Jürgen Engel and Insa Lüdtke: The place. The city. And the people. Pioneering buildings for the healthcare society.

We still see hospitals as standalone units, separate from their surroundings. But this is a very outdated view. Instead of  isolated plots and individual projects, what we need today is a holistic plan for a hospital’s infrastructure and surroundings.

We find ourselves on the threshold of a comprehensive paradigm shift: instead of curing diseases once they arise, the focus today is on maintaining health, as a universal and indivisible commodity. Given the continuing rise in life expectancy, health is the most important commodity for most societies. Rapid progress in medical technology is considered the most important driver of the health market. High levels of functionality and the requirements of equipment-based medicine mean that healthcare facilities often have a cold and anonymous feel. Below, five example projects show how architecture and design can play a vital role in aspects such as the quality of a stay in hospital and the efficiency achieved there.

Daring to explore new paths in the design of hospital architecture was the brief for the design of the new surgery building at Universitätsklinikum Ulm. In 2001, the Frankfurt-based architects’ office KSP Jürgen Engel Architekten was chosen as the winner from among 29 designs submitted. Space experiences such as a busy foyer designed in piazza style – inviting people to relax and spend time there and producing attractive lighting effects with coloured glass – create unmistakable places where people can feel at home. Despite the size of the hospital complex, including 235 regular care and 80 intensive care beds as well as 15 operating theatres, the designers wanted people to experience a clearly-­­structured building that they could identify with. The architectural solution presented in the design concept was to create a clear separation between the areas for medical treatment and the wards. The functional section – with its operating theatres, intensive care unit, accident and emergency, radiology, specialist out-patient clinics and dermatological clinic – blends into the landscape as a base construction. The three-­storey ward building, on the other hand, is a real eye-catcher that rises above the base and surroundings, providing excellent views.

A city for getting healthy. Integrating indoor and outdoor spaces creates sophisticated transitions between spaces and analogies to the city. The hospital thus be­­comes a familiar place rather than a high-tech artefact, which also helps to reduce people’s fear. The bright entrance area, flooded with light, is designed as an open piazza (‘marketplace’), from which the main streets (‘boulevards’) lead off to the various medical areas (‘districts’) and wards (‘homes’). Outdoor green spaces (‘parks’) divide the base construction into narrow, clear wings. A year after it opened, the project was honoured with the “Auszeichnung herausragender Gesundheits­bauten 2013” (Award for Outstanding Healthcare Facilities), which was awarded by the AKG (Architects for Hospital Construction and Healthcare) at the Association of German Architects for the first time.

Some of the crucial criteria for a modern hospital – including those with older buildings – are the soft factors of atmosphere and design, as well as a high level of flexibility and adaptability. In order to optimise func­tional processes, a new main street – the central access axis – in the three-storey extension of the Medizinische Universitätsklinik at the University of Freiburg picks up on the existing routes of the old building from the 19th Century. Modular planning in the form of multiple construction phases proved to be the most sensible option in a master plan used as a strategic instrument.

The addition of new function areas enables interdisciplinary emergency care literally under one roof: the new operating theatres are located in the storey directly below the helicopter landing pad, which is on the roof of the new building. The new building provides a total of 56 beds – ten beds in triage and 46 in intensive care. After five years of construction, the new building with its gross floor area of 20,400 m² was completed in summer 2012 – on time and on budget. Flexible expansion of the reinforced concrete construction with a quadratic support grid will also allow retrofitting with all kinds of media and installations later on. A high level of flexibility in the primary structure and the extension options it offers provide the ideal conditions for future adaptations made necessary by the short innovation cycles typical of medical progress.

Autonomous living in the district. The increasing medical possibilities and a healthier way of life are reflected in rising life expectancy and naturally result in increasing demand for healthcare services. Preventative services are becoming ever more significant. In line with political calls for “out-patient before in-patient care”, district administrations and housing associations are realising that, in a period of demographic change, districts need to become not only residential areas but health­­care locations, not least from an economic point of view.

In such districts, older people can lead autonomous lives in a neighbourly environment that incorporates every generation. Support comes in the form of an interconnected local infrastructure: shops, cafés, cultural services, chemist’s, doctors and even day centres and a small care home. Alternatives such as communal living and voluntary work also have potential. It is ultimately about providing an increasing variety of services and individual solutions anchored through architecture.

