La Spezia hospital by Hopkins Architects
Associate partner Laura Carrara-Cagni on the practice’s designs for a new hospital at La Spezia in the Liguria region of Italy.
You are well known for health projects in the UK such as the Evelina Children’s Hospital in London. How hard was it to break into the Italian market?
Laura Carrara-Cagni: We haven’t built in Italy before, although over the years we have looked at quite a few projects. It’s very hard if you’re not an Italian firm, and if they commission foreign practices they tend to like signature architects. There is not a lot being built at the moment and legislation is very constrictive.
This project came along through a contact with the Italian engineering and architectural practice Politecnica from a lecture I did at the University of Bologna in 2005. We entered a bid competition in a joint venture with them and healthcare specialist Fabrizio Gemmi and were selected from 22 teams. Our work at Evelina and UCHL helped, but so did Politecnica’s healthcare experience. However, we had to offer a significant discount in our fees.
What was the brief?
The new, 65,000sq m hospital will combine the functions of two hospitals in La Spezia and will have 520 beds serving a wide area including north Tuscany and west Liguria. It will be built on the site of the current 100-bed Felettino hospital situated on a hillside above the town with views south down to the sea, set in a protected mature garden and olive groves.
What organisational approach are you taking?
We are proposing an organisation determined by the “intensity of care” principle. This is a new concept where instead of having many different wards you have large departments based on the level of care patients need. This gives a more efficient system where different types of patients can use the same room. It should also allow patients to be treated more holistically because there is more integration of specialisms.
There are three outpatient and therapies floors and three inpatients floors arranged in degrees of intensity, with the paediatrics and maternity wards at the top on the sixth floor. A&E and diagnostics are on Level One, laboratories, dialysis and outpatients on Level Two and operating theatres and intensive care on Level Three.
Our priorities are legibility, efficiency and flexibility, making good use of the changes of levels and introducing lots of natural light and views. The healing benefits of hospital environments is a given nowadays and continuing on from Evelina we are trying to make the environment less institutional and oppressive. Within the intensity of care concept we responded to the special requirements for each group of patients – for example we provided a special terrace for psychiatric patients who smoke a lot.
How is the accommodation arranged?
We wanted to orientate the hospital towards the sea but clearly, because it’s such a huge hospital, we needed to break it down into smaller volumes. The main challenge is the slope. which necessitates a compact plan. We realised pretty quickly that a layout with four “fingers” of accommodation fanning out from a central spine with courtyards in between gave us the necessary volume and opened up the building to views.
About 80% of beds face to the sea, and the rest to the hills. The ground floor has most of the public activities: café, shops, nursery, canteen, with staff offices to the left and plant cut into the hill at the rear. The public enter through a double-height atrium central to the building, while visitor lift cores are on the exterior building to give a consistent sense of orientation. There are separate routes for ambulances and goods deliveries to the rear of the hospital. A tunnel connects the main hospital to a free-standing radiotherapy building on the east, which is being built as a first construction phase to allow continuity of treatment through demolition and construction of the main hospital.
We are preserving the gardens in front of the hospital and locating car parking for 800 cars fanning out in two levels with one level partially underground and triangles of planting between the cars. This helps mediate the transition in scale between the hospital and the surrounding small houses.
How is a typical floor configured?
The wards are generally arranged as five bays wide in the fingers where the bedrooms are on the outside on both sides with the support services in the middle flanked by two corridors. The nursing stations are at the corridor intersections. Each finger ends in a lounge with a large window onto a terrace with sea or hill views. Three atriums along the spine bring light into the centre of the plan.
Ninety per cent of the rooms are for two beds and the rest are single, each with its own bathroom pod. One wall of the room is integrated with washbasin, wardrobes and television.
Each room has a very large fixed glazed window and, next to it, a ventilation panel that opens behind horizontal louvres.
What materials are you using?
Maintenance is a concern in Italian public projects so we chose materials that are robust and will age well. The hospital has a concrete structure and will be faced in either render or precast stone panels.
We will try to include some wood, such as wooden louvres alongside the glazing. The entrance atrium will be a double-height exposed structure as public spaces are the one place where we can have exposed concrete and wood columns, everywhere else has to have washable seamless non porous materials.
To optimise the structure, on the upper levels the concrete columns are encased in metal. The chapel is in the lower ground floor with an oculus into one of the courtyards.
When will the hospital be open?
In Italy these large projects have a special planning approval process called Conferenza dei Servizi.
At present we have delivered the Progetto Preliminare, a stage C equivalent and we are waiting for approval. Then we will produce a Stage D equivalent design for a second stage approval before going out to tender with a design-and-build contract.
The current predicted tender is within a year from now. The main hospital should take three and a half to four years to build. Construction costs will be €127 million with total project costs of €179 million. Meanwhile, we’re detailing the radiotherapy unit and hope to start on site with this year.
Combination of facade materials helps break up the hospital’s bulk
The elevation treatment is mindful of the hospital’s hillside setting, with the architects incorporating wood plus a light tone of render or precast stone.
A typical bay of accommodation will have structural circular concrete columns exposed on the lower two levels in contrast to elsewhere in the building where the column structure is encased in metal.
At the base of the building will be wood or stone cladding below wooden horizontal louvres with metal frames. On
the front facade, these louvres will cover the full double height.
Above, the composition consists of horizontal bands of textured render panels below glazing and louvres.
Each two-bed room has one fixed glazing panel with an aluminium frame next to a wooden louvre with an insulated metal backing panel that tilts open at 30 degrees for ventilation.
The louvres of each two adjacent rooms are grouped together so that the wood forms a strong vertical element on the elevation.
Along with the use of projecting fingers of accommodation, this composition helps to visually break up the bulk of the hospital, which will be substantially larger than the building it replaces.
At the top of each storey a horizontal metal louvre panel provides more shading for the rooms. At the very top of the building, prefabricated modular metal louvre panels screen plant from view.
Architect: Hopkins Architects
Architect and engineer: Politecnica,
Healthcare specialist: Fabrizio Gemmi