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Circle Reading: where clinical practicality meets build efficiency

As construction of Circle's new hospital in Birmingham draws close to completion, we revisit Circle Reading, which we completed in 2012.

With the Circle Reading project, architects Bryden Wood have employed a design ethic powered by both clinical practicality and build efficiency, delivering a hospital not only visually distinctive, but one which utilises insightful, use-driven design and cutting edge manufacturing processes. It’s a space which continually upends expectations - a structure of steel and concrete, much of which was built offsite.

The achievement has been made possible by the implementation of a bespoke Design for Manufacture and Assembly system, which Bryden Wood developed in conjunction with Circle and tailored specifically for their needs. Ultimately, the system played a key role in the creation of Adaptable Platforms , which Board Director Jaimie Johnston says, ‘allows a far wider range of clients to get the same benefits without the need to create a new system.’

Speaking about the innovative qualities of the Circle project, Co-Founder Martin Wood comments that Circle Reading was the first exercise to really connect design and construction in such an intimate way. ‘The platform principle completely enshrines design and construction as a single entity,’ he says. ‘It’s effectively a way of thinking, a principle where the rationale in design supports the rationale in construction in a fully unified, virtuous circle effect.’

Johnston elaborates, explaining that the project employed an ‘evidence based approach’ to ‘balance various and often contradictory [stakeholder] needs.’ These included those of individual clinical specialisms, nursing staff, catering providers, facilities and maintenance providers, the Care Quality Commission etc... Ultimately, Johnston explains, this facilitated an ‘overall optimum outcome,’ which he describes as being a combination of fantastic patient experience, minimised costs, optimised use of DfMA and more. ‘We aren’t aware of anyone doing it in this way before,’ says Johnston, ‘because anyone who could do the stakeholder piece couldn’t then design the DfMA systems and vice versa...’

As the Reading project demonstrates, working in this way drives a great number of efficiencies and Johnston remarks that ‘Circle were highly supportive of the design and delivery approach developed for them evolving in this way,’ noting that they ‘have always been keen to share best practice with other clients.’

Indeed, as Wood points out, the benefits of Platforms can be applied across typologies, from healthcare to educational facilities and housing. As time progresses and ushers in vastly increased productivity demands for the construction industry, the use of digital technologies and automation will provide a key solution to facilitating the necessary increases, as well as generating an array of client, end-user and societal benefits. It’s a methodology which facilitates higher accuracy, reduced costs, less waste, improved user experience and performance.

To this end, Circle Reading provides a glimpse into the efficiency anchored future of architecture, delivering a 25% cost savings on Circle’s previous Bath hospital and being delivered in just over eighteen months. Uniquely, the focus for the facility was designed to be on cost per clinical outcome, rather than square meterage, or other metrics traditionally associated with buildings. In addition to this, Wood comments that patient experience ‘was paramount.’ ‘Circle Reading, we believe,’ he says, ‘balances these two factors to a degree that’s not been seen in hospitals, certainly in the UK, before.’

Ultimately, such a unique focus has brought to life a space which, at its most fundamental level, is designed to be the most effective type of hospital. Still, as Wood reflects, there isn’t anything ‘utilitarian’ about Circle Reading. The focus on driving efficiency and achieving value for the client, doesn’t have to compromise ‘the internal environment or the experience.’ On the contrary, this is a building which has been enhanced by it’s practical design ambitions.

‘Liberated’ is the word used by Theatre Lead, Albert Maswiken to describe the feeling he experiences working within the hospital. It’s a sentiment echoed in a myriad of small and large ways by other staff members, each of whom strive daily to deliver outstanding patient care within this uniquely beautiful, efficient and mindfully designed space.

Circle, whose ethos encompases excellent patient care, best management ideas and a culture of partnership, are the official supplier for British Rowing and were named Private Hospital Group of the Year by LaingBuisson in 2015. Still, at first glance, you’d be forgiven for not immediately recognising the building’s function as a state-of-the-art medical facility. This is a hospital which, according to Bookings Team Leader Adam Chivers, patients often comment, ‘looks like a five star hotel.’

