ONSTAGE: INTERVIEW WITH TIZIANO BININI, BININI PARTNERS
In an area known today as MIND, Milan Innovation District, a surface that hosted Expo 2015, in collaboration with the Human Technopole and the Università Statale, will arise the new headquarters of the IRCC Galeazzi, a building of modern architectural conception, designed by Binini Partners studio, according to the most innovative standards of sustainability and functionality. Extending over a site of 180,000 m2, it will embrace in a single location the skills and specializations of IRCCS Galeazzi Orthopedic Institute and of Sant'Ambrogio Clinical Institute, with a strong orientation in the cardio-thoracic-vascular and bariatric field, both existing, part of San Donato Group, GSD. It will be based on a close, synergistic integration between scientific research, university training and treatment, giving life to a polyclinic and overcoming the concept of monospecialistic hospital. Designed in terms of multidisciplinarity, it will offer the patient extremely efficient services with maximum optimization of time and maximum competence thanks to the team work of different specialists. Almost 90m high, it will be the first example of a modern vertical hospital in Italy, one of the few in Europe, embodying the prototype of ‘Hospital of the Future’.
The structure, which has been demanding to manage and to make operational from an engineering point of view, optimize routes, speed of movement and transport, offering remarkable advantages in terms of economy and functionality. Highly technological, based on robotics and digitalization, and very welcoming, the building will combine spaces and intervention methods among the most advanced, supporting the most sophisticated healthcare, focused on respect for the patient and man. Thanks to the choice of sober and eco-compatible materials, the absence of emissions, the use of renewable energies and the automated management of processes and routes, it is eligible of LEED Gold IV Certification. Equipped with a total of 16 floors above ground, an intermediate technical plan, and the roof with solar and photovoltaic, it includes a carpark in the basement. Located in an urban area easily accessible by public transport, it well interacts with the context and people. Permeable to light and greenery that surrounds the area and penetrates internally, it combines the sophisticated technological support with the important beneficial presence of nature.
I am pleased to interview the President of the group, Eng.Tiziano Binini and I thank him for his cordiality.
1. Your hospital has been defined 'Hospital of the Future': can you explain what makes it so innovative?
The new IRCCS Galeazzi of San Donato Group, under construction in MIND area, Milan, is designed according to an innovative functional-organizational concept, based on processes and flows of care, research and university training, with the patient at the center of the system. It is a model with no comparisons at the moment in Italy and, perhaps, not even abroad. The project aims to create a complex production "machine" of health, with the intent to realize a 'sustainable' hospital, not only in a green and environmental sense, but also on an economic and financial level, to make possible the best treatments for everyone, in a constant evolution. For all these innovative features, to Galeazzi was recently assigned the CNETO Award 2019 for Best Hospitality Project.
2. Hospitals of today must satisfy increasingly complex requirements: needs of a rapidly evolving technology and the specific needs of human being. Do you believe that both the demands can be fulfilled?
Certainly. It is necessary to have the best technologies and the most advanced university research and training, to offer everyone the most appropriate treatments in maximum comfort and humanization of treatments. The consequent costs, however, always higher, must be sustainable for a modern welfare. Therefore the structure must become efficient itself, both in terms of organization, accessibility, paths and employment of personnel, in terms of energy, resource management, consumption and reduction of emissions.
3. Some architects defend the 'horizontal structure', of three or four floors at most, as the best design choice, since it would no longer suggest the intimidating impact of 'hostile fortress' and it would better integrate with the city and the surrounding context. What do you think?
In our opinion this is a unilateral, not multidisciplinary, fundamentally a priori vision. In fact, it seems to us outdated to think of pre-established models: the aim is the production of health for the citizens and each hospital is entrusted with a different ‘mission’, integrated with the reference network of local or national services, for an efficient continuity of care. This determines the single ‘model’ that the hospital project must implement on every different occasion, because the need of people, at least in relation to acute care hospitals, is to find, without waiting queues, the best treatments in the most contained shortest time possible. In large cities, such as Milan, the demand to keep assistance, research and training closely integrated, in a fast changing and regenerated urban landscape, inevitably pushes to the development in height, as in the case of MIND, the new ecosystem of research and innovation that is being built in close integration between public and private. Furthermore, development in height is now perceived by people as a symbol of efficiency, innovation and urban regeneration, introducing new attractive and fascinating scenarios in the city skyline. At the same time, verticality allows for optimization and organizational efficiency, reducing routes and promoting orientation, a real obstacle for those who enter the hospital.
4. Do you shares the importance for large hospitals of an 'out-of-the-box' program, which should make the structures more accessible and integrated with the urban area, turning them into important power supplies for the surrounding institutions? If so, how would you conceive this program?
