Development by Studio Altieri in Italy, Europe
e-architect
Architecture News
World Buildings
New Surgery Centre
City of Verona Borgo Trento Maggiore Hospital, Veneto, Italy
Studio Altieri
1. The hospital in the territory
2. The concept
3. The hospital
4.1 Building typology
4.2 The floors
5. Green areas
6. Construction
7. Art in the hospital
1.The hospital in the territory
The original nucleus of the Borgo Trento Hospital Complex, in Verona, was the Alessandri Children’s Hospital, which was inaugurated in 1914 and comprised a single line of buildings looking onto the current Via Mameli.
In 1942 the buildings comprising the expanded hospital system were inaugurated, being situated in the area to the south-west of the Alessandri hospital.
The general layout of the expansion was characterised by the administrative pavilion positioned in Viale Stefani and by two adjacent avenues defining the central area.
The new surgery pavilions faced onto this area, as did the back of the Alessandri pavilion, so that the latter then became the main frontage.
The central area contained smaller buildings.
In recent years the existing buildings have been extended and other blocks have been built in attempts to respond, above all, to the enormous and continuously growing needs of diagnostic and treatment services.
Lastly, the location of the new staff car park, also made necessary by pressing demands for parking space, has further decreased the green areas and increased the fragmentary nature and disaggregation of the entire system.
The hospital area does indeed suffer from disruption by the simultaneous presence and overlapping of different flows from the outside, and to and from the various buildings in the complex. This is because the pavilions are linked by underground passages that cater only for “soiled” traffic and technical services connections, so that the only possible means of transporting emergencies and patients in general is by ambulance.
This flow of patients utilises the internal ground level road system which, at the same time, also carries the traffic of visitors and outpatients using the various structures.
It is therefore clear that this type of hospital with its pavilions and the construction characteristics of the older buildings create problems and heavy costs in terms of management and organisation.
Although the system of green areas in the Maggiore City Hospital has been modified by the transformations and enlargements of the original hospital buildings, the areas have managed to keep their unifying nature, preserving the recognisable identity of the site itself.
The distinctiveness of the whole site is the result of the close relationship between the hospital system, characterised by buildings differing in formal-distributional type, and the system of green areas based on a unified vision of the park.
The presence of substantial numbers of evergreen trees of considerable size in the whole area, such as Cedrus deodara, Cedrus atlantica and Pinus pinaster, constitute the framework of the site landscape and the predominant characterising trait.
2.The concept
The project to reorganise the hospital area must unite the objective functional and medical needs with the need to consider this area as part of the city, for which there are precise compositional regulations.
It is, therefore, not enough to solve the problems of a particular type or types of hospital building by realising constructions that satisfy medical requirements; there is also the desire to create a high quality urban area in which, like the existing buildings, the new constructions are fundamental components.
Essential prerequisites for achieving this desire are the collation, development and protection of the overall type of hospital settlement with its pavilions. That is not so say that each individual building should be saved, but the urban settlement as a whole with its particular characteristics should be preserved, even though recent interventions have distorted its original nature.
Earlier remarks referred to the strong sense of involvement in daily life that characterises the Borgo Trento area, and likewise to the absolutely exceptional morphology, building styles and environmental features of the site.
The site’s position within the urban network of Verona, its privileged relationship with the River Adige, the existing, still-recognisable building layout and the system of green areas, together with resolution of all the functional problems, must all become the core and pivotal values of the project.
It should also be noted that the functional requirements, as indicated in the notice of competition, express a need for significant volumes of new buildings that, if built using the methods used for recent extensions, would imply covering the entire remaining hospital area with buildings or, alternatively, using constructions that would be so high as to be out of scale with the original system and would hence completely undermine the original concept of the layout.
Other kinds of intervention, such as choosing to work in other areas, without taking account of the pavilion system, would lead to evident impoverishment of the overall complex: if no attempt is made to recover a system that as a whole is functioning and has its own identity, this kind of intervention would yet again continue the practice of resorting to sporadic, ad hoc solutions.
It is to prevent the danger of this occurring that the project must be approached as a solution for the entire hospital area, providing indications for the final layout of the whole system.
Only an overall vision will allow this approach to overcome the habit of tackling problems on a short- or medium-term basis. This method no longer proves to be viable because the result of a short-term intervention of limited vision would exact too high a price for the existing pavilion building system to bear.
We therefore wish to stress that the cornerstone of the project should be protection of the existing pavilion system, by reinforcing its axial layout and by inserting the buildings in green surroundings that further enhance the quality of the outdoor space that is typical of this kind of settlement.
