Doctor feelgood - Issue 125 - Magazine | Monocle

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Good health and good sense are two of life’s greatest blessings – so the old adage goes. Vienna clearly has both, as its latest venture suggests. At the gleaming Krankenhaus Nord, a new hospital in the rapidly growing district of Floridsdorf, the connection to health is obvious. The good sense, however, is less visible and part of a much longer history of prescient urban planning and considered health strategies.

The new public facility – which will be renamed Klinik Floridsdorf in 2020 for administrative reasons – is part of a long-term masterplan for hospitals, a concept originally that was cooked up by the city in 2008 that is due to be fully implemented by 2030. This strategy involves streamlining processes, updating technology and even closing some smaller, less modern, hospitals. “Vienna’s older hospitals needed to replace their equipment anyway,” says Margot Löbl, the new hospital’s medical director. “It made more sense to invest in a new building than update the older ones. But we also looked at demographic development: young families are moving to this area and care in Vienna was unevenly distributed.”

By starting from scratch, the city was able to reconsider what a hospital should offer and how it should be designed. That is apparent from the first glimpse of Klinik Floridsdorf, with its distinctive feel-good surroundings designed to aid recovery – airy, relaxed rooms in soothing colours with plenty of green space to see through the windows. With cities growing apace and the speed of life demanding ever more from us, health services need to not only care for more people but also to ensure that those people recover as quickly as possible.

“Vienna is good at thinking for the long-term,” says architect Albert Wimmer who, since opening his office in 1977, has designed stadiums, railway stations and other healthcare facilities throughout Austria. After winning the international competition to design Klinik Floridsdorf in 2008, he and his team conducted 2,200 interviews with Viennese medical professionals and caregivers before planning the building in order to incorporate their wants and needs. Klinik Floridsdorf is large – it has 785 beds – but not oversized or impersonal. The land it was built on, which once belonged to Austrian Rail, is surrounded by green space; about 1,000 trees were planted on the hospital’s grounds in 2016 and several “therapy gardens” allow patients in recovery to spend time outside.

Inside, ultramodern facilities cater to staff who specialise in traumatology, cardiology, gynaecology and oncology, as well as the everyday treatments for everything from stomach aches to broken bones. Klinik Floridsdorf also has an expansive youth psychiatric department and is equipped to take four times as many outpatient cases as inpatient ones. This unusually high ratio is advantageous to both the hospital and patients: shorter hospital times have been shown to aid in healing.

With their bay windows and recliners for visitors, recovery rooms are designed to assure peace of mind and privacy; the largest accommodates only two patients. Natural light illuminates every room here, splashes of green and other bright colours adorn the facade and recur inside, and atriums are decorated with hanging plants or cut logs. “It’s important to bring nature into the building,” says Löbl. “This place doesn’t feel cold and robotic. It’s a place to feel good.”

Klinik Floridsdorf opens in stages this summer: the first emergency patients were treated here in June and it will operate at full capacity come September. It clearly couldn’t come a moment too soon for the neighbourhood: more than 20,000 residents attended an open-house day in April, all eager to see the soaring entrance area, long halls punctuated with comfortable seating and lush roof gardens of their new hospital. The seating and wide, windowed corridors are designed to slow foot traffic and offer space and views to those nervously waiting for loved ones. The roof gardens are accessible from the building’s upper storeys and offer patients fresh air and space for outdoor relaxation. The emergency reception area is divided so that children and adults check in separately, reducing the transmission of contagious diseases, waiting times and unnecessary stress; younger visitors, for instance, won’t see grown-up blood.

“The patients’ wellbeing was brought into every step of the planning,” says Herwig Wetzlinger, the CEO of Vienna Health Association and director of Vienna’s General Hospital. “The patient arrives in a bad situation: he or she is sick. We wanted wellbeing to be a part of the architecture and design; our infrastructure is a bit like a hotel’s.” It’s true: staff admit patients at generous reception desks. Waiting and treatment times have been reduced by separating the entrances for patients who have appointments and those who don’t; the entrance to the accident and emergency ward, which resembles a colonnade, is at the side of the building. Even employees benefit from the space and light: there’s a vast lounge where carers and technicians who are working long shifts can take a break.

