How Huddinge switched from surgery to COVID care in just ten days

“The project serves as a good reference for the importance of building flexibility into healthcare facilities. This is an investment that paid off even before day one. It’s also a story about the importance of the humanistic perspective in the face of healthcare challenges, and about the importance of creating environments that support staff in situations as tough as those endured during this pandemic,” says Charlotte Ruben, lead architect for this programme at White.

The new building was completed at the end of 2019, with surgery due to commence in mid-April. However, during those dramatic days of the pandemic, when pressure on ICU beds was at its greatest, the decision was made to convert the brand-new operating theatres into intensive care beds instead.

The theatres already had generous amounts of light, good ventilation, and ceiling-mounted supply pendants, which meant they were well suited for use for other purposes. In addition, the strict hygiene requirements and good technical conditions in respect of things like ventilation systems made it possible to convert the operating theatres into ICU beds.

“Daylight is one of the most important factors in enabling flexible use,” says Caroline Varnauskas, Lead Architect at White.

The daylight and the environment of the O building have also had a positive effect on the staff’s work environment. While the conversion of operating theatres to ICU beds in the O building was underway, a number of wall-to-wall recovery beds were converted for intensive care use in the old part of Huddinge Hospital. The old premises have completely different spatial conditions. The lack of light made the situation somewhat more difficult for the staff.

“We can see a difference in the staff’s experience of the two facilities. Daylight makes such a huge difference. The O building has a different spatial layout, and it’s possible to take a break, leave the patient rooms, and step out into a completely different environment in the corridor without having to get changed,” says Björn Holmström, Chief Physician and Medical Manager for the O building project at Karolinska University Hospital in Huddinge.

The O building uses a concept solution developed in Huddinge where the corridor leads into a prep room with storage for materials and medicines that supply the operating theatres. Three ICU beds were provided in each theatre. This meant that six patients could be monitored from each prep room, which is a very staff-efficient solution. Once out in the corridor, the staff are not disturbed by alarms and can relax for a moment.

In the old section of the hospital, the patients are located in eleven open bays directly adjacent to the corridor, with a centrally located storeroom that can only be reached through the same corridor. Here, staff felt closed in and didn’t have the opportunity to change their environment without getting changed. The work environment is tougher and does not give staff the same opportunity to monitor patients or take a break.

The O building also has good contact with the landscape, with soothing views and the opportunity to go out into the courtyard. With the help of art and well-thought-out design, the environment shows consideration for those working in it. Small details such as the stairs with a real-wood handrail make the environment less hospital-like without sacrificing hygiene and cleanability.

Today, the operating theatres in the O building have been returned to their original purpose. The re-conversion went quickly and smoothly.

“It didn’t take long to put them back to how they were, but we were all so tired by that point that it was difficult to look forward to the new facility. Nevertheless, they’ve been very well received. There’s nothing in their design that’s perceived to be a problem, and that’s because the organisation has been very involved in developing the solutions,” says Holmström.

It doesn’t surprise him that it was so quick to return the theatres to their intended use. In fact, the only limiting factor in converting the operating theatres to ICU beds was the lack of staff and medical equipment. Had more equipment been available, they could have been converted even quicker. The ICU beds, for example, came straight from the factory in batches.

There are several reasons why the building was so well suited to conversion:

• Flexibility and general use was a basic principle of the project.
• Movable ceiling pendants for the supply of electricity and gas to the equipment in the operating theatres allowed for a good degree of freedom when re-equipping the spaces for new requirements and installing more intensive care beds. This also provides better conditions for surgical activities.
• The shape and size of the operating theatres were sufficient. 60 square metres is the standard that is sought after, but it is often dropped along the way in hospital projects. In the O building, the project resisted this change and didn’t scrimp on space.
• Daylight makes for a better work environment.
• The prep rooms with storerooms simplified the supply of materials. Intensive care requires a lot of material that could now be close at hand.

Birger Sundström, who was Skanska’s project manager for the O building, thinks that the project’s biggest success factor was the good co-operation and the consensus on the objectives and vision for the project. It’s also about making the right trade-offs and having the right priorities in order to meet the project’s financial framework. This was a prerequisite for reaching the project’s objectives on time, on budget, and with good results, despite the project’s complexity.

“It’s been such a fun project. This is a beautiful and functional building with fine architectural qualities,” says Sundström.

At the same time, he emphasises that we won’t know just how successful the project is until ten years from now. How flexible a building really is will only become apparent once activities have been underway for a long time. In order to deliver the project on time and within budget, it was necessary to scale back flexibility to some extent and the money was spent where it was most effective. For example, the building cannot be increased in height. This was a conscious decision, as the cost of doing so could not be justified.

“We’ve enjoyed a good relationship with the organisation and with talented architects, contractors, and other consultants. Everyone has had an understanding of the limited budget and challenged themselves to find cost-effective solutions and live up to the requirements within a set budget,” says Sundström.

Fredrik Hagel, project area manager at Locum, which owns and manages the building, also highlights the good collaboration and consensus.

“Flexibility is a buzzword that means different things to different people. This is why we brought together all the stakeholders at an early stage to formulate what flexibility means in this project. Everyone had their say, which resulted in a document that everyone agreed on and which we could use as a basis throughout the process,” says Hagel.

He’s very pleased with the result and sees the O building as a very successful project. In a most extraordinary way, the project has captured the management issues and ensured that nothing was left unresolved before handover. Of course, there are still some adjustments to be made, but the management situation is basically secure.

“This is an easy building to look after. It’s not complicated to clean or maintain. The choice of colours and materials creates a sense of calm and security, which results in good environments. The colour scheme also makes it easy for people to get their bearings, which is important in such a large building. The corridors are also a success. They’re wide enough to comfortably meet without colliding, and we’ve also incorporated light and views out towards the park. It’s clearly a well-executed project,” says Hagel.