With its distinctive black glass, basket weave cladding, the hospital’s exterior panels seem to reflect the expansive movement of sky and clustered cloud formations from every angle. It’s an aesthetic which manifests Bryden Wood’s belief that a hospital occupies a special status of building in society, one with such a substantial level of importance and value that it deserves to be signified in the very appearance of the structure. The physicality of the Circle Reading building is both luminous and reflective, fundamentally optimistic feeling, but also discreet and secure. ‘We were able, with Circle Reading, to give the building an aesthetic which was beyond purely functional,’ says Wood.

Beyond its striking glass exterior, lies the building’s central atrium - a sleek, communal space, three stories high and full of light, which houses a reception and cafe, accompanying tables, leather sofas and modern artwork. It’s an area Orthopaedic Surgeon, Raj Goel jokingly, but admiringly, refers to as ‘the foyer.’ ‘Patients say, “Wow, what a great place to work in,”’ he says.

The other Circle staff members seem to agree, united in their appreciation for this particularly special aspect of the hospital. Maswiken enthuses about the sense of cleanliness one is given, casting a view across the space. Kirsty Cobden, a member of the Business Development Team who often holds events in the atrium, says she thinks the area’s aspirational, calm atmosphere has a direct effect on patients. ‘It doesn’t look like a hospital,’ she says, ‘so it puts them at ease as soon as they walk in… There’s a smell to hospitals. Whereas when you walk in here, you’ve got the smell of the deli, of the food, of coffee.’

Martin Wood describes the concentration for the design of the hospital as being on efficiency of flow, in a way that ‘owes more to manufacturing processes, owes more to buildings that are directly about efficiency in outcome.’ However, he notes that at Circle this doesn’t compromise the user experience in the least. ‘Emphasis on value,’ he says, ‘does not necessarily mean that it precludes the use of interesting architectural form.’ Rather, the opposite. The atrium aids with facilitating natural and easy way-finding, says Wood, adding that the building’s concentration on flow efficiency, as well as the sense of legibility the space provides, actually lends itself to a reduction in stress. ‘Everything is self explanatory,’ he says. ‘There is no need for signs. It’s very evident where you might go for your consultation, or go to diagnostics, or in fact, go up to prepare for an operation…’

‘You can feel that it’s like the hub,’ says Adam Chivers, commenting on the central functionality of the atrium. ‘There are nurses backwards and forwards...consultants....and although you can feel that a lot is going on, it’s still calm.’

This last sentiment is one echoed by GP Liaison Abby Wilkinson, who adds that it’s nice for staff members to be able to come down and work in the atrium sometimes, away from the hustle and bustle. ‘If they need to crack on with something, they can in a quiet corner if there’s not many patients in,’ she says. ‘It’s quite nice to sit down there and have a conversation if you want to.’

Indeed, the atrium sets the tone for what is undeniably one of Circle Reading’s key architectural features - space. ‘Everything about this place is space,’ says Raj Goel. ‘There’s nice space everywhere.’

The facility generously houses five theatres, thirty inpatient and twenty day case beds, fifteen consulting rooms and an extensive rehabilitation department. Describing the process of layout design for the hospital, Wood notes that the more Bryden Wood understood about the hospital and its patients, the more they were able to ‘codify their operations, their adjacencies and their spaces…’ He discusses the fact that Bryden Wood were able to benefit from a considerable amount of consultation and direct input from the professionals who were actually going to be using the facility. All of that knowledge was then enshrined into a three dimensional design tool, he says, which became like a ‘vocabulary of spaces…’

Wood also describes how such a level of understanding about the function of the building, led logically to the next step of applying a level of systemization to its construction, in order to underpin it and make construction more efficient. ‘We understood...the scale and the spans that the structure would require’ he says. This enabled the development of a system which is ‘a hybrid, precast concrete and steel system specifically for Circle,’ one which follows the ‘grain’ and ‘functional requirements,’ of all the spaces to be contained within the building. ‘This made the delivery of the building faster,’ says Wood. ‘It made the quality of the building higher and the accuracy of the building higher, and it made this efficiency repeatable on future projects with relative ease.’ Notably, he says, the process also enabled ‘an understanding of the potential scale and efficiency of the building much earlier than normally possible.’

