Innovations in prof. Stanko Kristl health space designs, their humanity, and today's relevance
Research stage: initial doctoral stage
Category: Extended abstract
Despite their rapid development in the 20th century, the architectural profession often overlooked hospitals. They are ignored partly because of their complexity and the unpleasant unease that the feeling of a hospital gives us. We do not want to be admitted to them until we are ill, but we also want to be near them.
The development of the so-called Modern Hospital as we know it today was the result of international cooperation. The pressure on hospitals was further accelerated by high immigration to the cities and knowledge learned in the First World War. During this time in the profession, various congresses and groups emerged. Most know is CIAM. Architects of medical buildings formed the IHA (International Hospital Association) (Willis, Goad and Logan, 2019). The rapid development of social infrastructure accelerated dramatically after World War II. This included health infrastructure, which was included in Europe's post-war recovery programme. Technological developments led to new hospital designs even more rapidly to meet the needs of the military and experts in medicine.
As one of the federally organised Yugoslavia republics, Slovenia was one step behind international development until the 1970s. The decision to build a modern specialised hospital in Yugoslavia was crucial for our region. Prof. Edvard Ravnikar invited Prof. Stanko Kristl to work on the hospital project.
Germany was an important example for Slovenia at that time. In addition, Denmark and Sweden. Several meetings and congresses on hospital construction (IHF, WHO, DKI) were held in Europe and beyond, where Prof. Kristl gained good international connections and state-of-the-art knowledge for hospital design.
I will focus on some of the approaches to designing healthcare buildings. These approaches add architectural value to make a healthcare building humane and pleasant for users. The methods are closely linked to the analysis of the buildings designed by Prof. Stanko Kristl.
Adaptability-based approaches to design
Buildings intended for medical treatment are subject to constant change and adaptation, mainly due to the continuous advances in treatment modalities.
Hospital-related studies and projects deal with various topics and approaches, usually presenting solutions in response to problems of staff functioning or patients admitted for treatment or care.
A review of the development of such buildings over the last hundred years shows that hospital projects have primarily addressed issues of functionality, i.e. the spatial and technological organisation and the technological requirements for the functioning of the programme within them (Schirmer and Meuser, 2006).
The complexity of the modern hospital has required specialised knowledge. After whom the Friesen concept is named, Gordon Arthur Friesen was one of the first hospital technologists. He emphasised the adaptability of the facility to the programme and the integration of all support services and distribution (Nevit, 1968).
Approaches to planning based on co-therapeutic effects
Treatment facilities, which include hospital buildings, health centres, nursing homes and post-operational care, should be designed as spaces for psychological and emotional recovery in addition to the primary function of treatment. Their co-therapeutic effect has been demonstrated many times in other studies (Ulrich, 1984; Marcus and Barnes, 1999).
Despite rapid technological advances, hospitals have remained relatively detached from the external space and the proven co-therapeutic effects on patient treatment. While many other typologies have implemented this knowledge, the examples in hospitals are rare. It is essential to recall the example of the sanatorium for lung patients in Paimio by the architect Alvaro Aalto and the unrealised project of the Venice Hospital by the architect Le Corbusier.
Even though Mies van der Rohe did not build any hospitals, it is essential in this context to draw attention to an article in the journal Modern Hospital, where he points out the importance of south and east orientation of ward and points out a misunderstanding of economic rationalisations in hospital design (Whitcomb, 1945).
Approaches to planning based on work organisation
Due to the primary function of healthcare buildings and hospitals, several rules are usually applied to the organisational design concept. All of these rules are directly connected to hygiene. At the end of the 19th century, the situation in urban hospitals was catastrophic. The findings of Florence Nightingale, a nurse, that many more people died in hospitals than in-home care because of hygiene were shocking (Monteiro, 1985). Innovations in the spatial organisation followed the developments and findings of the profession. The separation of unclean and clean routes, the grouping of related programmes and the optimisation of staff routes influenced the spatial design of facilities. The military and field experience (triage, priority treatment, safety control) was also enormously influential.
