The Centre for Brain Health at the University
of British Columbia in Vancouver.
In the field of medicine, caring and curing are different disciplines: the former involves clinicians focused on patient needs; the latter involves researchers dedicated to conquering a disease. As modern medicine has evolved, these branches of health care have grown in parallel directions with less and less overlap. But in the past decade, medical professionals have begun seeking a new breed of medicine that blends the art of caring with the science of curing. This blended typology is commonly referred to as translational medicine, in which healing and learning are meant to intertwine, the insights of one discipline informing the other.
How can architects who specialize in either health care or education graft these separate building typologies? To blend the realm of exam tables with the domain of lab benches requires translational thinking—that is, health care and educational facility design with enough transparency to discover where the two parts can come together in support of a new whole. Successful translational medicine design requires a thought process that sees not the differences but the common features of environments that lead to healing, learning, and discovery.
Delivering effective translational medicine design begins with an understanding of the original purposes for which the philosophy was developed. Several industry leaders trace the ideals to the sophistication of cancer centers: over the past decade, these institutions discovered that if they could not cure everyone, the least they could do was care for the individual with a terminal illness. To this end, cancer centers developed a multifaceted focus on providing patient care while continuing to advance progressive insights on treatment and life-saving cures.
In parallel with cancer centers’ progress, government agencies that provide research funds, such as the National Institutes of Health, discovered the value of blending caring with curing. Incentives were introduced to motivate the industry to consider alternative research approaches by mandating interdisciplinary strategies. These interdisciplinary research operations were quickly followed by building designs that mirrored the blended aspects of caring and curing, allowing clinician and scientist to see each other on a daily basis with the possibility that interaction might stimulate a conversation leading to an otherwise unrealized discovery. Architecturally, transparency became a key design element of discovery in translational medicine, and architects pursuing this new building typology began seeking ways to create visual and physical opportunities for collaboration.
Another influence is likely the general university campus dynamic, because many of these translational medicine facilities stem from the education field rather than hospital territory. In the collegiate setting, multidisciplinary department buildings are becoming standard fixtures in the collegiate setting. Few institutions erect single-discipline biology department buildings anymore. Administrators now invest in “life science” buildings designed to intermingle students and faculty among disciplines, allowing the exchange and creation of new ideas and philosophies.
Translational medicine has become a veritable industry buzz word in facility design. But although its varying influences spring from different philosophies, a successful facility can only be achieved with a clear vision of and insight into what really sets the stage for “translating” between disciplines. A limited exploration of the blended research and clinical facility model yields an abundance of hurdles for success, most of which stem from the vastly different mentalities involved in designing space for two disparate uses.
Gathering the enthusiasm to execute translational
medicine–based design is helpful, the ability to
deliver this environment harmoniously is nothing
short of an art.
Architects associated with research buildings are typically accustomed to designing for a large-scale population that allows any and all researchers to function, whereas architects of clinical buildings develop designs to meet the specific needs of a clinic specialty while allowing any and all practitioners to function in the future. Both achieve flexibility, but both are arrived at through a different thought process. Translational medicine design requires thinking simultaneously about the differences and the commonalities, and discovering the blend that will benefit both.
From the perspective of health care administrators and/or chief research scientists seeking to share spaces, the facility agendas often conflict as well. Stand-alone hospitals and research facilities typically have precise structural grids and mechanical systems that not only differ from each other, but also can conflict, and the diverse building codes associated with each of these building types—when erected separately—will create innate design conflicts for combined facilities.
The operational differences begin with vastly different hours of operation and carry over into the overall arrangement of public versus private zones. Research facilities may feature a discrete rear entrance for autopsy samples, whereas clinical environments usually encourage use of open space and a sense of entrance/arrival for visitors, as well as interaction between clinicians and patients. The greatest difference may be in the ambience of these two environments: the varying needs of distracted patients and families versus those of casual and carefree research assistants present a challenge made even greater when the aim is transparency.
Gathering the enthusiasm to execute translational medicine–based design is helpful, and recognizing the differences in building types is essential, but the ability to deliver this environment harmoniously is nothing short of an art. Designers must embrace a series of absolutes in order to address the physical and intangible needs of these facilities. Two critical strategies are:
- Bring the parties together. By definition, translational in its purest form means “bringing all parties together,” which design practitioners quickly recognize requires a blended discussion among parties that seldom share the same conference table. Architectural consultants with research and clinical specialties need first to orient each other on their discovery processes, then conduct interviews with clinicians and researchers together, allowing each to understand and meld the different design needs.
- Push the envelope. Before the parties can come together, the architects need to understand the building’s essential elements. Building designers should initiate discussion about corridors and pathways to address conspicuous conflicts before trapping themselves in a box. The building designer must be involved from the outset to shape the space to fit the users’ needs and to consider where design elements—from solids and voids to material selection and access to natural light—help or hinder collaboration.
Use of natural light throughout the clinic not
only provides a sense of healing, but also
offers an environment conducive to optimism
The design of environments for the treatment and cure of chronic neurological disorders is among the greatest challenges in translational medicine. The Centre for Brain Health at the University of British Columbia in Vancouver, designed by Anshen + Allen, a part of the architecture and engineering design firm Stantec, serves as an example of how translational medicine—as a design driver—can provide unprecedented benefits for health care administrators, the patients they aid, and the researchers they employ.
This facility features critical components that every true translational medicine–based facility should embrace in order to deliver the ideal setting for users. Designers can create new sources of hope for patients—a true balance of science and art—by directly and positively employing resources to address the following elements:
- Lab organization. Primary laboratories should be arrayed in an open plan and positioned along the public edge to effectively put translational research on display and maximize viewing into and out of the laboratories.
- Lab accessibility. To better support translational medicine and its emphasis on transparency, it is essential to ensure that wet and dry labs are visible, though each needs to be secured differently. Wet laboratories should be secured spaces, whereas research areas might be a blend of secured and unsecured spaces with limited public access.
- Clinic organization. When clinics and labs are in the same building, a geometry should be created that allows the clinic to be free of the lab grid. Clinic staff support spaces ideally should align with lab spaces to allow true transitional collaboration.
- Clinic accessibility. Whereas oncology was the most common patient service offered in early translational medicine–based facilities, neurological translational research clinics are increasingly prevalent. Design of these facilities has three unique therapeutic goals: a single point of entry and exit, which eases the mental stress of wayfinding, especially for patients who may have limited focus; short corridors with simple decision points, which also eases mental stress but, more important, acknowledges patients who have difficulty walking any distance; and opportunities for starting and stopping along wide, sunlit corridors, which allow tired patients to rest and overstimulated patients to take a break.
The interior design of the research clinic should reflect the intended ambience—a calm clinic core balanced with an engaging staff work area. From a design perspective, the staff area in the clinic should be treated differently than the patient area. Historically, clinic staff areas have been surplus space, developed from unappealing, poorly lit environments. Use of natural light throughout the clinic not only provides a sense of healing, but also offers an environment conducive to optimism and hope—factors that motivate patients to participate in research initiatives.
In translational medicine, building design strategy can sometimes draw its inspiration from nature. Much like a botanist trying to graft a branch from one tree to another, architects seeking appropriate translational partners need to find the right “mates.” Blending design philosophies for research and clinical space presents challenges, but with those obstacles comes the opportunity to improve the lives of practitioners and their patients—to effectively blend the art of caring with the science of curing.