A multi-specialist hospital like Galeazzi has a national and international profile of users and relations. Its location within MIND relates in the most appropriate way with the Masterplan of the ex EXPO Milano 2015 area and benefits from the accessibility to the infrastructural networks of the national High Speed, Metro, Motorways and Tangenziali of Milan, maintaining a campus with sustainable mobility inside. It is therefore a large research and private teaching hospital, of public service, which integrates with some of the most relevant cultural and innovative realities in the country, such as Human Technopole and the Università Statale of Milan, but also with IT, pharmaceutical multinationals, automation, robotics etc., which have already shown interest in taking part in it.
5. Someone claims that we are actually practicing high-tech medicine in antiquated buildings and that hospital planning has fallen into unsuitable rigid patterns, unable to meet the requirements of change, growth and flexibility. Do you agree too?
Unfortunately, that's the way it is. A very large part of Italian hospitals is outdated in structural and plant engineering terms, such as to make the implementation of new technologies difficult and expensive, if not impossible. But above all their management is very difficult in logistical and economic terms, with waste of resources and consumption, not to mention fire and seismic safety. The investment in adequate and flexible structures would lead to management savings that could be dedicated to improving the quality and sustainability of care. In our opinion, the Galeazzi truly represents a new model of hospital, which surpasses also recent conceptions, although widely used from the 90s to today, offering free and flexible structures on all floors, a system of strictly separate paths for functions and progressive hygiene, wide and open lateral parts to accommodate the most modern diagnostics and the most complex hybrid rooms, a distributional organization that foresees the work areas of the staff in the ideal focal point of the floors, with the patient's spaces around, increasing the speed of intervention and comfort of people.
6. Hospitals must be flexible, capable of updating themselves. After fifty years, some argue that they are obsolete and that the cost to build a new structure equals that of running it for only one year. So what should be a better solution for old structures of historical value and the less important ones?
This is an evolution that has been evident, for example, in the industrial sector: after the Second World War, Milan is undergoing strong regeneration, favoring the recovery of green spaces, the quality and facilities of a ‘smart city’. The production spaces and logistics have found new areas and locations according to production systems and industrial configurations that employ the most modern technologies, defending the health and the environment that surrounds them. Where this has not happened, production inefficiency, degradation, strong urban and territorial impact remain, now no longer tolerated by local communities. Hospitals too should therefore be profoundly renewed, according to objectives and functions integrated with the various Regional Health Systems. First of all, to regain efficiency and safety for the benefit of a modern welfare, but also for the redevelopment of urban spaces and historic, sometimes precious, buildings today often used in an inadequate way.
7. The new IRCCS Galeazzi is an institute based on lean techniques: a term which architectural language does not make much use of. What exactly does it mean?
Lean Thinking is fundamental in healthcare and hospital planning: the reduction of waste, the standardization of processes, the centrality of the patient and the control of the service provided must be the obsession of all those involved in the management, to pursue the goal of an excellent healthcare for all. In this sense, the designer is a key figure: the correct management of spaces and paths, for example, is crucial to rationalize and optimize the use of resources. Planning in the health sector reaches unusual levels of complexity for the profession and the integration between the different skills, that is essential. Combining this with attention to architectural and compositional aspects, care for the environment and the context is a daily challenge, but we willingly take it, aware of the responsibility inherent in our profession.
8. What do you think about the assisted home care: a utopia in Italy or a possible reality? Do you believe that in the future it will be possible to see its application also in Galeazzi?
Today, talking about telemedicine and precision medicine is no longer a utopia and digitization allows to manage organizational systems that ensure continuity of care from the hospital of excellence to our residence, without lowering the quality and competence of the services. Galeazzi is already equipped in this sense, through the digitalization of all systems, which constitutes one of the main sectors of the GSD client, together with the promotion of health with the use of hygienic and natural materials, aiming at the certified control of the efficiency of technologies, systems and LEED Gold IV certification for the building.
9. A country that is a leader and can teach us to treat people and the environment. A hospital that you like and could be taken as an example.
Italy has developed, with the commitment of many, public and private institutions, universities, professionals, operators, researchers, technicians, etc., one of the best health systems in the world and I believe that it can export knowledge and quality for the care of people in all countries. We ourselves have had repeated experiences and job opportunities abroad, achieving highly appreciated results even in the most advanced countries. We believe that spreading the culture and skills for the care, respect and enhancement of man in all sectors, from medicine, architecture and engineering, is one of the essential factors of growth and peace between nations and cultures. About the hospital we really like at the moment and we are sure can be taken as an example, the answer is obvious: it is certainly the new Galeazzi where we have tried to condense the most advanced ideas and solutions that derive from several decades of study and experience at the highest levels.
IRCCS Istituto Ortopedico Galeazzi, Milano
Photography: Courtesy of Binini Partners