The Sherbourne Health Centre

A new model in healthcare

“This is a story about inventing a new way to supply healthcare services,” says IBI Group Director David Hastings about the adaptive re-use of the existing Central Hospital, an acute-care facility at 222 Sherbourne St. “There was no template for this type of facility. Certainly the Ontario Ministry of Health and Long-Term Care, which funded it, had never encountered anything like it.”

In addition to its geographic community, the Centre focuses on three populations with complex needs or barriers to service: the homeless and underhoused; recent newcomers to Canada; and lesbian, gay, bisexual, transsexual and transgender persons.

“It’s not often you spend time in a design review with this kind of client group,” Hastings says. “Nor had they ever spent a lot of time with architects. It was a new experience for everyone to sit there, exchange ideas and listen really hard.”

For the homeless, we found a way to remove barriers and maintain dignity. These individuals usually carry all their clothes and possessions around with them and may not have bathed recently. To that end, we provided an inconspicuous side entrance to the Centre that opens onto a shower and locker area.

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The main entrance, too, was made friendlier to street-people. This is important because homeless people tend to be independent and avoid shelters. They perceive such institutions to be mysterious and inscrutable. The new entry façade is transparent, which communicates a sense of openness. The reception desk was moved to the front and centre. Clients can enter slowly, at their own pace. This gives them time to realize that there is nothing to fear. “Homeless patients worry that once they enter the public system, they will be categorized and unable to leave,” Hastings says.

The third-floor has a 20-bed infirmary for people released from acute care who may not have adequate accommodations for a proper recovery. Traditional hospitals discharge patients quickly. If a homeless patient is discharged onto the street or a four-storey walkup, they often return, before long, to the hospital’s emergency room. The Centre’s infirmary gives them a place to recuperate and break free of this emergency-room procedure-discharge cycle, reducing hospital wait times.

Non-gendered washrooms serve clientele with gender identification or sexual-reassignment issues.

The infirmary is arrayed as a community of subcommunities. Treatment rooms are arranged in pods of three or four, all within eyesight of the nursing station, maximizing staff efficiency. Four pods contain four double or single rooms. All corridors end at the communal lounge with a TV and entertainment space.

"You can leave your room and still be in a semi-private area among a small group of people before entering a public area,” Hastings says. “There are subsections of society who want to be with their own kind: for instance, aboriginals who want to perform their healing ceremonies without fear of being ridiculed by others, or abused women who feel that there is safety in numbers.”

On the exterior, we economically updated the original Brutalist façade. The existing windows were masked by angled vertical panels rising from slab to slab, making the building look and feel closed off and depriving users of the impressive views of Allan Gardens. We removed the panels, replaced the windows with energy-efficient glazing and added a brise soleil of angled horizontal steel fins above each floor to filter the daylight. In an architecturally inviting gesture, a long curved steel canopy and sunshade frames the front door.

The Interiors group carried the original architectural concept of inclusion and openness right through to all four floors on the interior. Intensive design interviews and exchanges were held with the users who were all in agreement that although the materials chosen had to be functionally appropriate, a welcoming atmosphere was extremely important to staff, and clients.

“We created what looked like an unusually complex palette of colours and materials on the sample boards but that turned out to be a richly layered combination of bold and bright colours not often seen in hospitals. Our intent was for the finished product to reflect the diverse, lively local community the facility serves.”

This collaboration between architecture and interiors typifies IBI Group’s work style. Professionals from all four domains of practice—urban land, facilities, transportation and systems—often brainstorm together.

The timeline dictated a design-build process with an unusually high number of unknown variables. The Centre was still devising its staff complement and methodology while we were designing the building. IBI Group was responsible for the master planning, architecture, interior design and construction management of the 100,000-square-foot project. The construction budget was $14-million. However, the project was tendered at $10-million and was completed under budget. In turn, our success has helped spur the hoped-for, and now imminent, second phase of the renovation, which includes the 5th and 6th floors.