A later intervention will aim to improve the functional-formal aspects of the historic entrance building and the square in front, making it the main, representative entrance for the complex.
A final constraint on the project should be fundamental care in recovering the system of green areas; this should be given equal importance to that of the building system, also because this was how it was originally conceived.
3. The Hospital
The architecture for the new Borgo Trento hospital is not a reconstruction, but an invention and a fundamental action: it is the creation of a new community site. The monuments and the historic city are often perceived as containers of events in which everything must be preserved, without further discussion, as evidence of the times, but these parts can be living, continuously evolving pieces for the city of the future.
This project aims, therefore, at expansion and completion, inventing a space in the light of the interrogatives posed by the area and forming a relationship with the existing city.
The proposal is not for a single, plain building, but for a series of typifying elements (the central building, the park, the portico, the piazza), recomposed around an idea relating to the historical fabric and monuments of the city and attempting to configure, in its fragmentary nature, a form of the city on this site.
The new hospital is, therefore, a project of the city and for the city: it is an attempt to transform a great hospital structure, which at the same time is a part of Verona, through human and architectural dialogue.
The concept is of an “open hospital”: this does not just mean a transparent, readable structure, but also a hospital-city, that is to say a complex, multi-functional system comprising areas with different degrees of protection and accessibility and all, in any case, of great environmental value.
Symbolising this concept is the new park, which is not just a hospital garden but a place open to the city that will defuse the fear aroused by illness and isolation.
The architecture should aid and qualify states of mind: perception of the hospital as a place providing a warm reception, hope and care, and for fighting pain and suffering.
Privacy, comfort, a friendly reception, direction-finding, ergonomics are just some of the fundamental concepts of this project and the cornerstones of a design philosophy, the goal of which is Humanisation.
The hospital in this project will not seem an incomprehensible machine.
Its park and its nearness to the heart of Verona make it, first and foremost, a part of the city.
It is transparent because it allows one to see its component parts: the various historic and modern buildings in a continuing dialogue with the park and the diagnostic areas illuminated by the lowered courtyards that “carve through” them.
It is friendly and on a human scale, because the first impression is that of a grand hotel, with its large entrance and lobby, letting in plenty of light and characterised by elements, such as the arcade and shops, that are not usually associated with a hospital and soften the specialist atmosphere to create a more familiar environment.
It is a place of hope and devotion to life, symbolised by the large glass windows in the wards, which help the patient maintain a link with the outside world and the passing day with its changing light and natural colours.
The project is state-of-the-art as regards the provision for space and technology, and most of all as regards flexible design so as to keep up with the fast pace of continually changing systems of treatment and care.
To conclude, the proposed concept for the new Borgo Trento hospital is that of a place centred on the patient and on the city of which he/she is part, built to be as efficient as possible but caring for the person, whether a patient or, equally, a member of staff, for whom the quality of working conditions is of fundamental importance.
4.1 Building typology
The project plans for the realisation of a building intended for those functions having an initial impact on the public, such as information and outpatient clinics, with volumes similar to the original buildings and located on the site of the current supplies dept. pavilion. It will be placed so as to define and terminate a typical courtyard system defined by the entrance pavilion and by the medicine pavilion on one side, with cardiac surgery on the other.
Behind this building, and directly linked with it, is a second, larger building set around a large central courtyard.
The open space, taking its definition from the initial courtyard system and delimited by the existing tree-lined avenues, will assume the characteristics of an urban park, a public space and an element of reference for the entire hospital complex, hiding the medical functions that will be located beneath it.
In actual fact, the need for significant volumes allocated to diagnostics and treatment and, likewise, to the corresponding technological services, has been satisfied by creating a floor at about five metres below the current ground level and corresponding to the level of the Lungadige Attiraglio road.
Siting these volumes at the current zero level would have completely undermined any attempt to re-establish the pavilion system.
The accident and emergency entrance is situated along the Lungadige road and becomes the starting point for the whole functional system destined for diagnostics and treatment services, located in a large dedicated block on a single floor.
Siting the more specialised areas on the new floor, below the actual level of reference for the hospital area, and putting the accident and emergency entrance along the Lungadige Attiraglio road makes it possible to completely free the system of emergency traffic.
This layout is completed by creating two underground pathway systems on two completely separate levels, one for taking patients and clean materials between the new surgery complex and the various existing pavilions, and the other for technical services links and for taking soiled material to the existing underground passages and, via these, to and from all the existing buildings.
The project presents a further proposal to solve the parking problems in the area once and for all, by creating a new staff car park on the Via Mameli side.
