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Post-Occupancy: Yawkey Center for Outpatient Care | Children’s Hospital, Ambulatory Care Building | Naval Hospital More Health Care Projects Children’s Hospital, Ambulatory Care Building
Henriquez Partners and the IBI Group mitigate concrete’s tough side with bright color and warm materials for a children’s clinic.
Originally published in the Building Types Study section of Architectural Record – October 2004
Squeezed between snow-capped mountains, Juan de Fuca Strait, and the Fraser River delta, Vancouver has one of the world’s premier urban settings. While it boasts a mild, largely benign climate, it can be plagued by long periods of cloudy, wet weather. This suggests a climate ill-suited to the raw concrete architecture of Brutalism. Over the past decade, however, the work of Henriquez Partners has presented a strong argument for the appropriateness of bold concrete forms in urban Vancouver, with projects like the Coal Harbour Community Centre and two recent award-winning social housing projects. The firm’s Ambulatory Care Building (ACB) on the British Columbia Children’s Hospital campus (a joint effort with IBI Group and Karlsberger Associates as associate architects) succeeds on a tight budget in creating a bold but welcoming facility for young patients.
Pictured: Children’s Hospital, Ambulatory Care Building 
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Program
ACB replaces the demolished north wing of the Children’s and Women’s Hospital, a sprawling single-building complex with mazelike interior spaces that render its wayfinding, fresh air, and sunlight features “not very good” according to partner in charge Richard Henriquez. The hospital’s long-term program calls for smaller buildings, assembled with other nearby medical facilities into a campuslike setting using streets and landscaped quadrangles. A primary objective for the new, 115,000-square-foot facility, which provides outpatient pediatric services for 66,000 visitors annually, was to create a bright, welcoming environment for children and their parents. With more than 50 clinics required for nearly 30 specialties, treatment and procedure rooms had to be flexible enough for different disciplines to utilize them at different times of the week.
Solution
ACB is a modestly scaled building connected to the main complex by a glazed bridge on the second level. Henriquez stretched the four-story structure along a pleasant new street lined with trees, lanterns, and outdoor seating. Its animated south-facing public facade emphasizes transparency with a double-height, glass-fronted concourse shielded by an impressive concrete canopy that minimizes solar gain. “The relatively narrow floor plate made up of two rectangles of different lengths maximizes the penetration of natural light from Vancouver’s fickle sunshine,” says Henriquez.
Functionally, the floor plate is programmed into three horizontal and two vertical zones. On the first two levels, the bright, open concourse serves as the patient reception zone. The clinic zone, stretched along the center of the floors and organized as a series of three “pods” on each floor, is immediately visible and color-coded to ensure quick orientation. A third, private zone occupies the north side of the building and contains case preparation rooms. Patient files are stored in this zone, transferred each morning from doctors’ offices located on the third and fourth floors. These narrow upper floors boast extensive north- and south-facing glazing. Additional overhangs, along with tinted, slightly reflective glass and operable windows, help the non-air-conditioned building achieve an estimated 50 percent energy savings over similar conventional buildings.
In keeping with current hospital design practice, according to project architect Ivo Taller, the treatment rooms were kept generic and unprogrammed. “Each one contains digital imaging equipment, a pedestal sink with sensor-operated faucets, and a standard examining table—but they’re intended to be multifunctional so they can be in constant use,” he says.
Despite a modest budget, Henriquez says, “We wanted to up the architectural quality of the typical hospital, and we found it cheaper to build in concrete, where the structure and the cladding are the same.” A special seal was used on the concrete to prevent it from turning dark and streaky when wet, not a small matter in a city where it rains 197 days a year.
Commentary
ACB’s south elevation, with its tension between competing vertical and horizontal forms and structures as well as between concrete solids and glazed voids, provides a robust and transparent public facade. Inside, public areas are spacious, uncluttered, and filled with natural light—all helped along by crisp detailing in metal, glass, and wood, and softened by touches of bright color.
