Nothing has been left to chance in the ‘green’ and flexible design and planning of this new hospital in south Paris, a public-private partnership which combines a modern, beautifully landscaped hospital with a research park
Dominique Delepech
Managing director of the Centre Hospitalier Sud Francilien
Interview by Jane McDougall
The new regional hospital of Sud Francilien, which has attracted investment of €344m, represents the largest new hospital restructuring project in France between 2007 and 2011. It will regroup the current major healthcare centres including two existing hospitals – ‘Louise Michel’ at Evry/Courcouronnes and ‘Gilles de Corbeil’ at Corbeil-Essonnes – on to one new site with an overall area of 110,000m2.
In becoming the reference centre for the greater southern Parisian area, its 1,017 beds will provide healthcare for a population of more than 600,000. The design and construction of this state-of-the-art hospital has been planned with the end-user in mind: patients, visitors and healthcare professionals.
Easy access to healthcare
A major preoccupation in the design has been accessibility to the different healthcare services. This consideration has inspired the idea of having the hospital built as four architecturally distinct healthcare departments.
These are:
- Woman, mother and child: obstetrics, gynaecology, neonatal and paediatrics.
- Surgery: cardiology, orthopaedic, rheumatology, ENT, stomatology, ophthalmology, bowel surgery, urology, hepato-gastroenterology.
- Medicine: cardiology, cardiovascular rehabilitation, nephrology, endocrinology, diabetology and follow-up care.
- Tumour medicine: oncology, haematology, respiratory, dermatology, general medicine and functional rehabilitation.
Each department will assure complete healthcare provision for all of its specialties from consultations and exploratory examinations to a day hospital and inpatient accommodation on levels 2 and 3 of the building.
- The principal shared infrastructure includes:
- A central hall with shops
- A 300-place amphitheatre
- A house for visitors
- A patient library
- Offices for numerous associations working with the hospitals
- A multicultural centre
- Two restaurants
- A documentation centre.
Ground-floor access to each of the six-storey buildings has been a primary concern. The services that receive the greatest numbers of people and are open the longest time are situated at ground level. Ground-floor access has been facilitated by the natural incline of the site which enables the two lower floors of each building to have direct ground level access. Upper-ground level has been given over to activities that are associated with the emergency department, assuring triage of the patients into adult, paediatric, psychiatric and obstetric and gynaecology. Also at this level will be the intensive cardiac care unit.
Day hospitals, open for 12 hours a day, will occupy the lower ground or ‘garden’ level and will receive the consultations for the four different healthcare departments.
To facilitate the passage of users through the hospital, each department will have its own individual access from the ground floor separated from each other by tree-lined patios. The whole site will be accessible to people with reduced mobility.
Admission of non-ambulatory patients to the departments will be separate from that of visitors. Access by other users will be concentrated in the northern part of the building and two other entrances with be reserved for hospitalised patients. These separate admissions will facilitate the movement of users and healthcare professionals throughout the hospital and contribute to the comfort of patients at the same time.
Although the construction is truly enormous, care has been taken to create hospital units on a human scale. Thirty-seven separate units will be able to take short- or medium-stay patients. Each one will be equipped with 28 surgical and medical beds, 25 obstetric beds and 20 psychiatric beds. Over 85% of patients will be able to stay in individual rooms. All rooms will have an en-suite toilet, washbasin and shower and be accessible for people with reduced mobility.
The strictest environmental standards
Following the Grenelle Environmental meeting of October 2007, the French Ministry of Health aimed to set an example to the French public by showing what can be achieved by investing in energy-saving technology.
New standards are now applied to all healthcare establishments in France so that they are managed in an environmentally-friendly way to reduce both the consumption of resources and CO2 emissions.
Healthcare establishments are able to apply for certification known as HQE (High Environmental Quality). This certification acknowledges the efforts that a hospital has made towards having cost-effective buildings that are energy-efficient. The environmental quality approach of the HQE requires the environment to be taken into consideration at every stage of the development and life of a building – planning, design, construction, demolition and so on.
