Unhealthy stereotypes
What sensations and associations does any person have with the word "hospital" or "clinic"? Among the sensations, most likely, anxiety and discomfort prevail, one way or another accompanying any visit to these places. And associations do not help the cause at all. Each of our compatriots has a stable idea of what a hospital looks like. Only in rare cases does a pathetic image come to mind like the First Gradskaya Hospital, built in 1802 according to the project of Matvey Kazakov.
In the overwhelming majority of cases, a person born and raised in the post-Soviet space deals with the legacy of modernism in the form of typical panel polyclinics or brutal hospital complexes, such as the cancer center on Kashirka (1979, architects: I. Vinogradsky, V. Orlov, A. Echeistov, E. Bekritsky, V. Antonov), which has been mentioned more than once as one of
the ugliest buildings in Moscow.
The reason is not so much the quality of architecture as its inhuman nature. The typical nature of such an interpretation of healthcare facilities does not in any way contribute to an optimistic attitude of people towards any hospitals. It is not surprising that people in Russia do not like to seek medical help. Studies in 2016 showed that 54.2% of respondents go to the clinic only with a severe form of the disease, and almost 18.4% do not seek professional help at all.
What can and should be the architecture of healthcare facilities in the 21st century? The world has been searching for new forms for more than half a century, in which leading architects take part. An example is Maggie's cancer centers or projects and buildings from the WAF-2018 shortlist in the Health category.
In our country, this issue is still little emphasized and is mainly solved with the help of design techniques. But the situation is beginning to change, and not least thanks to the efforts of Asadov's architectural bureau, which received the Crystal Daedalus for the Center for Pediatric Hematology in 2011, and this year entered the WAF shortlist with the first building of the International Medical Cluster at the Skolkovo IC. in the project of which the authors set themselves the task of changing stereotypes and realizing the idea of a healing architecture, architecture of health.
Special zone - special rules
The Skolkovo innovation center combines several key factors, the main one being proximity to Moscow, which can provide a large client audience and a significant number of potential investors. The next factor is a wide range of economic and legal freedoms of residents of the innovation city. With the financial resources of the Moscow government, a unique combination of its kind will be obtained, the result of which is the project of the International Medical Cluster.
Timur Andrbaev, project director
The International Medical Cluster Foundation (MMK) comments on the concept and history of its creation: “The International Medical Cluster is a unique social project of the Moscow government to attract the best world medical practices and educational technologies to Russia, to exchange experience between Russian and foreign specialists. It became possible to implement the MMK concept thanks to the special legal and economic regime for the functioning of the innovation city, enshrined in the federal law “On the Skolkovo innovation center”. The Moscow government leased part of the innovation city and began implementing the program in accordance with Federal Law No. 160-FZ “On the International Medical Cluster,” adopted in June 2015, according to which the health care legislation of the Russian Federation and any OECD country will simultaneously operate on the territory of MMK. In practice, this means that in all clinics and institutions that are part of the MMK, it is allowed to use medical technologies, drugs and equipment certified in OECD countries without additional registration in Russia, in addition, foreign doctors and medical personnel do not need to obtain work permits. and quotas, as well as to re-confirm the qualifications of medical workers issued in the OECD countries”.
Health city
Within the framework of the MMK program, significant territories were allocated for medical specialization in districts D1 and D4, with a total area of 57 hectares, on which it is planned to build at least 15 hospitals and clinics specializing in oncology, cardiology, orthopedics, traumatology and neurology, and designed to receive up to 300 thousand visitors a year, as well as research and training centers, apartments for patients and doctors.
The general plan of the D1 area had to be adjusted taking into account the requirements for medical facilities and related infrastructure. This work was promptly completed by a project team from Transumed and Asadov's bureau, who received an order to design the first facility of the MMK program - a diagnostic clinic, and, at the same time, an educational and presentation center for the future cluster. The Boston Consulting Group (BCG), which oversaw the development of the MMK program, acted as a consultant for adjusting the general plan.
Focus block
The main attention of the project team was paid to the first stage of the cluster, located at an important urban planning point - not far from checkpoint-3, one of the main entrances to the territory of the Skolkovo IC. A block of three hulls: compact diagnostic, z-shaped in terms of therapeutic and interdisciplinary, with the configuration of an asymmetric catamaran, is located on an almost square area of 2.82 hectares. The first two buildings were connected by a common entrance area with an atrium space, and the third was located at a short distance from them, along the far border of the site.
Initially, the simultaneous construction of the first and second buildings was planned, but the Moscow government allocated funds only for the first, for which a co-investor and operator was selected in 2016 - the famous Jerusalem hospital Hadassah, which invested about $ 40 million in equipping, organizing educational activities and covering operating costs … So the architects had to provide a temporary "plug" in the part of the atrium that was supposed to be connected to the second building.
The first swallow
The pilot facility for the International Medical Cluster needed to be designed and built in record time. Only a well-played team, which became a tandem from the company "Transumed GmbH Medizintechnik" and Asadov's bureau, could cope with the tight time frames and fulfillment of all the requirements of the foreign operator. Irina Aleksandrova, managing director of Transumed GmbH Medizintechnik (Germany), comments on the principles of work and the distribution of functions: “Our company offers customers a full range of services in the design, construction and equipping of modern clinics with medical equipment. Together with Asadov's bureau, we have developed a project
a diagnostic clinic for the MMK Foundation and the medical operator Hadassah (Israel). Transumed was responsible for the general management and coordination of the work of Russian and foreign participants, architectural, engineering technological solutions that meet the standards of the Skolkovo IC, as well as for working documentation and interiors of medical premises, and Andrey Asadov's team was responsible for adjusting the general layout of the cluster, spatial and facade solutions, in addition: interiors of the atrium and the foyer of the conference hall”.
