When Growthpoint and Cintocare agreed to develop a specialist surgical hospital focusing on complex head and neck, spinal and vascular surgery, and simultaneously incorporating sustainability principles to enhance healing, A3 Architects was a natural fit. Over the past 30 years, the Johannesburg firm has successfully completed more than 350 healthcare projects locally for the three major healthcare service providers, government and private operators, and has also done work in Africa and the Middle East. Cintocare private hospital in the green Menlyn Maine precinct of Tshwane, alongside the Green Star-rated Central Square shopping precinct, was an extraordinary opportunity.
‘It presented a unique challenge and building typology for the firm, being bounded on three sides by existing buildings in an urban block,’ says Kevin Hinde, CEO and principal architect at A3.
‘Beyond that, hospitals have considerable carbon emission profiles due to the energy and water consumption required for their daily operations. The aim was to create a sustainable healthcare facility designed around the well-being of patients and hospital staff, in a building underpinned with green-building elements and philosophies that reinforce the healing aspects and extend the concept of human healthcare to environmental care.’
Working closely with Growthpoint and Cintocare, and with the guidance of environmental sustainability design consultants from Zutari and the engineering crew, the A3 design team’s achievement is apparent even as the patient or visitor approaches the facility. The 100-bed (expandable to 160 beds), 29 000 m² private hospital is set over seven floors. Below a roof level incorporating interconnected plant room equipment and a roof garden are three clinical and consulting levels set above three parking levels linked directly to Menlyn Maine Central (which augments the hospital’s own 335 parking bays with another 1 300).
A dense mix of live planted and synthetic green walls envelop the parking levels from the ground up, cloaking the hospital in what Milos Petkovic, senior architectural technologist at A3, describes as ‘green lungs’. A striking clear-glass feature, representing the curve in the spinal column at the neck, runs across the sleek tinted unitised performance doubled-glazed facade, which shades the building and enhances insulation.
‘The symbolic visual link to the body and to nature was central to the architectural design,’ says Petkovic, and it continues once you’re inside. The main reception area and all clinical areas face two huge atriums that allow a controlled flow of natural light and regulate heat and cooling. Filled with full-grown trees and lush plantings, the atriums act as the green heart of the hospital, its beat picked up in the natural materials, textures and colours used throughout. ‘Hospitals are usually hostile, sterile buildings but here we aimed to create a building that feels like home in a space where nature is abundant and its healing powers evident,’ says Petkovic.
The landscaping flows from the ground floor through to balcony gardens on Levels 4 and 7, and ultimately to the roof garden, giving most wards and consulting areas a view of nature, despite the site area being surrounded on three sides by a built-up precinct and 96.4% in use. ‘Integrating aesthetically pleasing elements into a space can help building occupants derive a measure of comfort, peace and joy from their surroundings,’ says Hinde.
‘Creating the space in alignment with Green Star standards that uplift the environment was the goal. Achieving this in a hospital is considerably more complex than with any other building type, due to its surgical and sterile requirements. Hospital design is a highly specialised field, and specialist hospitals are likely the most complex building type of all.’
This serene green-rated facility conceals a maze of complex service networks which supply the medical gas, water, chilled water, fresh air, exhaust air, conditioned air, drainage pipework, electrical reticulation and complex data network to all areas of the hospital, but especially to the surgical theatres. These are equipped with high-tech imaging devices, such as fixed hybrid imaging C-arm and X-ray scanners, which enable specialists to perform minimally invasive surgery for faster post-operative recovery.
The technical advances don’t end there. Cintocare is one of the first hospitals in SA to generate its own medical oxygen on demand utilising an in-house plant. The hospital also has a ‘robotic pharmacy’, where mechanical pickers select, pack and track medication and drip sets, dispensing them through a pressure tube system at a speed of 12 metres per second to treatment areas, where nurses distribute them to patients.
The services connecting the clinical spaces and equipment lie within the wall and ceiling voids, which have all been co-ordinated using the latest building information modelling software and virtual reality simulation. The doctors – including maxillofacial surgeons, head and neck, spinal, and ear, nose and throat surgeons, neurosurgeons, plastic and reconstructive surgeons, vascular surgeons, paediatricians and physicians – were consulted from project inception to completion, with design sessions held for every consultant, attending to their specific requirements. Requests ranged from specific wall finishes to custom kitchen layouts, and ironmongery that had to be powder-coated to a specific colour, says Petkovic. Throughout, sustainability was top of mind.
‘Considering the advancements in future healthcare, as Cintocare does, would be fruitless without including sustainability as a key element. Nature in itself represents growth and healing,’ says Hinde. The results are tangible and measurable.
‘Studies have shown that natural light promotes healing for patients and also promotes the general well-being of the people working within the facility,’ says Dr Linda Sigaba, fund manager of Growthpoint Healthcare Property Holdings. Cintocare research found that green design delivers 15% faster recovery rates, a 22% reduction in the need for pain medication, an 11% decrease in secondary infections and an 8% drop in hospital stay.
Green design in a hospital environment is an obvious requirement and the Cintocare development pushes the green envelope in healthcare design to the extent that the Zutari sustainability team spearheaded the creation of a new custom Green Star measurement tool for the GBCSA.
‘The requirements are more specific to the performance assessment of health and medical facilities in terms of sustainability, but also for enhancing the indoor environment quality, creating direct benefits for patients and medical staff,’ says Yovka Raytcheva-Schaap, an associate in Zutari’s buildings unit who specialises in environmentally sustainable design. ‘Examples are the use of environmentally and occupant-friendly fit-out materials for floor and wall covering, and appropriate acoustic design to reduce infiltration of noise from outside and noise generated within the building.’
Using the tool, the GBCSA awarded the hospital the first 5-Star Green Star Custom Healthcare Design rating last year, making it one of the first health facilities in Africa to be recognised for sustainability. ‘Cintocare is leading the way as a modern, high-tech medical facility with sustainability features that are aesthetically and seamlessly integrated,’ says Raytcheva-Schaap.
Lisa Reynolds, GBCSA’ s CEO, says that ‘earning South Africa’s first Custom Healthcare Green Star rating for Cintocare continues Growthpoint’s track record of exceptional green-building leadership and displays Cintocare’s innovation. Together, they’ve created a sustainable healthcare facility designed around the well-being of patients and hospital staff that supports the environment and its communities, changing the future of healthcare properties in South Africa’.
Michiel Gerber, development manager, Growthpoint Properties, adds that ‘this green-certification tool is a road map to drive the development of more green healthcare buildings in South Africa, and it’s available to everyone’.
& ENVIRONMENTAL CONSULTANT