The project approach as described above can be implemented in independent, operational phases and in our opinion provides a solution for the functional requirements and core project values as analysed in the previous sections.
The hospital area will take on a new overall quality: not only the realisation of new buildings, but also the creation of important open spaces, the importance of the tree-lined avenues and the clearly defined flows and pathways will contribute to the formation of an “urban” system that is able to hold its own with the rest of the city.
The large central park will become the nucleus of the entire system: a moderating element between the architectures looking onto it, and a socialising, relaxing element for the people who pass through it.
Finally freed of emergency traffic, Piazzale Stefani will return to its role as the interface between Borgo Trento and the hospital area.
4.2 The floors
Floor zero: the services block
Floor zero is the operating heart of the new Surgery Centre. This floor is 50 cm above Via Lungadige, so that it is completely secured against any danger flooding by the River Adige.
This large block is completely dedicated to the most specialised diagnostic and treatment services and is divided into five sub-blocks corresponding to accident and emergency, operating unit, diagnostic imaging, blood transfusion and sampling centre, and test laboratories.
Accident and emergency
This is situated on Via Lungadige and is linked by a lift to the emergency heliport on the roof. It is organised in two areas according to the severity of the particular emergency: a surgery area (with shock room, rooms for minor operations and diagnostic imaging) and a medicine area with examination cubicles and a reception/observation ward.
The accident and emergency department is designed and equipped for quick adaption to cope with catastrophic events and large influxes of patients.
Operating unit
This is situated next door to Accident and Emergency and has a vertical link with floors of the Surgery Centre, which contains intensive care, the day hospital and normal wards.
The 32 operating rooms are grouped into four blocks, with one block of six rooms dedicated to day surgery.
Some rooms can be equipped for operations using robots.
Diagnostic imaging
Diagnostic imaging is positioned to the right of the operating unit and occupies the first portion below the park. It is divided into two halves according the type of use: for inpatients on the left and for outpatients on the right. The latter half can be reached from the entrance overhang via two escalators and a lift. Diagnostics for outpatients cater for traditional X-rays, CAT and NMR scans, ultrasound investigations.
Inpatient diagnostics comprise traditional X-rays, ultrasound scans, angiography, CAT and NMR scans, haemodynamics, IMRT and stereotaxis.
Blood sampling and transfusion centre
This is linked with radiology for outpatients, and shares the same entrance. It contains the blood sampling and transfusion centres.
These two centres have their own reception areas and individual cubicles for taking blood and dedicated services.
Test laboratories.
The last part of the block is occupied by the testing laboratories dedicated to clinical chemistry and haematology, microbiology and virology, and the skin and bone banks.
The laboratories have been designed in modular form so that they are highly flexible, with technical equipment rooms situated at regular intervals and movable partitions.
Floor zero is linked to the existing buildings via underground passages and lifts to other levels. This means that transport of patients and goods is invisible from the outside.
All working and waiting areas have natural light coming from the courtyards in the park.
The entrance hall
The entrance hall of the new Surgery Centre is the centre of the project: it is the arrival point of the sequence of spaces that, starting from the entry point, leads to the inside of the hospital.
The entrance hall for the public is divided into two parts.
The first part has the entry on a level with the park.
Designed as a large gallery, it has the information desk and the entrances to the outpatient clinics.
At the same level, but on the opposite side of the entry point, there is the entrance to the services block via two escalators and a glass elevator.
These lead to radiology services, the blood sampling and transfusion centre for outpatients who, in this way, do not have to enter the actual body of the hospital.
The second part comprises the vast hall in the inpatient block. This is reached via a staircase and two glass elevators.
This part of the project is a great innovation with respect to traditional hospitals: a vast square space, two floors high, the result of designing the building with a courtyard, and lit by five, 8 m square skylights.
This constitutes the first hospital-patient interface and must, therefore, provide reassurance and guidance.
It has been designed to resemble the lobby of a grand hotel with additional spaces for the public, such as small shops, a bank, the appointments booking centre, a bar and self-service restaurant, and a small nursery.
The ceilings, mostly in glass, and the windows towards the gardens continue the link with the outside, bringing in changing light and shade as the day passes.
Taking care to provide natural light is a help in preventing people who pass through this area from feeling part of a completely artificial “machine”.
The extensive, transparent space also helps visitors to find their way around the hospital by keeping this “piazza” as the ideal point of reference.
At the four corners of the hall, where there are information points with terminals, there are lifts and stairs to take visitors to the four upper floors, where one is for intensive care and day hospital and the others are for normal admissions.