Maswiken recognises that the building’s sense of spaciousness comes from the fact that the hospital benefits from such a ‘well thought out design.’ ‘We’re very lucky with our building and the set up,’ he says. ‘You don’t feel claustrophobic at all.’

Goel says that from his perspective it’s all very well organised. ‘The radiology is very close by. Physiotherapy’s really close by. So it’s easy to get hold of people.’

Of the building’s general layout, Kirsty Cobden comments that usefully, ‘Everything goes round in a circle. There are no dead ends, so you don’t have to go back on yourself. You just keep going all the way round.’

Maswiken also remarks on this ease of movement within the hospital. He enjoys the freedom of not having to ‘push things aside’ to walk between areas. The hallways are very spacious, particularly when compared to the ‘narrow corridors’ of other hospitals in which he has worked. ‘For safety reasons,’ he says, ‘I feel very reassured that it’s very safe in terms of evacuation and day-to-day movement. It’s very good.’

Head of Nursing Paul Highton expresses this same sentiment when discussing the various options he has if needing to move quickly to another area of the facility. ‘It’s very easy, really,’ he says. ‘There’s a central stairway, which you can sort of run up, or walk with intent… The lifts are very quick. They’re very spacious. It’s easy to negotiate your way around. If, for some reason, I couldn’t go that way, there are fire exits at each end of the building, which I could go up if needed.’

The other aspect of the hospital’s sense of spaciousness is, of course, provided by the rooms themselves. Supplies Lead Wendy Bonard-Williams comments that her team are fortunate in this regard. ‘With the actual store rooms themselves,’ she says, ‘they’ve really thought about it.’

Raj Goel agrees when talking about the outpatient rooms. ‘There’s a clinic area next to each room,’ he says, ‘which is very good and that doesn’t always happen in other places.’

Maswiken comments upon the ample sizes of the recovery spaces. He, Highton and Goel remark upon the particular spaciousness of the theatres, with Goel commenting that this is a ‘major attraction’ of Circle and highlighting the fact that the anesthetic rooms are also very spacious.

‘This facility had a particularly large percentage of orthopedic surgeons,’ says Wood, ‘and orthopedic surgeons needed a very particular form of operating theatre...more instruments tend to be involved in the operations. Therefore, we actually simulated in three dimensions, in a virtual environment, how they were going to use their equipment...we were able to position the components within the operating theatre more accurately, so that the efficiency of the operations could be greater than within a typical, general purpose operating theatre.’

The high ceilings in the theatres are mentioned by Maswiken, as being a particularly excellent feature of the building, with respect to the way they aid with the use and management of equipment. ‘You can actually leave the key equipment in those theatres, rather than moving that equipment up and down all the time,’ he says, before reflecting that actually, because the theatres benefit from ‘integrated systems,’ everything is already mounted and can just be moved around, which he refers to as, ‘yet another advantage.’

Johnston elaborates, commenting on the high level of integration between the structural, MEP, architectural finishes, electrical, data etc… All of this, he says, allowed Bryden Wood ‘to create a high level of prefabricated MEP (building in ease of maintenance and replacement) interfacing with a highly systemised superstructure.’

In addition to these advantages, Maswiken enthuses about how lucky they are at Circle Reading to have their core/prep rooms, as well as the benefit of a layout which enables patients to go out through recovery to the wards, rather than back through the theatres.

Goel also comments on layout efficiency saying, ‘The recovery, the day case ward...is very close by.