A residential building for the third age, the “DKV-Residenz in der Contrescarpe” is located right on Bremen’s historic city wall, just a few minutes’ walk from the old town. Adjustable window shutters provide the apartments with privacy and sun protection and give the six-storey building’s clinker façade – so typical for Bremen – a play­­ful element of lightness with a changing face. The 138 one and two bedroom apartments and 28 care home places are furnished to the highest standards.

Service areas and shared facilities are provided on the ground floor. The complex also includes a restaurant with a terrace, club rooms, an underground wellness and fitness area with a swimming pool and sauna, a small grocer’s shop, a hairdresser and a café with a terrace. A doctor’s surgery, physiotherapy practice and home carers from the DKV provide safety in the form of medical care and assistance.

Age-appropriate accommodation in existing buildings. Designed as a self-contained residential estate, “Neue Burg” in Wolfsburg’s Detmerode district is a typical example of the large city expansion projects of the 1960s and 1970s. Over the years it had become marred by an­­­onymity, insecurity and low occupancy rates. In order to turn this complex situation and thus the estate’s image around, the client Neuland Wohnungsbau­ge­sell­schaft and KSP Jürgen Engel Architekten worked together closely to develop a range of solution strategies. First, the existing buildings – some stretching to 14 storeys – were reduced to the height of four storeys, while the number of residential units was reduced to 116, some with the addition of a penthouse level. Balconies, loggias and penthouse levels now take full advantage of the estate’s central location and its position on the edge of a forest. Differences in the façade designs distinguish the residential blocks from one another, giving each its own address. Excellent accessibility helps older residents in particular to remain living autonomously in familiar surroundings. This conversion and reduction, as well as the many measures implemented to im­­prove energy efficiency, have re­­sulted in attractive and en­­ergy-efficient homes that offer excellent quality of life and the standard of new con­­structions. The project was awarded the “Zukunft Wohnen” architecture prize in the “Liv­­ing in existing property” category.

As well as the development of local solutions, the healthcare market is one of the key international economic fac­­tors. Healthcare providers are in global competition for patients (“health tourism”) and staff. Asian and Arab countries in particular are see­­ing the emergence of highly-qualified healthcare locations, such as the Al-Imam Academic Medical Campus in Riyadh. According to the master plan drawn up by KSP Jürgen Engel Architekten, a 1,000-bed university hospital with an associated polyclinic and a university cam­­pus for 3,000 students with seven faculties and numerous research facilities will be built on an area of 600 hectares (a gross floor area of 1 million square metres).

Intercultural working. Interdisciplinary exchange and intercultural understanding – across both national and cultural boundaries – are essential in construction projects in a global context. Headquartered in Frankfurt am Main, KSP Jürgen Engel Architekten now has six offices abroad, including in Beijing and Hanoi. The Frankfurt site and its international focus are reflected in the growing, 200-strong team from around 20 countries and play a key role in shaping the corporate culture. The intercultural expertise and connections, including with local cooperation partners on the ground, enriches the office’s working processes and architecture far beyond the limits of the content of individual construction projects.

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In contrast to that of some specialist competitors, the self-image of KSP Jürgen Engel Architekten is shaped by its diverse range of projects as an all-rounder with specialist knowledge in a range of fields. Working as a “director”, the architect has to coordinate the various people involved throughout the entire planning process and integrate the different requirements to form a coherent building design. His role is to combine functional and design aspects. Given the rising demands on healthcare properties, such as efficiency, flexibility and quality of stay, they can only benefit from solutions to other planning projects, such as those for hotels, residential buildings, commercial property, offices and even urban planning.

KSP-JÅrgen-Engel_Foto-Kirsten-Bucher_4559_F-kopierenJürgen Engel (born 1954), Architect S.M. Arch./MIT and principal at KSP Jürgen Engel Architekten GmbH. He studied Architecture at TU Braunschweig, ETH Zurich, RWTH Aachen and the Massachusetts Institute of Technology (MIT) in Cambridge, USA. He has been managing partner at KSP Architekten since 1990. Since 2009, Jürgen Engel has been principal and responsible for around 200 staff at the office. He lives in Frankfurt am Main and works for various associations as well as an assessor and adjudicator. Projects from his architects’ office have been honoured with numerous prizes, including the AKG’s “Herausragende Gesundheitsbauten 2013” award.

Insa Lüdtke (born 1972), Dipl.-Ing. (TU Darmstadt, Architecture faculty) works as a freelance journalist for various media in the field of architecture and health and owns the consultancy firm CoconConcept. She lives and works in Berlin.