According to the terms of reference, the first diagnostic building had to accommodate five groups of rooms. The first is a multifunctional space at the entrance that combines the reception, a waiting area with a cafe and a winter garden. The second is a "check up" diagnostic center with doctors' offices and a hospital, occupying three floors to the right of the atrium. To the left of the atrium are the office space, as well as a conference area on the third floor with a separate lobby and conference room. Above the diagnostic block, on the fourth floor of the clinic, there is a training and training center with classrooms equipped with everything necessary for training doctors and nurses, including distance learning. The last group - technical and utility rooms are concentrated in the basement and partly on the first floor, where they do not interfere with the distribution system of visitors. Thanks to clear zoning, all blocks were able to be compactly placed, without going beyond the height boundaries of 15 meters (4 floors), set by the design code of the Skolkovo IC.
Health showroom
Despite its compact size and restrained plastic, the first building was supposed to fulfill an important urban planning and presentation function. In addition to the already mentioned location at the entrance and the role of a showcase for the entire future of the Medical Cluster, the architecture of the building should have clearly indicated the signs of a new typology of healthcare facilities. According to Andrey Asadov, “the key task for us, as architects, was to create an image of the hospital of the future, a space that does not oppress or suppress, but heals in itself. It should energetically tune in to an optimistic mood, reduce stress levels caused by fear and pain, and accelerate the healing process. Everything should work for this goal: light, air, color, the presence of the natural environment, lightness, airiness, atmosphere, and so on. Everything that will contribute to the attractiveness of the future center, which means that it will contribute to the preventive health care of its visitors. When developing architectural and interior solutions, we tried to comply with five key principles - innovative appearance, energy efficiency and environmental friendliness of design and engineering solutions, versatility and comfort. And we ourselves did not expect that our efforts would bring such a strong and positive effect."
External cardiogram
The ideas of innovation and energy efficiency are fully implemented in the outer shell of the diagnostic case. The facades are a lightweight stained-glass system with energy-saving glass with high thermal insulation values. Outside, the stained-glass window partially covers the structure of vertical metal lamellas, set at an angle to the facade plane, following its turns and roundings. All lamellas are painted white from the side of the building, and from the outside - in one of two green shades selected taking into account the visual comfort. Thanks to this double-sided painting, when looking at the building from different angles, the effect of a "chameleon" facade appears.
The lamella setting frequency varies, resembling the rhythm of a cardiogram. Most often, the plates are installed on the northern facade, while the southern facade, in the center of which is the main entrance to the clinic, leading to the space of the multi-lumen atrium, is left completely glass to let in as much sunlight as possible.
The height of the lamellas also changes - either breaking the white horizontal interfloor lintels and growing two floors, then making way to accentuate the large window portal opposite the double-height hall in front of the conference room or leave a glass tape along the entrances to the technical rooms. The upper tier of lamellas is made with an increased height, forming a kind of cornice "crown", complemented by an openwork ribbon of thin metal fences, going with a slight indent from the perimeter of the roof. These fences cover the volumetric blocks of engineering systems installed on the roof.
Horizontal belts and vertical white-green lamellas form a volumetric structure that gives dynamism to the laconic volume of the clinic, thanks to the rounded corners, a bit reminiscent of modern high-tech gadgets. Developing the theme, Asadov's bureau, well known for its passion for bold spatial forms, could not resist a spectacular constructive gesture - a five-meter cantilever extension with a rounded corner on the top floor, accentuating the key view of the building from the side of the main road.
Health space
The principles of environmental friendliness, multifunctionality and comfort are applied everywhere in the building, but they are most vividly expressed in the space of the atrium, whose interior filled with air and light serves as a kind of visiting card not only of the International Medical Cluster project, but also of the entire concept of health architecture declared by Asadov's bureau.
The spacious atrium - a kind of covered area - is used as the reception area of the diagnostic clinic, the conference center lobby, the exhibition hall, and also as a universal venue for events. Functional and planning freedom is ensured by load-bearing concrete pylons placed along the perimeter of the hall, which take the load from the translucent cover.
Initially, the architects and designers wanted to cover the atrium with a system of several lanterns or use pneumatic cushions, but the example of Zaryadye Park with its “glass bark” suggested a better solution. The authors contacted the manufacturers of this structure, the Russian company "Bearing Systems", and it turned out that their system is lighter, and in terms of cost it is almost identical to the traditional girder floor. The shell was calculated on a computer using the principles of parametric design and taking into account the regulatory requirements for slopes; in this case, the rise of the shell was only three meters.
Environmental friendliness has been achieved thanks to the active use of natural materials in the decoration, as well as the original landscaping of the atrium space. The architects, together with the Atrium SC specialists and the landscape gardening engineer Igor Safiullin, interpreted it as an intermediate zone between the external and internal space. The improvement elements were continued inside the atrium, being separated only by stained glass. The trees planted next to the building echo the huge tubed trees installed inside the building. As a floor covering, large-sized slabs of porcelain stoneware imitating natural stone and wood are used.
Development of typology
In September, the clinic opened and began operating as a diagnostic and training center. In parallel, the design of the second stage was launched and the procedure for selecting an operator for the third building is being completed. In either case, other teams with experience of cooperation with specific Western clinics will be involved in the development of projects; however, all subsequent decisions will one way or another proceed from the already set standard - a new standard for medical facilities, with a completely different atmosphere in terms of perception, architecture that meets modern trends, as well as new principles of working with visitors.
