Architecture

Faced with an outdated hospital in a growing region of North Cowichan, British Columbia, Canada, owner Island Health saw an opportunity to start anew with a 607,600-square-foot replacement facility.

Scheduled to open by 2027, the 204-bed Cowichan District Hospital will incorporate design features that reflect the culture of the local Cowichan people, the largest Indigenous population in British Columbia. Sustainable features will take a priority, as well.

Shane Czypyha (Image credit: Albert Law Photography)

Here, Shane Czypyha, architect and principal at Parkin Architects (Vancouver, British Columbia), lead architecture and interior design firm on the project in association with ZGF Architects (Vancouver), discusses achieving cultural and environmental goals in healthcare design.

How did input from local Indigenous Nations and the community guide this project?

The project team learned how important it is that the building feel welcoming to the Indigenous community to foster trust, respect, and comfort, encouraging Indigenous People to seek medical care without fear of discrimination or misunderstanding.

Key elements include artwork, traditional patterns, and materials that resonate with the local Indigenous culture; creating spaces for cultural practices involving burning with appropriate ventilation systems; and ensuring signage and information are available in Indigenous languages.

This sense of welcome is crucial for bridging healthcare disparities and improving health outcomes within the community.

How did that feedback impact the design?

There are many design considerations that have been taken, such as obtaining approval from the fire department to shut off the mechanical system ins some of the staff and patient spaces to allow for traditional burning protocols, such as burning herbs, sage, or incense during times of illness or death—a common Indigenous healing practice.

Additionally, the emergency triage desk has been designed to be more welcoming and less threatening for patients by concealing the typically front-facing security office behind the enclosed triage desk. Security or police presence has historical punitive connotations for local Indigenous people and can induce trauma, discouraging them from seeking care. To make this area more culturally safe, the security office was renamed “Ts’uwtun,” meaning “greeter” in Hul’q’umi’num, the native language of the Cowichan People.

Additionally, an Indigenous food preparation kitchen was programmed to provide traditional foods that can be served to both staff and patients alike. The landscape design includes many Indigenous plants, such as salal, Oregon grape, and Pacific dogwood, and the water on the site is naturally treated through rain gardens so that it does not have an adverse effect on the salmon population downstream.

What’s driving demand for more culturally sensitive healthcare environments?

Education of the general public has increased following recent findings about practices at Residential Schools in Canada’s past, including the In Plain Sight report by Canadian lawyer Mary Ellen Turpel-Lafond, which highlighted the disproportionate mistreatment of Indigenous Peoples in the healthcare system. There is no option but to do better.

The healthcare industry is also shifting to better educate staff and professionals about cultural sensitivity and historical contexts, facilitating real engagement and consultation with Indigenous communities.

During the construction phase, cultural training is provided for all people working on the construction site, and instructional stand-downs are implemented to address instances of racism against Indigenous construction workers immediately and effectively. Stand-downs allow employers to voluntarily stop work to address concerns, such as reported instances of racism. Although stand-downs are an option, there have been no instances of one being implemented so far.

This project also set big goals for sustainability. How did those become a priority?

The project’s collaborative delivery model, encompassing the owner, designer, and contractor, set a Key Result Area (KRA) for sustainability. Full electrification helped us exceed the minimum conditions of satisfaction in that KRA by aiming to be British Columbia’s first all-electric healthcare facility.

A significant hurdle was assessing the capacity and sustainability of electricity generation within the local grid. We overcame these challenges by collaborating with local utilities to ensure a sufficient green energy supply and implementing aggressive energy targets and regular monitoring to achieve more sustainable outcomes.

What other strategies are on your radar?

Sustainability alone is not enough due to the significant energy, water, and resource consumption of healthcare facilities. Our buildings need to bring regenerative solutions that give back to our ecosystems and energy grids, such as generating more energy on-site and utilizing site water.

Operationally, we are exploring food production on large sites and encouraging clients to adopt more sustainable practices, such as eliminating single-use plastics in food services and medical supplies.

For more on this project, check out the session “Reconciliation and a Net-Zero Carbon Future: The New Cowichan District Hospital,” at the HCD Conference + Expo, Oct. 5-8, in Indianapolis. For conference and registration details, visit hcdexpo.com.

Tracey Walker is managing editor of Healthcare Design and can be reached at [email protected].