It is also possible to reach Accident and Emergency directly from the hall via a staircase and lift, and an outdoor staircase leads to the park to be created in the future, on the roof of the current staff car park.
Great care has been taken in designing this area: the predominant materials are marble for the floors and wood for the fittings of the shops looking onto it. Colours and light are warm and friendly.
Tables and waiting areas are scattered around the hall, the central well also being enhanced by pot plants.
The outer ring of the entrance floor is occupied by doctors’ offices and all the operational units of the surgery complex, which are grouped together in a single area in order to encourage positive relations between departmental-type and inter-disciplinary operational units.
The inpatient floors
The three floors comprising the wards are characterised by large glass picture windows, 3.2 metres wide and 2.90 metres high, at intervals following the (four metre) structural module.
These windows are fundamental to the project and initiate a new way of designing the patient’s room.
Often, even in the latest hospital buildings, the wards are lit by traditional windows that reduce the space to a kind of tiny prison cell.
The patient passes most of the time lying in bed with no perception of the outdoor world because vision is blocked the wall and window ledge on the horizon.
Modern trends are increasingly moving towards “humanisation” of the “hospital machine”.
This goal can be achieved via two routes: the common areas project comprising the hall and waiting areas, which are an introduction to the building and resemble a “hotel” type of environment in the use of materials, finishes, lighting and colours; and then, most importantly, the wards project, which has a profound effect on the patient’s stay in the care and treatment structure.
The picture windows maintain a link with the outside world and the changing light and natural colours help the patient to feel a little less part of a machine that often operates in mysterious, seemingly hostile ways.
The glass windows are, of course, designed so as to prevent problems of intense sunlight and heat dispersion.
Thermal break aluminium frames are used with glass providing high levels of sound and heat insulation.
On the outside there is a kind of overhanging balcony that, with the aid of three inclined brise soleils in aluminium, creates a shadow effect that almost completely eliminates direct sunlight.
Further protection, to ensure a darkened room when necessary, is provided by an external Venetian blind on metal guides, which can be adjusted electrically from the inside.
Rooms are divided into three parts:
- the vestibule : the door space, set back from the corridor, and the bathroom which, with the corner bevelled at 45° makes it easier for care personnel and doctors to see inside the room from the corridor.
- the bed space: fitted with highly specialised equipment and materials
- the sitting area: the space near the window where the ceiling is lower but, above all, the materials suggest a more friendly, family atmosphere.
This is where the patient can eat, read or just sit and enjoy the extraordinary view from the large window.
5. Green areas
Outdoor layout
The system of green areas at the Maggiore City Hospital has undergone changes as the original hospital buildings have been transformed and enlarged, but it has managed to preserve its character as a force that unifies the site and defines its identity.
The distinctiveness of the site comes from the close relationship between the hospital system, with its buildings differentiated by formal-distributional type, and the system of green areas that was originally designed to provide a unifying vision as a park.
The new surgery complex presents an opportunity to improve the whole Maggiore Hospital park, reorganising the various spaces according to their various functions (definition of ambit types) and, as a result, re-designing the layout of green areas for each ambit.
During the first phase of the works, the central park, the linear gardens and the green areas for the new Surgery Centre will be created, while the “romantic garden” and improvement of the inner courtyards and urban boundary areas will be postponed to a second phase.
The central park constitutes the new focal point of the Maggiore Hospital, creating a direct dialogue with the main entrance looking onto Piazzale Stefani.
It is the largest green area and comprises a number of elements, each with its own individual character: the wisteria pergola, the roof garden, the basement gardens, and the water ponds at the entrance.
Water is the element providing the first approach to the hospital structure: the ponds become the new hospital entrance.
This provides a softened entrance to the hospital structure, with the running water creating a sense of serenity. The pond is crossed by a stone path, at the entrance to the park and leading directly to the entrance of the Surgery Centre.
The pergola acts as a frame to the central park and forms a pedestrian link between the main entrance and the new Surgery Centre. It will comprise a wisteria-covered colonnade above a path in Lessinia stone.
The roof garden is passage area to other parts of the hospital, but most of all it is conceived as place for relaxation, with a play area for children and a refreshment area.
The seats in the garden are reached by crazy paving paths in Lessinia stone.
From the roof garden there are views of the areas below, where there are basement gardens for the departments on that level.
The roof of the entrance to the new Surgery Centre will also be a green area covered by numerous varieties of fern.
The linear gardens are green bands at the edges of the long avenues along the sides, starting from the Piazzale Stefani entrance and leading to the departments at the far end of the hospital complex.
The project plans to widen the two bands of green, in order to enhance the effect of the existing trees by planting more trees and bushes and to complement efforts to soften the effect of the new surgery complex.
