aTRM recently completed an $18 million redevelopment of the diagnostic imaging department at St. Joseph's Healthcare in Hamilton, Ontario.

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At a time when evidence-based design is filtering into Canada’s healthcare model, architectural firms invested in the healthcare sector are incorporating more elements that have a proven, beneficial impact on the patient’s stay.    

At aTRM Architects, a London, Ontario-based architectural and planning firm, the overarching architectural philosophy is to create facilities that function well for the end-user and provide a healing atmosphere for patients. “I’m a big believer that the money spent in healthcare design needs to have proven and positive outcomes for the patient and end-users,” Principal Tom Tillmann says.    

Tillmann says design influences from the United States healthcare model can be seen in the new projects coming through the pipeline. As evidence-based design takes hold, the Ontario Ministry of Health is in the process of developing general outline criteria. In evidence-based design, the architect, together with the client, make decisions based on the best information available from research, from project evaluations and evidence gathered from the client’s operations. Evidence-based design should result in demonstrated improvements in the organization's outcomes, economic performance, productivity, customer satisfaction and cultural measures.   

An estimated 60 percent of aTRM’s portfolio is comprised of healthcare related projects, while 30 percent of its work is in higher education and the remaining 10 percent consists of other community-based projects. The 32-person firm opened a second office in Toronto in 2006 to accommodate its growing clientele.    

aTRM – represented by architects Tillmann, Ruth and Mocellin – provides architectural design and master planning services for hospitals and acute, long-term, rehabilitation and ambulatory care facilities, but also holds experience in education, research and recreation. These robust sectors, along with continued investment in Ontario’s infrastructure, have resulted in additional business for the firm, Tillmann notes.    

The firm’s involvement in the healthcare industry has earned it a good reputation, Tillmann says. It has completed work for clients such as St. Joseph’s Health Care, Toronto General Hospital, South Muskoka Memorial Hospital and Stratford General Hospital.    

aTRM has also benefitted from keeping its primary geographic focus on Ontario. “Healthcare on the design and construction side is strong,” Tillmann asserts. “There is a lot of activity as it relates to infrastructure. The Ontario Ministry of Health, coupled with Infrastructure Ontario, has taken on getting healthcare projects underway from projects that are $30 million to some well over $500 million. The province has really made a strong commitment to healthcare.”

Integrated Approach
Integration is a key component when working in healthcare environments, and it is put into practice on each new project aTRM tackles. Since every healthcare project in Ontario is subject to the review and approval of the Ministry of Health, architecture firms must work within the organization’s guidelines.    

Functional programs for each new build or renovation are typically completed before aTRM becomes involved in new projects. The reports are independent of the design team and include a cost report to ensure the hospitals are not adding what they can’t support. Projects are then tendered through the hard-bid process, although today, Tillmann says, a more collaborative approach is preferred, as public-private partnerships become the preferred construction model.       

At the start of each project, aTRM’s project participants gain insight to the client’s operation goals and care models by visiting with administration and researching the facility or concept. aTRM investigates existing conditions and interview staff to understand what works and what doesn’t in each particular department.    

aTRM’s staff determine the type of project its clients require by consulting user groups such as the nursing, medical, infection control, IT, security and maintenance staff on their needs. “It’s critical for us to work that way because the people that we work with are out doing the work and they see what’s needed in the facilities – they’re living and breathing it everyday,” Tillmann says.    

Although the healthcare construction climate is strong in Canada, hospitals have reached the point where they are competing for well-qualified staff. Patient demand for higher quality facilities and services has also led some providers to renovate and expand.    

As a result of the increasing competition among hospitals for the same services, the Ministry has focused on restructuring healthcare where hospitals can share information and patients can receive the same level of services and care across the board. This has led to renovations and, where feasible, new build projects.    

In 1997, the Health Services Restructuring Commission (HSRC) – an independent body of health experts and professionals – called for the restructuring of health services in the London region. The restructuring effort is part of a province-wide initiative to modernize Ontario's health system so that people receive services where and when they need them.   

"We believe that the additional reinvestments we are recommending today will ensure that health services will be there for the people of London when they need them,'' HSRC Commissioner Dan Ross said in a statement. “Restructuring is about creating the appropriate level of services with the bottom-line of more health services in hospitals, long-term care facilities and their homes.''

Building on History
aTRM’s history with St. Joseph’s Health Care in London dates back to its roots in the early 1900s when it first began providing architectural services to the hospital. The firm has completed recent projects for the center, including the Mount Hope Centre for Long-term Care and the Monsignor Roney Facility for Ambulatory Care, as well as on-going projects at the Lawson Research Institute and Parkwood Hospital.    

aTRM is currently providing professional design services to help lead the health centre through its $125 million restructuring mandate. The firm was retained by St. Joseph’s Health Care in the fall of 1997 to begin the restructuring program.

Other Major Expansions
Additional work is also underway with St. Joseph Health Care in Hamilton, Ontario. aTRM completed an $18 million redevelopment of the diagnostic imaging department, and is now gearing up for a $56 million operating room and recovery area expansion in association with Perkins + Will. aTRM will serve as the prime consultant.   

This project will involve the replacement of 12 operating rooms, two new surgical day care units, a post-anesthesia care unit and a sterile processing department. The substantially larger operating rooms will allow for the latest robotic technologies that support the hospital’s commitment to minimally invasive surgery.    

As a teaching and academic hospital, the new state-of-the-art facilities will enhance and expand the telehealth educational services at the center. This represents the first phase of work in a master plan prepared by aTRM, which will see major expansion over the next 15 years, Tillmann notes.

To increase the accessibility to specialized surgeons in communities where none are available, telehealth and telerobotics make it possible for a surgeon to provide complete laparoscopic surgical intervention from hundreds of miles away. Using a three-armed robot to translate the surgeon’s natural hand, wrist and finger movements, a surgeon in an urban hospital can operate on a patient in a remote location.   

The Hamilton location is the regional center for mental health care in south-central Ontario, and provides a complete spectrum of mental health services to nearly 2 million people.