Few projects have represented as exhilarating and daunting a challenge for AHR as the construction of Cleveland Clinic on Al Maryah island in Abu Dhabi. Billed as the first seven star hospital in the world, and measuring a mammoth 500,000m2 in total, of which 250,000m2 is clinical space, it is one of the largest healthcare projects in the world, the largest medical facility in the region and the biggest hospital the practice has ever worked on. The hospital stands 18 storeys tall and can accommodate 360 beds and 324 exam rooms, though planned expansion zones can significantly extend both inpatient and clinical services capability.
To make matters more complex and challenging still, AHR (formerly Aedas UK) came on board after the concept design stage, through a limited competition, and was tasked with completing the design and production work started by US architects HDR. The turnaround time was tight with over 6,000 architectural, structural and MEP drawings having to be reviewed in a month and another 8,000 drawings developed from scratch in just six months, to ensure a successful tender and start on site by March 2010.
“The natural tendency would be to pick an architectural team that had three or four monster healthcare jobs under its belt,” says Gareth Banks, Healthcare Sector Lead at AHR and project architect in charge of clinical planning for the scheme. To handle the sheer size, scope and speed of the project, AHR harnessed resources and expertise from around the globe. The base-build and coordination was handled by Aedas Hong Kong; the clinical planning and production was undertaken by two of AHR’s UK-based offices (Manchester and Shrewsbury), which have hospital experience going back 60 years; the façade engineering and interior design was completed out of Aedas’ Dubai office; and client liaison was directed from their office in Abu Dhabi.
“On the ground we had people who understood and knew the culture of the country and the businesses that we would be working with and who had experience of the technological challenges of building in a desert,” says Banks. “We were able to mobilise 100 people on two weeks’ notice,” he continues. “No single office would usually have the manpower or specialist skills to do that.”
It soon became clear that for a building of this size you need to be very disciplined. “It was a tremendous effort that took almost military precision,” says Banks. But it was also about flexibility of approach. Part of the reason the client exercised its right to retender the job when it had concluded Stage E explains Banks, was that the previous architects and client had not seen each other enough and it was getting difficult to stitch everything together. “We have an extensive background in partnering on projects and are used to dealing with fellow consultants and professionals, developers and contractors, money men and project managers, and saying ‘we are all in this together, we know how to be the glue that pulls it all together’.”
Banks agrees that one of AHR’s greatest strengths was its high level of engagement with the client and the end user, Cleveland Clinic. “We were on site from the beginning, the Aedas Abu Dhabi office was the same office as that of the client and project manager and we also went over to Cleveland, Ohio to speak to the clinicians,” says Banks. “There was a great willingness to travel and sit next to the client to understand what was needed.” Since Cleveland Clinic is a US-based hospital, AHR also seconded an American healthcare architect for six months to its Manchester office to advise on interpretation of the regulations. “It meant that we were able to make judgements and make a case to the client if we felt the changes were unnecessary,” says Banks.
The success of the Cleveland Clinic Abu Dhabi project was also down to AHR’s exemplary use of technology says Banks. The practice used Building Information Modelling (BIM) to identify potential conflicts and eliminate them long before it went on site. “The fact that we did our clinical planning in BIM (in Revit) meant undertaking the changes was far easier than if we had done it in a CAD environment,” explains Banks. He cites the example of last minute service line changes that couldn’t have been done in the timescale required without BIM. “We were able to take the models that we had already generated and the information we already had, and manipulate it very quickly without having to redo it.”
Finally, Cleveland Clinic Abu Dhabi is noteworthy for setting new and pioneering standards in terms of patient-focused design. A very high standard of interior finishes was used that include terrazzo or marble flooring and hardwoods or wood veneers in the private rooms says Banks. The project also features extensive public space and generous waiting areas. “Quality of environment as a fundamental part of the healing process is absolutely pivotal to the approach that Cleveland Clinic has, and it’s something we trade a lot on now as a practice,” says Banks. “When you are stuck in a bedroom, particularly in the Middle East where people tend to be accompanied by several family members, you need it to be generous, you need the spaces to be light-filled and to belie the fact that you are in a hi-tech hospital.”
In fact, patient bedrooms at Cleveland Clinic in Abu Dhabi have been designed to mimic hotel rooms with medical gases, equipment and services discreetly incorporated into headwalls to ease anxiety. “You walk in and think ‘this doesn’t feel like a hospital bedroom’,” says Banks. “All that extraneous stuff has been designed out and hidden away.” Another aspect of the Abu Dhabi project that Banks believes was of vital importance was the generosity of the arrival and circulation spaces. “Circulation spaces are a key function of a hospital so don’t trim them back, make them pleasant, make them engaging.” Now that the building has opened, Banks says he can hardly believe the firm managed to design and construct such a large and complicated building in such a short timeframe. Especially given how demanding the client was at times and the major changes that occurred within the client’s organisation. “We believe we are valued and respected for what we helped to achieve,” says Banks. “That is something to be proud of.”
Giovanna Dunmall is a freelance journalist based in London who writes about architecture, design and the arts for publications such as the South China Morning Post, Economist online, the National, the Guardian, DETAIL, Frame, Mark, Azure, Metropolis, Blueprint and Wallpaper.