The new Sud Francilien Hospital conforms to HQE recommendations from its conception through to its equipment, and was awarded HQE certification in December 2008, the first new hospital to acquire this status.
Thanks to the prodigious use of vegetation and the natural slope of the site, the hospital design is aesthetically pleasing, blending in with its surroundings rather than dominating them. Set in a terrain of 8 hectares, part of the communes of Corbeil-Essones and Evry, the hospital is well served by public transport and easily accessible from the greater Paris ring-road
(the Francilienne), the RN7 and the RD91.
The plans have incorporated ways to obtain the maximum natural luminosity by careful positioning of windows and doorways and other openings using materials of high transparency wherever possible to give the feeling of light and space. This helps the integration of the building in its environment and adds to the comfort of users.
Large patios of 300-400m2 help the passage of natural light into the main part of the building and also the walkways between buildings. The northern entrance that serves as access for the general public will have a 250m glass-covered walkway connecting the four healthcare departments with the central hall.
Vegetation is also being used to make the surroundings more pleasant, in as much as there will be more than 15,000m2 of roof gardens and green spaces including the tree-lined patios. Car parking has been designed so that parking for 2,500 cars (80% of the capacity) will be underground, with the roofs planted with flowers and shrubs, while external car parks will, for the most part, be landscaped with trees.
To the south of the site, trees will block the hospital from the view and noise of the Francilienne, while, to the north, a screen of vegetation will shield the hospital from the neighbouring houses in this residential area.
In terms of renewable energy sources, 80% of the heating will be from a boiler running on biomass, predominantly wood and straw, renewable energy sources that are found in the neighbouring vicinity of the Île de France. This central device, fuelled by non-fossil sources of energy, will be run in parallel with gas-fired equipment and, as a final back-up, oil-fired generators – this latter representing only 20% of the hospital’s energy needs. All buildings will have air-conditioning systems to allow the temperature to be altered in line with the weather.
Intelligent solutions have been put in place to contribute to mastering energy usage, facilitate internal transmission and anticipate future needs. Insulation from the exterior will be assured by lagging, and south- and west-facing buildings will be equipped with directional solar protection to limit overheating in the summer.
The building combines wired and wireless WiFi networks for the transmission of electronic data, images and sound. A transport system based on pneumatics enables the sending of biological samples in pipes to the labs and the delivery of certain medicines.
Planning for the future
All partitions in the hospital will be moveable and the height of the three first levels offers the capacity to consolidate future technical installations at. These have all been planned with the ability to increase capacity by 20%. In addition, the original planning permission application has provision for further land use, if necessary.
Not only a hospital, this new health facility will be integrated into a major public-private research network for clinical and translational medicine. Teams of researchers from both academia and business will be able to work alongside medical teams to transfer the most recent advances in medical research to clinical practice.
Novel finance
An innovative project of this scale required a novel method of funding. The project has been financed as a joint public-private venture on a 30-year emphyteutic (or perpetual) lease between Heveil and the management of the Centre Hospitalier Sud Francilien. This agreement was formalised in July 2006 in the presence of Xavier Bertrand – the Minister for Health and Social Security at that time.
The planning, construction and finance for the project is the responsibility of Heveil, a subsidiary of Eiffage, one of Europe’s largest construction companies, and all services directly affecting patient care and security are that of the hospital. The terms of the lease mean that Heveil is charged with handing over a fully operational building to the Department of Health – or more specifically the Hospital Centre Sud Francilien – in May 2011 with guaranteed maintenance, cleaning and upkeep of the establishment for the next 30 years.
Future proof
This form of financial arrangement was adopted because it allows greater flexibility if plans need to be modified or developed during the construction phase. The obligation from the health authority is to pay its annual rent – which is estimated to be around €40m in 2011, two-thirds of which will be paid by the state – and to equip and run the hospital as efficiently as possible.
At the termination of the lease in 2041, the building will belong to the hospital group, however it must still comply with all of the standards in place at this time.