Comparison and projects by Prof. Stanko Kristl
When Prof. Dr Lavrič entrusted the task of designing the new Ljubljana Hospital to Prof. Edvard Ravnikar, he invited his assistant, Stanko Kristl, to participate. They approached the task pragmatically, research-oriented, due to their lack of experience. The agreement to dedicate more time to research was crucial. Thanks to good political connections (Prof. Dr Lavrič was a personal physician and friend of president Tito), the group had the opportunity to follow world developments and new professional links. They learned and tried to design a hospital such as Yugoslavia had not yet known.
Prof. Stanko Kristl and his team received the first award soon after research started. They received the prize for the design of the ward at the IHF Congress of the World Health Organization (WHO) in Paris in 1963. The bed tower was designed with the shortest staff routes, while all rooms have good quality natural light and sufficient privacy despite the multi-bed rooms. This is just one of the proofs of the intensity of the team's work and their follow-up of the world profession.
Parallels to the University Medical Centre project in Ljubljana can be identified in the patterns of hospital development at the time. Prof. Kristl designed this hospital, and later others, according to principles and principles similar to those that prevailed in the 1970s. Nevertheless, through the evolution of the project and the technical complexity of the building, he was able to incorporate critical ideas that were new for the time.
After discussions with Prof. Kristl, I have concluded that the lack of knowledge at the start of the work was an advantage, enabling them to contact foreign experts directly. Very important was also close contact with the medical staff in the clinics. The dialogue between the architects and the medical staff allowed for ongoing adaptation of the designs and, at the same time, encouraged the medical staff to consider changes in their working process.
Prof. Kristl notes that most approaches to hospital design are strictly utilitarian and technical. I found two critical methods of his empathetic understanding of human need and psychology about buildings designed for healing which were essential for the projects in Ljubljana and Izola health buildings and plans for Mostar, Dubrovnik, Novi Sad, Samobor and Kuwait.
The first principle is the blurring of the hospital boundary. This is reflected in the design of the spaces inside the building and before entering it. In this way, the entrance space of a hospital becomes similar to the entrance to any other public building. The building is also lower towards the entrance, and the facade has pleasant warm colours. He treats the lobby as an extension of the square, and he put many carefully selected public programmes that would otherwise be found on the ground floors of buildings in the city centre.
Furthermore, the waiting areas are designed with elements and materials that encourage a feeling of warmth, intimacy and distraction for the patient when thinking about his illness. Staff workstations and offices are increasingly hidden but still well lit with distant views, most often outside. The particular choice of colours calms the users and, at the same time, provides an orientation in the building.
The second principle is his tendency towards optimisation. He designed the emergency room as a common ward for all medical disciplines, where the patient is brought in straight from the "street". Despite the two dominant principles of operating ward design at the time, he "reworked" the way the anaesthesiology disciplines worked, bringing them into dedicated rooms next to the operational theatre. This solution reduced the need for staff and the simultaneous performance of anaesthetic preparation and surgery. Mentioned before, he designed a bed ward, which was already recognised in congress in 1963.
Despite the complexity of the design of this type of building, I recognise the extreme relevance of the designs developed by architect Stanko Kristl. Despite the trend towards densification and the construction of compact healthcare complexes, already in the 1960s and later, Prof. Kristl introduced several principles on how these buildings, despite their complexity, can be very humane and adapted to the function they have to fulfil.
Today, the elements of Kristl's design are only very superficially known, especially in the design of healthcare buildings.
Today we are designing and building differently. We need to ask ourselves again what today's hospital buildings have to meet and offer. Do the health buildings we are building today meet the future needs for which they are built?
Figure 1: Stanko Kristl, 1972, Innovative design of the hospital floor plan, technical hand drawing
Figure 2: Stanko Kristl, 1974, Entrance hall UKC Ljubljana, technical hand drawing
Figure 3: Janez Kališnik, 1976, Department of Internal Medicine First Aid UKC Ljubljana, Slovenia
Kristl, Stanislav Jožef (1922), Borsetova ulica 19, 1000 Ljubljana, november, december, januar 2022
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