. Conceptually, the new
hospital is arranged on base that gives
structure to the health care units,
outpatient diagnosis and treatment.
Structured in three modules or parallel
buildings that reflect the best hospital main
structures: flexibility, expansion, functional
clarity and horizontal circulations.
On this structure are arranged two units
of hospitalisation, two oval crown with
gentle curves drawn give a different view
from the depressive sensory residential
forms of the rationalist block bar, and
draw on the best of recent residential
architecture: the elimination of corridors
and in consequence the elimination of
annoying noise, concentric circulation,

029

Example of Breitfuss Model I

4
1. Overall view of the hospital in daytime. Two oval crown
with gentle curves are arranged on a square base
2. Side view of the hospital and surrounding landscape
3. Crown and Base form a new architecture offering
good environment for the professionals and patients
4. Roof detail of Crown
5. View to oval architecture from the roof of the base
6. Envelope detail

light and silence around a common

atrium.
Two functional concepts space: base
and crown, which are linked to form a
new architecture, a model that offers
to the professionals the oppor tunity
to treat and to the citizens to be
treated in an environment where the
natural light and the silence resulting
therapeutics.

030

The overall concept is based on the

architectural proposal for a hospital of
this nature: it should allow adaptation
to the requirements of the programme
needs,
and
expected
financial
requirements. It has also sought to
respond to the complex functional

Sketch and Volume Trias

031

Example of Breitfuss Model I

programme with contemporary and

attractive architecture. It has had
par ticular regard to the human scale,
solar protection and above all to
distinct the patients spaces through
the hospital. The build is the result of
a different point of view against to the
simples and common spaces in hospital
architecture.
Architects purpose is also give
therapeutics spaces and provide
architecture that serves to the rest and
recovery of the patient. To use the
architecture as a medical treatment.
The design is structured on a large
base, which encompasses various
medical areas of the hospital, holding
two volumes of glass where the ward

032

is developed. This approach develops

to a complex system of ar ticulated
spaces within three prisms that make
up the base, geared to each other as if
it were a machine, a healing machine.
In addition to the functional treatment
of the base, a symbolic treatment
was essential to remark the towers.
The space of the patients is planned
only thinking in the needs and in the
best way to them to feel better with
harmony and light. From the first
moment, it was determinate to have
different spaces between the area of the
patients and the other functional areas
of the hospital, allowing in this area the
relation between the green roof garden
and the views from each room.

Achieving
a
perfect
functional
relationship between the areas,
providing maximum flexibility to the
scheme between the exterior and
interior spaces. Differentiate between
internal and external circulation,
distinguish the accesses and the
specificity of ver tical communication
cores, allowing clarifying the scheme.
The position of the two towers,
responds to the functional need to have
an immediate access to the operating
rooms, delivery rooms, emergency
and diagnostic. The functionality of
the building lays in the way of life the
patients and their relatives have during
the time they have to be inside. The
strategy of the implementation is the

7. Atrium with opened roof and skylight, day view

8. Atrium with functional areas surrounded at night

Section

033

Example of Breitfuss Model I

10

Typical Floor Plan of Inpatient Unit

organisation between all the elements

that are involved in the project. The
three prisms of the basement organise
the circulation in an exemplary manner.
In the two prisms of the edges are
arranged for one to be used externally
and the other internally, the block in
the middle shares uses when internal
and external circulations are necessary,
but always without interference. The
architects systematise the building
by structural modulation with the
subsequent
pre-industrialisation
process linked with a technological
innovation in the materials and systems
used; give a unique result with the last

034

technology making the difference with

the traditional hospital buildings. One
of the architects main points in the
building is the sustainability; considering
the conditions of solar orientation,
topography, built environment and the
greenery nearby, without forgetting
the urban conditions of application.
They incorporate in the system green
materials and renewable energy
technology, with the objective to save
resources and optimize operating
costs, providing through the green
roof, natural light and ventilation to the
inside of the building.

