December 2000

Kwan O Hospital

Healing concepts

In the heart of the fast-developing Tseung Kwan O New Town is a new acute general hospital surrounded by residential high rises. Tseung Kwan O Hospital, however, gives little away of its clustered surroundings, set as it is against the verdant backdrop of a low hill, with extensive landscaped open space in front framing the interlocking forms of the complex.

"We included a lot of landscaping to make it attractive in what is otherwise a very urban area," explained David Foxley, director of projects at TPS Consult, the firm responsible for developing the specifications for the project.
        To ensure that the hospital would blend in with the leafy setting, green tinted strips of windows were deliberately chosen to complement ceramic tiles in a pale shade of green.
        "We didn't
want huge glass walls as they wouldn't fit into the surrounding area or the concept of a hospital. Huge glazed areas would also increase the cooling load, but they've attractive in small quantities," Mr Foxley said. 
        The hospital comprises five blocks: three ten-storey high ward blocks, which are set behind a six-storey clinic block and a five-storey rectangular diagnostic and treatment block. A central circular core links the blocks together to create a complex of interlocked geometric forms.
        The different heights of the blocks not only make the complex more interesting, but also create roof space for landscaped recreational facilities. A pergola was created on the fourth floor podium of the diagnostic and treatment block. In addition, the geriatric wards in the east block and the paediatric wards in the north block are both provided with direct access to their own gardens or play area.
        Landscaping is also used in the public areas surrounding the hospital to define pedestrian and vehicular access, improve the appearance of the open-air car park and mask the morgue.
        The main pedestrian access to the hospital is addressed by a four-storey atrium. Covered by a skylight equipped with sunshading devices, the atrium leads visitors to the main lobby via two sets of escalators, providing a clear path of travel which minimises the chance of visitors getting lost. To further assist visitor orientation, the blocks are colour-coded.

Triangular ward configuration
The most notable feature of the hospital is the three triangular ward blocks, which provide a total of 598 beds, including 140 day beds. With wards on three sides arranged around a nurse station in the middle, the user-friendly layout allows nurses a view of every patient bed from their central position.
        Another advantage of the design is that, unlike traditional hospitals where medical staff have to patrol up and down long corridors, the triangular layout vastly reduces the distance nurses have to walk in order to reach every bed, thus minimising the fatigue they experience. Finally, the layout makes it possible for a small staff to serve a relatively high number of patients without undue stress, thus improving operational efficiency. Mr Foxley said the ward blocks, which produce a windmill plan, also drove the shape of the hospital, generating an architecturally interesting building.
        Other facilities are also arranged to be as user-friendly as possible. Wards catering for a particular type of patients are located on the same floor as the outpatient clinic dedicated to the same type of patients. To provide the fastest treatment possible, direct access is provided between the operating theatres and the intensive care unit. The accident and emergency department is located close to the radiological department to facilitate diagnosis.
        Tseung Kwan O Hospital is the first hospital in Hong Kong to be developed under a design-and-build contract. According to Mr Foxley, the Hospital Authority decided to adopt this form of contract because of the speed and certainty of completion it promised. 
        "Normally it would take about ten years to develop such a hospital; this one was completed in five," Mr Foxley pointed out.
        Unlike design-and-build projects where the contractor is selected and left to work with his architect in developing the design, TPS started with a firm concept and worked closely with the contractor and architect in ensuring that the concept was realised. The triangular ward system was among the key elements which the successful tenderer was required to incorporate into his design. Another one was energy efficiency -- a stipulation which resulted in use of a sophisticated temperature control system with 2,000 monitoring points, low wattage lighting, and dual fuel boilers capable of using oil as well as gas.

End-user input
Appointed by the Hospital Authority to project-manage the project, TPS was responsible for not just developing the brief and evaluating the tenders, but also for obtaining the input of end-users concerning their requirements. As the hospital had yet to be built at that stage and therefore did not have any staff of its own, end-users were "borrowed" from other hospitals to lend their experience to the design process.
        The process began with the contractor dividing the hospital into different departments and producing drawings on a room by room basis. These were then presented to the end-users to be signed off, if they agreed that the drawings represented what they wanted.
        Attention was paid to every detail. For example, in designing the maternity ward, how the rooms were set out, where delivery rooms would be placed and even where the scrub sinks would be were all discussed and finalised with the help of the doctors and nurses whose colleagues eventually moved into the built complex. More than 100 end-users were involved in signing off 150 sets of drawings.
        "In a way the hospital was almost designed by the end-users," Mr Foxley observed.
        Due to the building services requirements of a hospital, the complex has a generous headroom of 4.5 m. Among the services provided is a fully automated pneumatic tube system which links all the departments together. Tubes sent from any department go to a central server located in the above-ground "basement" (due to the high water table the hospital was built on a platform which subsequently housed the basement at street level), from which they are directed to their destinations in a matter of minutes.
        Built at a cost of HK$1.2 billion, the 60,000 sq m hospital is designed to serve a population of 300,000 in the new town. Occupying the eastern corner of the 3.7 ha site, the hospital was developed with a view towards expansion some time in the future, with a 50 per cent increase in the number of beds.
        Construction was completed in April 1999 and various sections have been progressively commissioned, beginning with several specialist outpatient clinics in December of that year. The accident and emergency department began service in July this year.

client Hospital Authority
project manager TPS Consult Asia Ltd
architect (design concept) Wayne Fishback & Associates
architect (detailed design) Kwan-PTP Architects & Hospital Planners Ltd
structural engineer Ove Arup & Partners (HK) Ltd
building services engineer Parsons Brinckerhoff (Asia) Ltd
quantity surveyor Levett & Bailey
main contractor Laing-Hip Hing Joint Venture

-- Building Journal