Further to this, he and Maswiken have many other positive elements to highlight about the Circle theatres. The three used predominantly for orthopaedic surgery have laminate floors and special ventilation systems providing ultra clean air, which Goel describes as ‘perfect.’ He also enthuses about how having images of x-rays on the computer system, enables them to be projected onto a television screen on the wall. On a more personal note, he enjoys the ability to put music on. ‘Everywhere else, I have to take my own box because they don’t have sound,’ he says, ‘so that’s quite nice.’

Maswiken also talks about the benefits of the lighting flexibility, with the ability to dim the lights or increase lumination, which he says provides options depending on the type of surgery being conducted. ‘Particularly if you’re doing laparoscopic work,’ he says, ‘you might need to dim the light a bit to give the surgeon a better view of the images, so in that way it works very well.’ He also speaks about how lucky he feels to have windows in some of the theatres. It’s quite an advantage,’ he says, ‘Because, just imagine, I’ve been in theatres all day and it helps at times, just to be able to reconnect a bit with the outside.’

This theme of bringing a sense of the outside into the internal hospital space is another picked up by multiple staff members. ‘I think for the patients on the ward the nice thing is that all of our bedrooms have their own windows that look out to an internal courtyard,’ says Highton. ‘So they all have a natural element to them. They’re not looking out into an industrial unit or to another wall… The atrium is very large. It’s open, it’s airy, so that provides light. It’s quite a light feeling building.’

Wood confirms that by turning the upper floor, outpatient windows inward toward the courtyard, Bryden Wood were able to create ‘much better acoustic and views’ for those rooms. ‘We made the building an experience that was unaffected by surroundings…major roads and other buildings that we had privacy issues with onsite. We turned the section of the building, so it’s quite introspective…instead of looking out, or typically out, to the surrounding environment, which is compromised.’ Additionally, he comments that the removal of the ‘domesticity’ of these windows aids with providing the building’s external aesthetic that ‘higher, almost iconic value,’ it manages to achieve.

It’s all part of Circle’s larger focus on personal experience, which Highton also discusses with respect to the patient bedrooms. These he describes as being ‘of a very good size...not too big… So they’re not cold and very clinical,’ he says, before highlighting that because the patients all have their own individual rooms, ‘there is much more space.’ Each in-patient room also contains a couch able to double up as a bed for guests if they want it overnight. It’s all been well considered, in other words, with practicality and comfort being the priorities.

This ongoing sense of space, light and comfort lend themselves to what is undeniably a positive hospital experience for staff, with the feeling manifesting in a variety of ways.

Sharon Matchey, Circle’s Admin Lead, works alongside Adam Chivers on the admin floor and comments on the department’s open plan structure, ‘If you’re having a bad day the team lift you,’ she says. ‘We all keep an eye on each other.’

‘It’s a bit of a team spirit, really,’ confirms Adam.

Paul Highton is located nearby with other key members of the Circle Team, including the Head of Operations and the Hospital Director. ‘What I really like is that there’s no segregation.’ he says. It allows people to interact with each other… Anybody can come in and just have that conversation with us.’

In other words, at Circle Reading, there is the dual benefit of both a sense of community, as well as a sense of peacefulness. Wendy Bonard-Williams says that her favourite area of the hospital is the glass walkway up on the second and third floor. ‘It’s in a big figure eight,’ she says. ‘Hardly anyone goes down there and it’s just a complete glass wall so you can see out...see across to the hotel and things like that.’ She talks about the quietness of the space. ‘You can literally go up there for five minutes and escape and you won’t see another person… So that’s quite nice,’ she says, laughing.’

Raj Goel sums up the general mood about Circle’s Reading facility. ‘It’s a great place to work,’ he says. ‘It also encourages a positive attitude when you come in because even the patients...when they come in...look impressed. So they have a positive approach to it and even the staff, really.’

‘I think it’s a lovely environment to work in,’ comments Highton, before adding that he admires the way Circle learns from every establishment it builds. ‘I think the building lends itself really well to care and nursing,’ he says. ‘It makes giving good care easier. I very much enjoy working at Circle.’

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