9. Entrance lobby of the base

10. View to the roof of connection
part between Crown and Base

035

Example of Breitfuss Model I

11

12

12. Operating room with shared

hand-washing station outside
13. Wall decoration and softy
light in the patient bedroom

036

037

Example of Breitfuss Model I

13

15

14-15. Sunlight provide bright but

soft light for the patient room
16. Ensuite/bathroom and opened window

14

038

Diagram of Window Installation

Typical Floor Plan of Single Patient Bedroom

039

Architectural Concepts of Hospital Building I

3. COMB OR DOUBLE COMB STRUCTURE

General
The comb or double comb structure is characterised by a traffic zone in the centre from
which different building wings protrude like the teeth of a comb. The building structure
is designed like a uniform grid. It comprises many end walls, the so-called open ends,
which make it simple to add extensions.
Access
Due to the many open ends, the external architecture gives the impression of being unfinished.
In contrast with the Breitfuss model, for example, an overall picture of the hospital is not
visible. If located in the heart of the traffic zone, the main entrance may be hidden between
the teeth of the comb. In the case of large hospitals, this structure can lead to a sprawling
design.
Functional Relationships
Functions which have to comply with the same requirements are grouped in one wing.
From the point of view of size and technical requirements, the teeth of the comb are
geared to the functions to be housed there. Practical experience has shown that stacking
spatially related functions with specific requirements regarding installations can also be
successfully done in one wing. For example, the emergency depar tment is located on
the ground floor, intensive care on the first floor and the operating unit on the second
floor. Other designs may include all laboratories in one wing, plus the pharmacy and the
central sterile supply ser vices unit, or wings with only nursing functions.

Example of Comb Structure A(See page 042)

Location and Name of Institution:
Barcelona, Spain - Sant Joan De Reus Hospital
Date of Completion: 2011
Gross Floor Area: 92,037m
Example A of Double Comb Structure B (See page 054)
Location and Name of Institution:
Murcia, Spain - New Santa Luca University General Hospital
Date of Completion: 2010
Gross Floor Area: 114,369m
Example B of Double Comb Structure C (See page 064)
Location and Name of Institution:
Murcia, Spain - New Los Arcos del Mar Menor Hospitall
Date of Completion: 2010
Gross Floor Area: 61,352m

The comb or double comb structure is in principle fittable for all three models described
in 3.3 with regard to accommodating the care organisation.
Flexibility
The double comb structure was developed at a period when flexibility had become one
of the most impor tant design criteria. Flexibility is guaranteed by extending the teeth of
the comb or by extending the traffic structure by adding a new wing. The basis structure
of the hospital remains unchanged after these extensions.

040

041

Examples of Double Comb Structure I

Sant Joan De Reus Hospital

042

Architects:
Corea Moran Arquitectura S.L.
and Pich-Aguilera Architects
Location:
Barcelona, Spain
Building area:
92,073m 2
Project year: 2011
Photographs:
Cour tesy of Architects

This project is presented according to the

urban requirements of the plot and the
guidelines established by the functional
programme. It must be taken into account
that the building, due to its public use and
size, is a very impor tant benchmark for
the new technological park and the city
of Reus. At the same time, the architects
consider that the facilities are going to give
an emblematic and modern image so as
to achieve a high architectural quality and
efficiency as new hospital.
The objective of the new hospital building
project is to take the most of the site
features by improving the functional
programme and its link between the

different areas and their surroundings, and

also optimising the vehicular traffic and
flow of people. All this is accomplished
in the final project organisation. After
evaluating different alternatives, the project
is presented as a major horizontal unit
with light wells on which six two-storey
hospitalisation volumes rest as if they were
floating. These volumes are linked to a large
public circulation area (rambla); the slanting
faade and the project of some smaller
annex buildings give the hospital a more
pleasant appearance along with the city, the
technological park and the new university
campus. The project is organised into two
circulation axis or streets. The medical
circulation axis, the par t that is more in

043

Examples of Double Comb Structure I

1. Dusk, street side view of the hospital

2. Aerial view of the hospital
in comb structure
3. Front view of hospital
4. Front square and main entrance

Sections

contact with the dual carriageway of

Bellisens, is in the nor th par t of the site
where the entrances and exits of the
parking lot and the technical logistics
sector will be built.
The public circulation axis, located in
the south of the site, opens onto a new
pedestrian walk. In this large circulation
area, called rambla, all public entrances
to the hospital emerge from a square.
The idea of this hospital design is to
control its size and make it similar to

044

the urban dimensions, controlling and

balancing the landscape impact of such
a building in the city.
The project consists in building a low
height hospital, with changes in the existing
topography, a big well-lit unit where the
general public and the physicians can
communicate, with green spaces, evoking
nature in the building area. In the faade,
where pedestrian accesses are located,
the large scale building is softened with
two project strategies.

On the one hand, the faade plane

that covers the whole building is bent
over, optically reducing the physical
presence of the building and increasing
its perspective effect. On the other
hand, on the ground floor there are
rounded pavilions at a lower scale that
receive people, helping to organise
the different entrances. In the big area
of the public rambla, the personnel,
patients and visitors encounter a public
square which enters into the building as
if it were par t of it.

Elevations and Sections

045