For at least half a decade, Vienna has gained about 29,000 new residents a year and population growth is expected to continue, especially in Floridsdorf. But until now the area’s healthcare provision was insufficient; it was difficult, for instance, for expectant parents to register upcoming births. “We had a very small hospital in this district,” says Wetzlinger. Klinik Floridsdorf has absorbed that site, along with two others and several specialised departments from other Vienna healthcare centres. This move has redistributed medical services in Vienna at the same time as modernising medical standards and maximising human resources. “Our goal by 2030 is to have two hospitals in each of the city’s three health zones to take care of our people,” says Wetzlinger.

Klinik Floridsdorf wasn’t built without controversy: like many of Europe’s urban projects, it was long overdue – having been slated for completion in 2015 – and over budget, coming in at €1.3bn more than the originally projected cost of €850m. Now that the building is complete though, its potential patients and 2,500 medical professionals (450 of them doctors) are enthusiastic. “This hospital is a living organism, from the people who make sure the blinds work to the surgeon who opens your ribcage to perform a heart operation – even the cleaners and the administrators who make sure that everyone gets paid,” says Löbl. “It’s an interlocking chain of people who make sure this all occurs.” In other words, it’s like a city within a city.

Case studies

Breaking the mould

It’s not just Vienna that’s doing things differently: a hospital in the Netherlands is set up to respond to mass catastrophes at home and abroad, while a clinic in Japan is designed with the country’s ageing population in mind.

Test case 1
Major Incident Hospital
Utrecht, Netherlands

Diagnosis: From terrorist attacks to natural disasters, cities are facing trauma on a mass scale.

Prescription: Facilities that specialise in treating a large number of casualties with major traumas.

“Disasters as routine” is the reassuring – if unsettling – slogan of Utrecht’s Major Incident Hospital, a collaboration between the University Medical Center Utrecht and the Dutch ministries of health and defence. The hospital contains short-term care facilities that can be fully operational and ready for the admission of hundreds of patients within 30 minutes of a catastrophe at home or abroad.

Since 1991 the Major Incident Hospital has been called upon 43 times, assisting in the aftermath of events including the crash-landing of Martinair flight 495 in 1992 and the repatriation of Dutch victims of the 2004 Indian Ocean tsunami. Though the hospital is equipped with sophisticated systems, including an automated personnel alert to ensure the rapid availability of trauma staff, rudimentary decor is key to efficient triage. Coloured lines on floors help staff to route patients according to the severity of their conditions: red for the most critical, yellow for less critical and green for the rest.

In the event of a terror incident, the hospital can handle large numbers of heavily wounded patients. Whereas other countries have to work with tents at the site of an incident before splitting casualties between hospitals, the Major Incident Hospital takes on the extra capacity, allowing regular hospitals to function as usual. The facility can also be used to help with international emergencies: in 2011, 51 civilian casualties of Libya’s civil war were treated there.

Decontamination tents and a bespoke air-conditioning system can be used to keep patients in quarantine. In 2014 an Ebola patient who had been serving with UN peacekeeping forces in Nigeria was nursed back to health here in strict isolation.

Test case
Sayanomoto Clinic
Saga City, Japan

Diagnosis: Ageing societies mean that city hospitals and clinics are facing an increasing number of geriatric patients, some of whom are dealing with mental decline or are resistant to treatment.

Prescription: A health centre that caters specifically to ageing populations and takes into account the health-and-comfort needs of the elderly in everything from treatment to design.

The majority of the 1,000 patients registered at Sayanomoto Clinic in Saga City are elderly. It’s a common story in this part of Japan thanks to its ageing population. Founded by Dr Machiko Kametani, who had previously been teaching at a Tokyo hospital, the centre offers general care but specialises in conditions, such as dementia.

“I was thinking about my next step and wondering what I could do to help the older population,” says Kametani. She decided to return to her hometown to set up her own clinic – designed by Tokyo architect Kentaro Yamazaki – in a conservation district, near a 1,000 year-old shrine and next door to her great-uncle and grandparents. “I studied existing hospitals and clinics in Japan to understand the elements necessary for a medical facility,” says Yamazaki. “I realised that while medical technology and research were improving, the buildings themselves were not.” Yamazaki believed that the designs failed to take into account the patients’ experience, particularly the mental stress that they must feel when going to hospital. “In a society with an elderly population, no-one should be ashamed about visiting a clinic,” he says.

Both the doctor and the architect wanted to create an interior that would make patients as comfortable as possible – the facility has large windows running along one side and a 30-metre-long bookshelf encourages patients to read while waiting. Some feel so relaxed that they nap in the waiting area.

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