Barriers between hospital and city: seven Italian casa studies

It was February 2012 at the Faculty of Architecture, University of Belgrade during the course “Health Urban Design” when we have developed the topic of Healthy spaces around the hospital complex. Thanks to the Basileus Erasmus Mundus programme we had the chance to work together for one months and then we have received the funds by Sapienza International Office on the basis of the mutual agreement between our Institutions, to go on with our research and teaching activities. The Serbian students, during the Course, worked on the regeneration of the outdoor environments at the Clinical Center of Serbia in Belgrade. To let them fully understand the topic, the students together with us, met the board of management of the Clinical Center and they interviewed, through a questionnaire given by us, 108 users amongst which there were patients, hospital staff, students and visitors. The interviews’ results were really interesting. On the one hand the results highlight the bad feelings of users towards outdoor environments, on the other hand the great importance of outdoor environments for the users as an integral part of surroundings city and the importance of the relation with the indoor activities of the hospital. We discussed the topic in deep, concluding that there are a lot of places around the world where the outdoor environments around the big hospitals are not properly taken into account by the designers. Even if the hospitals occupy a big portion of the city, the outdoor spaces are not integrated into the city, nor used as an extension of the healthcare activities. It can be argued that the ‘outdoor spaces’ are not ‘places characterized’ but only physically ‘open spaces’. The book “Health spaces. Hospital Outdoor Environments” comes from that teaching experience and from the studies made during these years. We decided to write this book involving different experts in the healthcare design and landscape, aware of the need for interdisciplinary approaches and of the significant importance that landscape design gains in these last years. The book discusses and shows design solutions aimed at creating the right balance as much between the city and the hospital’s outdoors, that much between hospital open spaces and indoor environments, in accordance with users’ needs and behaviors. The book develops the topic of “Health spaces: Hospital Outdoor Environments” starting from a general approach to go on in the real case study’s analysis. According to that, the book is divided in two parts: the first part collects essays on planning and design approach and the second part shows significant case studies located in Serbia and in Italy. The first part of the book collected six papers. They explore theoretically the main topic from different points of view, from different disciplines. The paper “Hospital open spaces and urban open spaces” (by Z. Ðukanovic), which is opening the book, presents a brief review of the relation between urban open space as a wider, complex system of contemporary cities and the hospital open spaces as its, not less complex, sub-element. There are several different types of approaches to researching and defining the ‘openness’ of the open spaces and the author discusses the main five approaches: landscape, formal, functional, cultural and economic. The paper “Regeneration and restoration of the hospital spaces” (by F. Terranova) proposes a critical path that a designer should follow in designing a meta-project of a hospital, starting from the analysis of the importance of the social determinants. The paper also argues that the goal of a good design is to find solutions aimed at mitigating environmental pressures and the increasing gaining importance of the landscape design. At the end the author closes the paper with some recommendations to address the designers. The paper “Healing environments design” (by N. Beretić) researches a gap between urban open spaces and health care facilities and it symbolically presents green spaces as health promoters, but considered balance between notions and presents theories dealing with the research of urban open spaces within healthcare facilities. It researches those notions trough two lenses: the first is a review of existing literature about defining the main theories in the field of healthcare outdoors, and the second one observes historical and cultural conception of outdoor spaces within healthcare facilities. The paper “Observation as a way of knowing and measuring open hospital spaces” (by F. Quici), discusses two main questions: “Can open hospital spaces be considered ‘places’? Can it be said that the open spaces of today’s hospital structures present characteristics sufficient to qualify them as public spaces?”