6. Construction
The works are planned to take place in 3 phases:
Phase 0 - preparatory works -
Preparation of the construction site area requires two important interventions.
• Formation of an “integrated main technical services unit” to be realised in the area presently occupied by just the electricity substation: this will contain a new central heating plant and the refrigeration plant, the co-generation system, the oxygen store, general control room and workshops. These works will marginally affect the existing technical services networks, and allow them to remain in service until the new structure is completed.
• Upgrade of the technical services distribution network, mainly using the existing system of underground passages.
Upon completion of these preparatory activities, the construction site area is to be handed over, free of all restrictions, while healthcare activities are able to continue with no significant interference.
Lastly, access to the construction site is to be located on the Lungadige Attiraglio road, which is able to tolerate the heavy vehicle traffic required by such an important construction project.
Phase I -construction of the surgery centre -
The first phase will comprise construction of the surgery complex, of the outpatient clinic building and of the first part of the services block (radiology and laboratories).
Phase II
On completion of phase I and after inauguration of the operating rooms, intensive care services, accident and emergency dept. and radiology, completion of the services area can begin.
Phase II also includes a series of works to renovate and extend the existing historic buildings left empty after transfer of all current surgery activity, in order to unify all medical specialisations.
A new visitor’s car park will be built for integration with the Piazzale Stefani system, and the current underground staff car park will be enlarged.
Lastly, the technical and hospital supplies services will be completed (kitchens, canteen, laundry, sterilisation centre, waste disposal area, workshops,….).
7. Art in the hospital
Using the various means of expression at its disposal, art has always enriched and nurtured a culture that is sensitive to aspects that are able to interact creatively and positively with spaces destined for treatment and care and that tries to transform them for use as therapeutic tools and opportunities as well as for improving the working environment.
The principal goal is to abolish the anonymity of the common areas in the hospital and in this way contribute to the process of humanising the environment (one of the requirements of the ten guiding principles for designing hospital structures).
A further objective is to alleviate the monotonous colours and emotions typifying the hospital environment, making it possible for patients and their relatives to face even difficult moments with greater tranquillity.
Inserting evidence of artistic work in the hospital can help people to relate to themselves and to their illness, thus contributing to creation of a psychological space that is more inclined towards the reconstruction of a shattered equilibrium.
What is more, temporary exhibitions are a continuing opportunity to inform users and patients and involve them in an ongoing, stimulating educational process.
Ultimately, the purpose is to fight feelings of alienation and isolation by using contact with artistic objects to stimulate a sense of regeneration. If it is possible to see something (an image, a line, a journey into a colour) that draws the mind into an imaginary world, this can recreate that vital symbiosis between mind and body that is behind every successful therapy.
The project has taken account of the need to find a new way of seeing this world, a way that is softer, more transparent, less aggressive, with more open spaces, with more silence for listening out for a dialogue between ethics and aesthetics, taking the starting point as a new vision of the sick person, of times and spaces for the hospital stay, where there has been constant attention to the interaction between the environment, the well-being of the patients and the working conditions of all the staff.
Verona Borgo Trento Maggiore Hospital New Surgery Centre images / information from Studio Altieri 240209
Another Italian hospital by Studio Altieri:
New Mestre Hospital : World Architecture Festival Awards 2008
Health Category Finalist
Italian Architect
Verona Borgo Trento Maggiore Hospital - Building Information:
Appointed designers:
Studio Altieri S.p.A. (capogruppo mandataria)
Studio Von Gerkan, marg und partner
Land S.r.l.
Tifs Ingegneria fellin-siper
S.t.e.p. Studio tecnico professionisti associati
Professional role of Studio Altieri:
Project Coordination, Concept Design, Detailed project design building and structural works, Construction project building and structural works, Direction works
Surface area: 96,296sqm
Beds: 513
Value: € 203.295.913 € 19.334.820 for preparative works
Project progress: Design (Mar 2001 - Jun 2002) Construction (Oct 2004-)
Client: AZIENDA OSPEDALIERA “ISTITUTI OSPITALIERI DI VERONA”
Italian Buildings
Buildings / photos for the City of Verona Borgo Trento Maggiore Hospital New Surgery Centre Italy Architecture page welcome: info@e-architect.co.uk
Verona Borgo Trento Maggiore Hospital : page - adrian welch / isabelle lomholt
Key Links:
Skyscrapers
Architecture Studios
Contemporary Interiors
Church Buildings
New Houses
Office Buildings
School Buildings
University Buildings
Italian Architects
Italian Architecture