My pulse quickens. As I reach for the door, I notice my palms are starting to sweat. A familiar unease rises from the pit of my stomach, fomented in a haze of vague childhood memories and — more recently — the gurney ballet of a pre-operative procedure. I’m stepping into a hospital. It conjures a mental landscape of taupe walls, chemical smells and labyrinthine hallways. Drop ceilings. Fluorescent lights.
But the environment I find on the other side of the revolving doors is a world apart. Even in the physical distancing era of masks and Plexiglas partitions, to step into Toronto’s revitalized Princess Margaret Cancer Centre (PMCC) is to be embraced by an unexpected intimacy. Siamak Hariri is waiting for me inside. The founding partner of Toronto firm Hariri Pontarini Architects led a 3,778-square-metre reinvention that transformed the whole of the hospital’s ground floor, and created an oasis-like area on the second storey (HPA was design architect and NORR Architects & Engineers was prime consultant and architect of record on the project). Past the temporary COVID-19 check-in booths, we take in a space furnished in natural wood, soft lighting, terrazzo flooring and bronze accents. There is an entrance lounge with a fireplace that — even in the midst of a pandemic — implies an invitation to linger and rest.
And that’s just what patients are doing. As we weave through a sequence of spaces deftly carved through the heart of the busy hospital, the ceiling’s wooden baffles gently modulating the ambient din, a sense of quiet hospitality pervades. This isn’t your typical healthcare setting, but then, Hariri isn’t your typical healthcare architect. A renowned Canadian practitioner whose métier spans from residential and cultural buildings to the stunning Bahá’í Temple of South America in Santiago, Chile, the architect is quietly charting a course in patient-centred healthcare design. It began with a smaller-scale but remarkable work — Casey House, Canada’s only stand-alone hospital for people living with HIV/AIDS — and is evolving into mega-hospital projects including the upcoming BARLO MS Centre at St. Michael’s Hospital and this seminal achievement, the just-opened Princess Margaret refurbishment.
AZURE: I remember the old Princess Margaret. Like a lot of large urban hospitals, it was built out in many phases — and layers on layers of renovations. No matter where you came in from, it always felt like the back entrance. How did you approach the project?
- Siamak Hariri
Princess Margaret has long been ranked as one of the top five cancer hospitals and research facilities in the world, with an unparalleled level of care. I have had loved ones treated here. Every one of them was deeply impressed with the level of attention they received from the doctors and nurses. At the same time, it was very hard to feel that care when you stepped inside. It was almost a maze of hallways and signage, and it wasn’t a particularly welcoming or functional space. A sharp breeze blew in when you opened the doors — from either entrance — and finding your way through wasn’t at all intuitive. From afar, you couldn’t even see over the reception desk; you didn’t know there were people there. The care was always there though, and we wanted to translate that into the space, so that you feel looked after from the moment you step inside.
What does “care” mean to you as a designer?
Care is not one moment, it is a thousand little moments. And you slice it and slice it so that it touches everything you do. It’s all the small things: What does it feel like as you drive up to the hospital? You have cancer, and your energy level is so low that to walk from where the car leaves you to the door is a massive undertaking. The driveway used to be like a ski hill, so we made it just a little gentler. As you enter the hospital, it’s a smoother, more comfortable transition inside, and you see right over the reception area and through the space. It becomes demystified.
We organized the space on this idea of “green to green,” creating a passage and a clear view through the ground floor, so you see a glimpse of the outdoors from either entrance. And that way you know this space — and this thing you’re going through — doesn’t last forever. You can see outside and realize that at some point “this thing ends.”
And look at it from another perspective: Imagine you’re dropping off a family member at the door. Shouldn’t there be a nice place for them to sit while you go park the car? So we created a lounge right by the entrance, with comfortable chairs, a nice view outside and a fireplace. When you sit down and see the fireplace, you know “this is my space.” As a designer, you have to think deeply about how people feel.
