ASK THE ARCHITECT: Chiso Simioni is Architectural Lead in the pre-construction team at MTX Contracts Ltd

You moved from working with an architecture practice into MTX – what is the biggest change for you professionally?

I have worked in the healthcare sector for a number of years collaborating with MTX, but now as part of the pre-construction team I can get involved with projects at a much earlier stage.

Typically, when we get involved a client may already have some design work because they need that to get planning and finance – creating those designs was something I did in the past before joining MTX. But in some cases, the architect is not so experienced in MMC principles, and that may mean opportunities are missed for creating the best solution.

Within the pre-construction team we now aim to engage with the client at the earliest stage, when the project is preparing to generate funding or gain planning permission. MTX has vast amounts of knowledge and experience of both MMC and healthcare, and we can start advising right from the start with early designs, 3D concepts, and more accurate costing. All this at no cost of the client – we provide this as part of our service – show us a piece of ground or a site, and we can quickly come up with thoughts on how the building will fit, its orientation and use of space to deliver the client’s objectives.

Many people see MMC as an opportunity to standardise designs – is that your view?

Our first priority is to deliver the building that the client wants, to ensure they are totally satisfied with the end result. You cannot allow pre-manufacturing and modern methods of construction principles to dictate a design that does not benefit the client. Every one of our designs is bespoke – and results from detailed discussions, consultation and collaboration with the client.

We design the building around the service, not the other way around, and we won’t allow factors such as the spacings within a modular grid to force a compromise. MMC is a tool – it is a technique.  It cannot determine that the building will look a certain way – and no-one wants a building that is just a series of boxes!

Standardisation is a means to an end, not an end in itself.  In a recent forum with other experts I was the odd man out – taking the view that bespoke design is the key to good MMC projects, not standardisation for the sake of it. I also pointed out that to comply with unique standards within the health sector we use concrete floors, not typical modular-build floors that can create a ‘bounce’ which is totally unsuitable for a medical environment. For example, operating theatre floors need to have a certain dynamic response. Excessive structural vibrations in hospitals and other medical facilities can interfere with the performance of medical procedures, compromise the operation of sensitive equipment and have adverse effects on patient comfort. Our method of delivery – installing poured concrete floors in steel trays even on upper floors – is rare in the MMC arena, but it ensures our floor designs are stable.

What elements do you view as central to architectural design in a healthcare setting?

In a medical setting, the factors you have to consider are complex and ever-evolving, and encompass everything from administration requirements to infection control!

That said, I see the patient’s journey as central to every project. This, of course, differs from setting to setting, but factoring dignity and respect into everything from their first impression to their final discharge is central to creating an optimum healing environment.

For example, whilst observation is usually key in medical settings, without an accompanying sense of patient privacy, its inclusion in design could lead to patient anxiety. These concerns, in turn, must be balanced with the staff journey, the use of space and other key elements that are conducive to a healthy working environment. Overall, it’s essential to ensure that the drive for efficiency never comes at the sacrifice of a positive human experience.

Is there a project where that relationship with the client and recognition of key elements have produced amazing results?

The new Essex and Suffolk Elective Orthopaedic Centre at Colchester General Hospital. The design of the Dame Clare Marx Building has been collaborative; ultimately involving the client, MTX, the original architects employed by the Trust to prepare the original concept RIBA Stage 2 design, building control, planning and both the Trust Fire Safety Officer and a specialist fire consultant.

The original Stage 2 design was reviewed and reworked extensively in line with the MMC process and the client’s preferred patient flow from admission through to discharge. Ideally, you want patients moving in one direction – admission, prepped, procedure, recovery and then discharge.

The final design consists of a combined admissions and second stage recovery, prep, waiting, theatre, first stage recovery, and discharge rooms located on the first floor with a continuous flow, where possible avoiding crossing of paths or doubling back. The intention is to make the experience as linear as possible and avoid, for example, any anxiety caused by a newly admitted patient encountering post-operative patients leaving the operating theatres all located on the ground floor.

Naturally, it was important to optimise the use of the available space and essential to ensure that all the recovery ward rooms had an outside view, because we know that natural light has a strong connection with wellness and healing.

We also maximised the value potential of vertical connecting spaces, rather than horizontal, through the use of dedicated staff lifts and staircase. This will assist infection control and help to limit the distances travelled daily by hospital staff to complete tasks, move patients and retrieve essential items. Co-locating vertically not horizontally demonstrates three dimensional problem-solving thinking to optimise patient flow.

What challenges did you face in executing the final design?

Optimising the design to deliver the desired outcome for the client is at the heart of the scheme. As such, this may be as much a cultural and social challenge as it is an architectural one, exploring alternative designs that may challenge current working methods or practices.

The site has presented its own challenges. There is a considerable slope to the site and it is flanked on two sides by access roads with a substantial ditch and existing buildings on the other two sides. Planning considerations have also dictated the extent of the useable footprint and the massing and aesthetic treatment of the proposed building.

The Client wanted the majority of the recovery areas to be single-bed rooms rather than 4-bed wards, and we put a great deal of effort into getting those right – ensuring the right balance between the need for observation and the desire for privacy and comfort.

Can standardisation still benefit clients in an MMC project?

Of course, standardisation can be used very effectively. For example, every single operating theatre  created by MTX has been bespoke. But there are certain elements you require in a theatre, so it is logical to consider offering a standard theatre design, dictated by best practice, that could be shared across Health Trusts.

In Colchester, the 8-theatre complex is going to be used by many different surgeons and it needs to  be familiar and comfortable for them to work in, with the various elements arranged so they can concentrate on their role changing saving lives. This is where standardisation may have a role.  Likewise, the single-bed rooms at Colchester could be an exemplar for future developments.

What are the most significant changes in the industry since you started your journey in healthcare architecture?

Today, MMC rivals traditional build methods, matching their longevity, potentially exceeding their sustainability, and providing time-saving and efficient solutions with much less disruption. It is great to see it embraced by the mainstream as a functional, adaptive solution.

MMC is constantly evolving to become more efficient and cost-effective in a variety of settings. However, the main focus remains: to absorb limitations and tailor the MMC process to the need for maximum efficiency without compromising the resulting patient and staff experience.

Have you identified any emerging industry trends to keep an eye out for in the future?

In my opinion, tactility and human-centric design are the future of medical architecture. Tech doesn’t negate the human touch and should be used to enhance the social aspect of design, especially in a healing context. We’ve seen the barriers that isolation creates towards wellness and healing through the pandemic, and human-centric design has the potential to solve this issue.

Finally, tell us about your connection on a personal level with medical design and architecture, and what maintains your passion for the work.

It’s refreshing to carry out wellness and people-oriented design. The work can be really emotive, especially when the project is complete and you get to hear direct feedback from those impacted by the positive changes you’ve help bring to fruition. It’s uniquely fulfilling on a level that commercial and residential projects could never match. Being able to add a splash of colour, an injection of natural light or literally a breath of fresh air to the everyday setting of people suffering with either their physical or mental health is immensely rewarding.