. The paper argues that the first step towards understanding the nature and the function of such spaces is to investigate the behavior and the expectations of the users. It discusses some methods that can be useful to address the designers. The paper “Exploring the relationship between outdoor and indoor environments in the hospital design process” (by F. Giofrè) discusses the relationship between the city, the hospital and its indoor and outdoor environments. It contends that the outdoor spaces need to be integrated as part of the design process through a multidimensional design approach that involves the user groups. The paper introduces new categories in relation to the different levels of usability – public, semi-public, private. The design of these spaces is of great importance insofar as it potentially influences and alters the behavior of the people that use it, even more so if those same people are involved in its design. The paper “Hospital outdoor environments on dualities and contradiction” (by R. Božović-Stamenović) closes the first part of the book. It discusses a number of dichotomies and paradoxes intrinsic to the nature of the hospital outdoor spaces. The outdoor realm is put in perspective with the urban, social and personal domains. The paper argues that the healthfulness of the outdoor hospital environment is deeply imbedded in design’s qualitative substance rather than in its formal appearance. In that sense narrative strategies and exploration of indeterminacy and multifaceted character of outdoor spaces seem more opportune for achieving the lasting positive effects on users. The second part of the book is opened by the paper “Health facilities and open spaces: integrated policies at the landscape and territorial level” (by R. D’Onofrio, E. Trusiani). It examines the relationship between health facilities and open spaces from a landscape and the territorial point of view, considering not just the hospital closest surroundings, but also more distant areas. It argues that the open spaces’ network is a connection system of different green areas and natural amenities, inside and outside the city, and comprises a variety of functions at very different levels. The paper discusses some national and international examples in order to show how a different use of natural parks and other protected areas could represent a precious opportunity, still unexplored, for human health and social wellbeing. The paper written by A.M. Giovenale illustrates an Italian case study “ A Master Plan for regeneration: Piacenza Hospital complex, Italy” as the result of the synergy of different skills and different specializations. It examines the design of a hospital building, in particular the prevalence of functionality rather than architecture, highlighting how the Master Plan represents a possible solution which is ’outside the box’. The paper discusses as the master plan reinterpreted the hospital in Piacenza as a place where citizens should be able to meet, in order to recover the sense of the hospital being an “urban site”. What are the types of barriers between hospitals and city in Italy? The paper “Barriers between hospital and city: seven Italian case studies” (by F. Giofrè) analyses six university hospital complexes with more than 950 beds. The study applies a quantitative research method and its aim is to offer a reading, also photographic, of the current situation of those hospital complexes and their relationships with the city and also to analyze the data collected in order to understand the redevelopment potential of the external spaces of the hospital complexes. The paper “Image of a hospital city: clinical center of Serbia” (by I. Miletić), discusses the open spaces within the Clinical Center in terms of the urban environment. The analysis shows a very varied and confusing conglomeration of buildings that passed through different social systems and therefore constantly changes its organization, methods of management and urban planning with significant repercussions on the physical layout. Another interesting case study is analyzed in the paper “The role of outdoor public space in a pavilion university hospital. Case study: Policlinico Umberto I of Rome, Italy” (by V. Napoli, G. Primiceri). The paper investigates the outdoor space of the Policlinico Umberto I of Rome, through the analysis of its phases of evolution from the original project to current day proposals. The analysis of the external space in its current state is based on considerations and also on the basis of understanding the relationship with its urban surroundings. Along with the study, a questionnaire on the use and perception of the space was submitted by different categories of users. Through the process the possibilities that could be linked to the use of outdoor space are highlighted, especially in large university pavilion hospital situations. The paper “Hospital open spaces. Healing or threatening environments. Case study: Clinical Centre of Niš and Clinical Centre of Vojvodina in Novi Sad, Serbia” (by V. Mandić and T. Stanisavljević), analyses the existing open space in the two Clinical Centers. Methodology of research process includes desk and internet research, field research, site surveys and interviews with patients,local inhabitants and employees of the Clinical Centers. The goals of the study are to present the emerging need for developing integrated healthcare systems focused on overall well-being of patients and other users. The last paper “Analysis of some renovation projects indoor and outdoor. Case study: Policlinico Umberto I of Rome, Italy” (by R.Belibani and M. Cardi), shows some of the several renovation projects of the hospital, particularly focusing on the one regarding the re- functionalization of Pediatrics and Obstetrics Clinics. The paper investigates also the tools for the design of green spaces pertaining to a hospital, in order to satisfy a high quality of the hospital landscape.