Breaking new ground in sustainability and disaster preparedness.

Better known for its biomedical research and business friendly atmosphere, Singapore, a country of just 4.4 million people, is quickly making a name for itself in world-class healthcare.

As in the US, major factors driving the development of the healthcare system include an aging population, longer life expectancy and anticipated population growth.

Singapore's close call with SARS in 2003, its famously hot and humid climate, and its proximity to politically delicate situations, require new initiatives previously unseen in healthcare design.

Alexandra Hospital @ Yishun, currently on the boards at Hillier Worldwide Architecture and CPG Consultants Pte Ltd, illustrates some of the new techniques in sustainable design, disease control and security. At 102,245 square meters, this 550-bed replacement hospital will enhance patient care and staff efficiency as a "hassle free" hospital. It is designed to be a model of energy efficient design, planned to consume less than half the average kilowatt hours per bed per month when compared to the current Singapore average.

The hospital breaks new ground in sustainability and disaster preparedness--issues that resonate deeply with U.S. healthcare institutions, many already grappling with rising energy costs and potential biological threats.

A Hospital that Breathes

Singapore's climate, roughly five to ten degrees warmer than south Florida on average, creates unique challenges for healthcare providers. In order to minimize operating costs and maximize resources available to patient care, the architects incorporated ventilation and exterior envelope strategies into the new Alexandra Hospital @ Yishun.

Careful building orientation, exterior detailing and interior planning, mean that only 30 percent of the hospital will require air-conditioning. These air-conditioned portions of the building, such as operating rooms and laboratories, will be co-located to minimize their external surfaces and heat gain. Ancillary spaces, such as balconies and circulation routes, are designed to be naturally ventilated. Green roofs, green walls and landscaping will also be used to help lower heat gain.

Building orientation and high performance exterior envelopes are critical to minimizing operating costs. Alexandra Hospital @ Yishun's east-west facades will be fitted with intricate sunscreens to shield the perimeter from direct sunlight.

A First Line of Defense

After emerging stronger from its scrape with SARS, Singapore now implements carefully designed hospital policies to prevent future epidemics.

As in the U.S., the majority of inpatients--85 percent--come directly through the emergency department while only 15 percent enter through prescheduled appointments. As the emergency department becomes the de facto front door to the hospital, the design philosophy of the hospital begins to reflect this.

Having a single, public access point can also be the key to isolating potential biological threats. With this in mind, the project team established an entry protocol and an accompanying layout to facilitate the identification and isolation of infected individuals.

From the Alexandra Hospital @ Yishun's entrance to the Emergency Medicine Department (EMD), all patients and visitors will undergo passive thermal scans before moving to a triage area that separates into two paths--one for non-infectious individuals, another for those potentially infected. The latter will be directed to an isolation wing within the EMD.

Converting for Crises

Natural disasters like Hurricane Katrina and the December 2004 tsunami, as well as the threat of political disasters, are testing hospital capacities and disaster preparedness plans around the world.

Following 9/11, the United States crafted provisions for surge hospitals--facilities designed to supplement existing hospitals in case of large-scale emergencies. Based on Israeli models, Singapore has gone one step further by subtly incorporating protected facilities into their new hospitals in order to buttress the hospital's role in a national emergency response and maintain key functions during direct attack.

In Alexandra Hospital @ Yishun, the Hospital Protected Vital Facilities (HPVF) house ambulatory surgery units and a parking structure, during regular operations. In emergencies, the HPVF can be quickly and securely transformed into a fully functioning hospital complete with operating theaters, diagnostics services, inpatient wards and a civil defense shelter.

As political forces, healthcare demands and design aesthetics continue to influence hospital architecture and operating procedures around the world, hospital and government officials continue to look for the next innovative step. Singapore, with its technological ingenuity and political savvy, is leading the way.

BY STEVE GIFFORD, AIA, MITCH

GREEN, AIA, AND JESSE McCARTER

HILLIER ARCHITECTURE

Steve Gifford, AIA, is managing and planning principal of the New York City office of Hillier Architecture. Mitch Green, AIA, is director of Healthcare Planning for Hillier's New York office. Jesse McCarter is an associate in Hillier's New York office.