Revisiting the British Columbia Children’s Hospital Ambulatory Care Building suggests that even an award-winning structure, which has received favorable ratings in post-occupancy reviews, can use some fine tuning—and teach us how to provide medical services even better.
The building was awarded an AIBC Lieutenant-Governor of BC Merit Award in 2004. An in-depth survey ordered by the Provincial Health Services Authority that year found that overall satisfaction with the facility was 76 percent. Users especially liked the fact that it “supports patient-centered care” as well as its “flexible, innovative, and efficient use of space; the amount of space; and the welcoming, comfortable, and pleasing environment.”
The amount of light in the workspaces received 100 percent approvals, as did the air quality. But there were some nuances to these favorable responses. Susan Greig, a parent who had used the hospital and was hired by the administration to bring the “family voice” of the Partners in Care Family Advisory Committee to the table, observes that the lobby “can get hot and stuffy (no air flow) on warm, sunny days. People actually stand close to Starbucks to benefit from the small amount of air-conditioning and air movement their system creates.” She adds that families really like having “the Starbucks in the lobby as a meeting place and point of reference for directions.” This is important because she says wayfinding at the hospital is problematic and recommends installing maps or a highlighted numbering system.
Greig adds that her group also appreciates “the number of meeting rooms” and the fact that “there are no sloppy bulletin boards in the elevator stuffed full of research projects and information.” As for what parents like best, Greig says it’s “the number of washrooms”—but their most serious concern is that “there are no youth change tables in any of the washrooms. Baby change tables are great, but we have children up to the age of 18 coming here, and many of them are in wheelchairs. Parents who need to change older youths end up doing so on washroom floors.” Since the architects at Henriquez Partners say they are pleased that there “are specialized change rooms for patients with severe disabilities,” these spaces must not be adequate for some of the older patients. Getting things like this exactly right is difficult—and is what prompted the hospital to hire a patient advocate.
Design teams with IBI Group clearly made every effort to make the building “inviting and friendly to patients, staff, and visitors.” They are proud of the ample light, air quality, and operable windows—and that the hospital is equipped with “ample patient support services such as a two-story hall, patient library and resource center, and mother’s breast-feeding rooms.” The architects are also pleased with “the nine-meter span structural system, [which] allows for easy reconfiguration of all offices, exam, and procedure rooms”; the system makes it possible for the building “to expand horizontally without requirements for additional exiting.” They are happiest with the fact that the building accomplished a 40 percent reduction of energy use “compared to similar structures, even though it was built prior to LEED standards. We fully embrace sustainable principles in all our building designs. ... Energy savings of 40-60 percent are easily achievable with more sophisticated mechanical systems by cutting air volumes and using passive energy features in slab heating and cooling, and in heat recovery.”
Energy savings, of course, need to be accomplished within a particular set of climatic conditions. Vancouver’s climate, though mild, is often windy and rainy. Perhaps that is why Maryam Saeri, administrative manager for Pediatric Surgery, is enthusiastic that the building is so “bright and airy.” She thinks these qualities keep the space from seeming too institutional. The only thing Saeri dislikes is “the design of the public bathrooms and the temperature-control in the offices.” She adds that very few changes have been made since the building opened, except to create more office space—and if the hospital were being designed today, Saeri would recommend including “more storage space!”Vancouver’s climate is creating some concerns. For the moment, staff and families must walk outdoors from the Ambulatory Care Building to British Columbia Children’s Hospital. “There is a ‘covered’ walkway, but the rain blows in at an angle and you can be soaked,” Greig says. “There is also the wind tunnel effect.” Citing the region’s frequent rainstorms, she advocates building “covered parking for families who have to get a child out of van into a wheelchair or a child into a stroller” in the parking lot. As her comments suggest, although there are universal principles at play in health care design, some elements are very specific to a place.
- A spacious, light-filled lobby enhances the entire hospital visit.
- A nine-meter span structural system allows for easy reconfiguration of offices, exam, and procedure rooms.
- In rainy climates, covered parking spaces are desirable for patients unloading wheelchairs or strollers.
- Bathroom equipment should be designed for the specific population that will use a facility.
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