A crocheted wedding dress. Kids’ jeans. A pair of pajamas. These scraps of donated fabric were woven into a tapestry like the needs of women were woven into the architecture of the ambulatory care centre. The tapestry, enclosed in a glass display case on the first landing off the atrium, is emblematic of the care with which the design of the newly redeveloped Women’s College Hospital incorporated the feedback of its patients.
The look and feel of the airy, light-filled facility reflect the input of diverse groups including people with disabilities, recent immigrants and trans-gendered people. Their input was captured in a study called A Thousand Voices for Women’s Health, which formed the foundation for the redevelopment of Women’s College Hospital.
Design architect Susan Black, principal and director of Perkins Eastman Black, enlisted community members and volunteers to help create the tapestry. The art piece will be the first in a series of themed installations that will appear on the landing of each floor in the facility.
“The hospital serves people from many diverse backgrounds,” said Black. “What came out of that was a need for more cultural elements, more engagement.”
Future installations along this vertical spine will incorporate artifacts relevant to Indigenous sensibilities and to the history of refugees.
The $460-million building, which spans 600,000 square feet on Grenville Street in Toronto, was completed in two phases, the first ending in 2013 and the second ending in 2015. Undertaken as a public-private partnership, the redevelopment saw Women’s College Hospital work with Infrastructure Ontario, the Ministry of Health and Long-Term Care and a consortium contracted to design, build, finance and for 30 years maintain the new facility. The consortium comprised Bilfinger Berger, Perkins Eastman Black, IBI Group, the Walsh Group, Bondfield Construction and Black and McDonald.
Women’s College Hospital was made independent roughly a decade ago, which set in motion plans for the redevelopment, said Heather McPherson, executive VP of patient care and ambulatory care innovation at Women’s College Hospital. In addition to the original facility being dated, having been constructed in the 1920s and expanded in the 1950s and 1970s, it had been designed as an inpatient hospital. With quad bedrooms and wide corridors, the facility was ill-suited to the organization’s new mandate to serve as the province’s only standalone outpatient hospital.
The project also presented the opportunity to address some of the health gaps women face in accessing the services and programs they need, said Lili Shalev-Shawn, chief communications and marketing officer, Women’s College Hospital. One of the themes to emerge from A Thousand Voices for Women’s Health was the anxiety some people associate with entering hospitals in general. Some of the anxiety comes from visitors having to find their way to their appointment, which the redevelopment of the ambulatory care centre addressed with a hospitality-inspired lobby.
A reception desk gives visitors a place to “check-in” with volunteers who can help guide them. The surrounding undulating walls, echoed by ribbons of colour that cut through the tile floors, provide wayfinding cues, said project architect David Wood, associate at IBI Group. And the elevators are clearly visible across the open space, which is outfitted with wingback chairs and other casual seating that might traditionally be found in a hotel lobby, but for the fact that they were specified in cleanable material.
“When you come to the elevators, you have a choice of taking the stairs, which promotes wellness for people moving through the building,” said Wood, “but it also decreases the use of elevators, which is of benefit to the occupants, but also to the building operations.”
With reception visible off the elevator and waiting areas located next to windows, the clinics all follow the same floorplan, providing the flexibility to contract and expand different departments in response to demand, as McPherson pointed out.
“We monitor use of space very closely,” she said. “If areas aren’t using all their exam rooms, with the volume of patients, then we take them away.”
Contributing to this flexibility is the generic signage used to simply identify “clinics,” which also considers the privacy of patients, who McPherson observed may not want to advertise the reason for their appointment, such as substance abuse.
With roughly 1,000 people flowing through its doors every day, the building is organized based on foot traffic, said Wood. The busier the department, the closer it is to the ground floor, which placed the clinics on the lower floors and the surgical suites on the upper floors.
Departments are further organized to group together services that patients are likely to require in one place, added McPherson. For example, a woman can receive the results of a mammogram within 20 minutes because GP oncologists, radiologists and surgeons work in the same area.
This co-location of complementary services responds to the desire for a “one-stop shop” expressed in A Thousand Voices for Women’s Health. Part of the desire for a one-stop shop relates to the importance of communication between clinicians. Another part of the desire for a one-stop shop relates to the need to be sensitive to women’s time. Mothers, for example, commented that lack of child care may prevent them from attending medical appointments, which led to the inclusion of kids’ areas alongside clinics.
The clinics and surgical suites are housed in an L-shaped tower, which wraps a lower form, a pavilion containing the atrium with a fuchsia “gift box” cantilevered from the south-west corner, as Black described it.
“It’s a beacon from the outside,” she said. “It says you’re here before you see the words.”
The coloured, translucent glass temporarily casts a green haze over the interior the Pink Cube, as the meeting space is known, but the effect quickly dissipates as occupants’ eyes adjust. The Pink Cube is co-located with a 175-seat auditorium in the conference centre, which is rented out for various events and thereby helps to generate revenue, said Shalev-Shawn. The conference centre is often used to host educational events, which is appropriate as the academic hospital places 1,000 students every year, giving them an opportunity to gain experience in an integrated ambulatory setting.
Incidentally, when the University of Toronto campus, located close to Women’s College Hospital, went into lock down last year due to reports of a person seen carrying a gun, so did the ambulatory care centre. With its access card-controlled doors and the way it manages the flow of foot traffic, Women’s College Hospital was able to establish its command centre within five minutes, a feat McPherson said would not have been possible in its former facility.
Security is particularly important at the ambulatory care centre as it intakes patients who have been victims of sexual assault, she said. Women’s College Hospital works with its outsourced service provider to maintain a noticeable but unimposing presence of security personnel.
Much like the relationship between the consortium and Women’s College Hospital is long term, so is the work of improving women’s healthcare. The ambulatory care centre recently completed a follow-up study, which revisits the themes identified in its original study, spotlights voices from marginalized communities and spells out what it’s doing to respond.
As Shalev-Shawn put it: “Beyond just having the right building and facility, what else do we need to do in how the building is managed, how the staff work, and the services we provide, and the programs we have, to help women close the gaps they are still experiencing in healthcare?”
Michelle Ervin is the editor of Canadian Facility Management & Design.
Photography by Ben Rahn/A-Frame Inc.