When you put it that way, it sounds obvious. Shouldn’t all hospitals be designed with human experience in mind? But most healthcare spaces don’t look like this. Big institutional hospitals are typically overseen by big institutional architects, sometimes resulting in a sense of being project-managed rather than truly designed. Yet you broke out of that.
There’s a perception that it can’t be done, and that the technical complications leave no room for design. And I won’t lie to you, it’s very difficult. We were working within a living, breathing hospital that was never shut down during construction. And that meant there were lots of things we couldn’t touch. But we were lucky to work with Frank Panici and the team at NORR Architects & Engineers, who saw much of this through on a technical level.
You also need one or two champions on your side, and we had them in Dr. Mary Gospodarowicz, Marnie Escaf and the Princess Margaret Cancer Foundation, which funded it all. They believed in the project. When you use natural materials in a hospital, like the wood and bronze we used here or the Algonquin limestone at Casey House, it violates every institutional norm, and it has to be tested and tested and tested. You need people on your side to get through that.
There’s also a logjam with how the Canadian procurement process — and the trend toward public–private partnerships — treats architects, and especially the way it limits opportunities for the younger firms coming up now, though that’s another story. But from a design standpoint, of course it can be done.
You’ve designed exceptional healthcare spaces before, albeit on a more boutique scale. Toronto’s Casey House is akin to the Maggie’s Centres across the U.K., but the PMCC space is at the heart of a much larger hospital with 264 beds and international research. How did that influence your design decisions?
At Casey House, we were starting with an old Victorian house, so extending that feeling of “home” throughout the hospital felt natural. We wanted to do that here too. But obviously it’s a different context, and so we started thinking about hospitality. What if a hospital could feel like a home and a five-star hotel? In many ways, this is a modest project, and not a particularly glamorous one, but it’s an environment that I hope conveys a sense of being cared for, a sort of concierge experience. Creating a space which says, “We got you. It may be what it is, it may not be perfect, but we are going through incredible efforts to extend your life.” That touched everything we did.
I drew from that sense of being cared for, and service — from doctors and nurses. I know that people in architecture don’t like this word, “service,” but I actually think it’s our higher calling. And great service is intertwined with beauty. It’s at the highest level of that conversation, which is that it reaches the apex of beauty, justice and truth. I don’t know if you agree with me, but I think that the highest thing that you can do is be of some usefulness or service to others.
Architects don’t like the term “service,” or to be thought of as “service providers,” because it just sounds like fulfilling the term of an RFP, coming in under budget and not really “designing.”
I’m trying to debunk it. Service is actually a very high order of work. And I think that to be of really great service means to have that level of care, and that sense of the aspiration to be very noble.
If you ask yourself, “What makes a really good doctor?” I would say a really good doctor would treat me as a human being — and treat me with care — and understand that human life is precious. To be of really great service means to have that level of care, and to embody this sense of nobility.
And the affirmation of life is central. How can we create an environment where you step into it and it is life affirming? As an architect, you’ve got to use all of the best levers that design gives you, which is light, which is proportion, which is materiality, which is craft, which is thoughtfulness. You got to use all these tools, in the most intelligent and most interesting combinations, to bring it together.
The concept of “service” and “care” recalls the work of the late anthropologist David Graeber, who elucidated a distinction between the “caring class of professions” like nursing or teaching and the so-called “bullshit jobs” rooted in managerialism. Can architecture fundamentally be about care?
It’s the mantra of the work that I try to do. I think when you do a really good house, it’s incredible how much you have to think along the lines of care. Because there’s no project more intimate. Arthur Erickson used to say, “The hardest projects are temples, and then houses.” I agree with him. I think that at the highest level, it’s exceptionally difficult, because the most intimate things in your life are happening within the home: You’re eating, sleeping, bathing, breaking bread with loved ones. It is an experiment in infinite care.
All of that also happens within a hospital. And so, why shouldn’t we, in our most vulnerable moment, when we’re in a hospital environment, not be obsessed with how we’re going to lift the spirit?
The renowned Canadian architect is bringing the grace and comfort of home to institutional healthcare settings, starting with Toronto’s Princess Margaret Cancer Centre.