The Swiss children’s hospital based on healing principles

Denise Chevin explores the children’s hospital that is revisiting what we consider to be a healing environment.

Good ventilation, lots of natural light, tranquillity and a connection to nature – all have long been seen as creating favourable environments to aid patient recovery and wellbeing. As long ago as the mid-19th century Florence Nightingale, for one, was espousing their value.

Nightingale believed that light and air quality in a hospital building play an important role in healing. To this end, she revolutionised hospital design in what became known as Nightingale wards, where large windows provided cross-ventilation (sash windows opened at the top and bottom with a heat source at the centre of the room for good air circulation) and abundant natural light.

As Steven Lockley, an Associate Professor of Medicine at Harvard Medical School, wrote in Scientific American: “In the decades since, numerous studies have shown that Nightingale was right: daylight is a critical determinant of human health and wellness. Patients in rooms with daylight and views of the outdoors have quicker recovery times and need fewer painkillers.

“Natural light has been shown to decrease heart rate, lower blood pressure and even treat depression faster than antidepressants. Importantly, just as Nightingale theorised, daylight can also decrease harmful bacteria and viruses.”

Legacy of care

The convalescent homes in the UK during the 1950s and 60s – many again stemming from the Victorian era and founded by charities – were designed around principles that emphasised rest, recuperation and holistic wellbeing for individuals recovering from illness or surgery. These homes were often located in the countryside or by the sea, far away from the stresses of urban existence. They played a crucial role in bridging the gap between hospital care and a return to everyday life, but they dwindled with advancements in medicine and shorter hospital stays.

While their legacy is reflected in modern healthcare approaches, such as rehabilitation centres and holistic patient recovery programmes, these principles have not always been apparent in later hospital designs. Windowless corridors, strip lighting and hard surfaces – not to mention overcrowding and noise – have become endemic.

Architecture of healing

There are numerous good examples in UK hospital design that are bucking this trend, most notably perhaps Maggie’s Centres. These are dedicated spaces that provide free practical, emotional and social support to people living with cancer, as well as their families and friends. They are designed to promote wellbeing through a combination of thoughtful services and innovative architecture. But generally, few UK hospitals would come close to the Kinderspital, a new children’s hospital in Zurich, designed by the Swiss architects Herzog & de Meuron and completed last autumn.

Practice Co-Founder Jacques Herzog is firmly of the view that architecture can contribute to healing. Kinderspital aims to do this by using natural materials such as wood that are not only appealing to look at, but also pleasing to the touch. Large windows bring in natural light and look out onto well planted courtyards, for visiting children and families to play, and generous greenery blurs the distinction between inside and out. In fact, the whole building – although large – is designed to be on a human and domestic scale.

“Hospitals should not be towers that frighten, but welcoming. And the scale, next to the material, is an important dimension,” said Christine Binswanger, Senior Partner in charge of the project, in a lecture about the building.

Children in mind

This new hospital has touches throughout that make it approachable and child-friendly, such as a low-level reception desk for them to see over when they arrive and coated walls to encourage scribbling. “We’ve tried to make the architecture address the curiosity of children,” Binswanger told The Guardian – there is even a hole in the lift for passengers to see into the shaft.

Kinderspital lies in Zürich-Lengg at the foot of a hill, adjacent to other hospital buildings from several eras. It is the largest facility for children and adolescents in Switzerland. It is operated by the Eleonore Foundation, a charity founded in 1868. The project consisted of two buildings: an acute-care paediatric hospital with 200 beds and a separate cylindrical building with an open, five-storey atrium for research and teaching.

The acute-care hospital is 200m long and is a single three-storey structure with a gently curved façade. Two floors are predominantly treatment areas and offices, while the patient rooms are on the third floor; these are designed to look like small-scale wooden cabins with pitched roofs, again adding to the friendly feel.

As well as big picture windows, these rooms also have porthole windows at child height that can be opened for natural ventilation. The hospital is organised like a town with courtyards, streets, alleys and squares, again adding to familiarity and helping visitors find their way.

Project stats
Location: Lenggstrasse, Zurich, Switzerland
Design competition: 2011/2012
Start on site: January 2018
Completion: July 2024
Site area: 46,650m²
Number of beds: 200
Gross internal floor area: 96,246m²
Client: Kinderspital Zürich – Eleonorenstiftung, Zurich, Switzerland
Architect: Herzog & de Meuron
Site architect and main contractor: Gruner
Structural engineer: ZPF Ingenieure
Civil engineer: EBP Schweiz
Landscape architect: August + Margrith Künzel Landschaftsarchitekten (planning), An-dreas Geser Landschaftsarchitekten (construction)

Joint discussion

An innovative aspect is the structure. Binswanger explained that they would have liked to have built the hospital entirely out of timber, but at the time the client was not ready for that.

Instead, the architects opted for a combination of concrete and wood – a concrete frame with wooden in-fill panels – so that the wood has a tactile role. It is a two-storey concrete structure above ground, with the patient rooms built from wood to form the third storey.

A spokesperson for the practice says: “Since the patient rooms have their own specific set of spatial requirements, we needed to find a way of keeping the structural grid in the lower floors while ensuring this met the requirements for the patient rooms on top of the building. The solution was to build the rooms out of prefabricated timber elements, with prefabricated bathroom units sitting on the concrete structure.”

In advance of the construction, a six-metre-wide segment of the building was mocked up, not least to help show the stakeholders – staff from across all the different groups – how the building would work. “And I can tell you that was a very long process with those 50 user groups,” Binswanger noted.

A major area for discussion was the use of wood for interiors. Binswanger says that in most hospital projects the attitude is ‘forget it’, but here they were willing to consider the combination of hygienic and easy-to-disinfect surfaces with wood and explore how it could be realised. For example, the bedrooms have wooden floors coated with ultra-hardwearing polyurethane, which adds a sense of warmth, but also makes them hygienic and durable.

As Herzog has pointed out: “The children don’t actually want to go to hospital and neither do their parents, but it should still be as pleasant as possible for them.” Few would argue with that, especially Florence Nightingale.

The Science Behind Sash Windows and How They Ventilate Our Homes: b.link/UoC_ventilate
What Florence Nightingale Can Teach Us About Architecture and Health by Steven Lockley: b.link/SA_Florence

Image credit | Maris Mezulis