Footscray Hospital’s Evidence-Based Design Sets Healthcare Benchmark

Convincing financiers to allocate more than 20,000sq m of possible hospital floor area to courtyards, terraces and winter gardens instead of clinical beds requires more than architectural vision. It requires a certain level of moxie—and creative clairvoyance. Melbourne’s new Footscray Hospital will be a business case for wellness-driven healthcare infrastructure, as data and research underpins design decisions that challenge conventional hospital development models. The $1.5-billion public-private partnership (PPP) integrates community connection and patient wellbeing as measurable outcomes alongside clinical functionality. Delivered by Plenary Health with architects COX Architecture and Billard Leece Partnership, and built by Multiplex, the 180,000sq m campus is one of Victoria’s largest health infrastructure investments. And it’s not your average hospital. PPP’s competitive advantage COX Architecture director Paul Curry says “there’s really nothing like Footscray Hospital anywhere else in the world right now”, and that the PPP framework was the commercial mechanism that made the innovative wellness-first design viable. “The competitive tension between public and private finances allows a designer to take the best mix of long-term quality and durability within a competitive framework,” Curry tells The Urban Developer . ▲ The $1.5-billion campus-style layout integrates into Footscray’s suburban street grid rather than dominating it. The 25-year concession model meant Plenary carried long-term maintenance obligations, creating a convergence between commercial interest and public benefit that justified premium materials that conventional procurement might have otherwise rejected. The government brief included minimum requirements and a wishlist—the PPP structure allowed the team to deliver a premium product and offset costs across the concession period. Plenary Health project chair Kelvyn Lavelle says the hospital ticked every box on the list—and then some. “It had to be more than just a yellow brick building in the middle of a car park,” he tells The Urban Developer . “It was just too rare an opportunity not to be transformational for the Footscray community.” Championing evidence-based wellness Office of the Victorian Government Architect principal advisor Sophie Patitsas tells The Urban Developer that “the hospital needed to be delivered in a way that is manageable for the state, it needed to be an affordable hospital but it also needed to be catalytic and impactful for the community”. The Government Architect adopted an urban design approach operating at precinct level, co-designing site-specific principles with Western Health and the Victorian Health Building Authority: calm, inspiring, contextual, approachable, connected, with access to nature and open spaces. Patitsas acknowledges some might view certain features as indulgent but points to credible evidence that good design qualities make tangible contributions to patient wellbeing, visitor experiences and staff effectiveness. The project draws on two decades of Victorian Government advocacy for health infrastructure design, with lessons from the Royal Children’s Hospital, Bendigo Hospital and the Victorian Comprehensive Cancer Centre informing Footscray’s approach. “And all aspects of this project are replicable for future projects,” Patitsas says. Victorian Government architect Jill Garner describes the outcome as achieving equilibrium between competing demands. “The design for the new Footscray Hospital strikes the right balance,” Garner tells The Urban Developer. “The design approach capitalises on the site’s unique and strategic location and focuses on the human experience to deliver an efficient and effective health service.” ▲ First Nations artists Maree Clarke and Mitch Mahoney’s tapestry incorporates symbols repeated throughout the hospital, helping wayfinding and connecting design to the cultural iconography of place. The evidence base From the outset, the design team treated the hospital as civic infrastructure owned by the community rather than a service facility. “We asked what are the qualities of a civic building that we should be bringing into a hospital and really making health an everyday part of the community,” Curry says. Connection to green space was front of mind. Billard Leece Partnership principal Mark Mitchell points to a landmark 1980s study on the healing benefits of nature that “we mined and integrated with our own design experience”. BLP drew on a UK study into ward efficiency, using U-shaped layouts that kept patients and staff in visual contact. Families were identified early as active participants in the healing process, with research showing family members can detect patient behaviour and health changes before clinical staff. “We designed for connection, security and safety by not isolating patients and families. We provided a space that supports the supporters,” Mitchell tells The Urban Developer . Each ward includes winter gardens—floor area that could have been beds. Mitchell describes wayfinding as responding to research on stress. “Most stress stems from having to make a choice, so we de-stressed that process,” Mitchell says. “There is always a reference point wherever you are.” ▲ Natural materials and visual connection to the village green create intuitive wayfinding, reducing stress from decision-making throughout the hospital street. The economic multiplier Beyond health outcomes, the precinct model delivers economic value. Lavelle says the economic multiplier effect will provide further justification for the precinct investment model and design choices. The hospital is projected to spur close to $300 million in additional investment including Plenary’s $60-million Tiernan Street building, a proposed $27-million tram superstop and a potential private hospital. At full capacity, the precinct will draw 5000 people daily. The project pursues WELL Gold certification—a national first for a hospital. The framework focuses on human health and wellness in the built environment, reinforcing the principle that buildings designed for longevity must be sustainable. In commercial terms, Lavelle says Plenary “wanted to help government reduce ongoing costs and make the facility more sustainable—energy and water-wise”. Mitchell says “there is such a strong economic argument for pursuing WELL certification, but really, we’re focused on the human experience”. “The people are the ones who will make this work.” Delivering on aspiration The campus comprises five interconnected buildings around a central village green designed by Tract ( pictured below ). The landscape anchors the site with retail, food and beverage outlets, ceremonial space, children’s playground and pedestrian pathways. Curry says the five-building approach responded to community consultation revealing how different cultural backgrounds experience large institutional buildings. Tract senior principal landscape architect and urban designer Rob Copeland says “the landscape and urban design work together to create a green civic heart that centres the wellbeing of patients and staff and invites the wider community in independent of healthcare needs”. “This is a truly integrated healthcare design, with biodiverse native planting, generous courtyards and green roofs offering restorative visual and physical access to nature at all levels,” Copeland tells The Urban Developer . Billard Leece Partnership senior associate and interior design lead Allison Jessup says the village green is central to permeability. “Whichever way you enter, you’re orientated by this village green that is really a community facility, not a hospital facility,” Jessup says. ▲ Five buildings frame the central village green—designed for community members to visit for coffee or meals, not just hospital appointments. There were more than 650 user group and reference group meetings with Western Health staff, separate from broader community engagement, which totalled more than 1000 hours of consultation. Mitchell credits Western Health’s willingness to question convention. “Western Health, instead of just saying ‘build us another one like the one we’re in’, put serious thought into the layout and what was needed to create a truly healing space. They made pioneering decisions,” Mitchell says. Lavelle says Plenary’s active equity model creates a “convergence between commercial interests, equity, facility quality and public benefit” that incentivised long-term thinking over shortcuts. Covid a challenge and catalyst Curry says the team won the competition mid-pandemic and modified the design during construction to address future pandemics. “There was flexibility built into the design, but also the design process,” Curry says. The emergency department can rapidly flex capacity by separating paths and repurposing clusters. The southern building was designed with top levels in lighter concrete specifically to enable future expansion. Mitchell says the pandemic influenced material choices in unexpected ways. Rather than defaulting to easy-clean clinical materials, the team specified hand-glazed mosaic tiles in lift banks specifically to invite touch in non-clinical areas. ▲ Clockwise from top left: Paul Curry, Sophie Patitsas, Rob Copeland, Kelvyn Lavelle, Allison Jessup and Mark Mitchell. Lavelle credits Multiplex’s construction sequencing, delivering on time and budget despite pandemic-related inflation and supply chain disruption. “At one point there were nine cranes on the skyline just around Footscray,” Lavelle says. Tracking outcomes, setting benchmarks COX and BLP are applying learnings to the new Bundaberg Hospital in Queensland. Both practices will track health outcomes at Footscray against the old facility, with Western Health operating both sites providing a rare before-and-after data set. Curry believes research will make the strongest case for wellness-driven design. “Having that data and demonstrating the value of these design decisions—things like recovery times and improved efficiencies across the 25-year period,” Curry says. Lavelle says replicability boils down to health outcomes and value capture. “The key is the precinct approach. How do you add value? This is a clear example of that. I think that’s what government’s looking for—value for money and value add in projects they do and the flow-on investment from them,” Lavelle says. Patitsas suggests the government would look to replicate the approach. “All these things are replicable. We know they are things we need to do. We just need to work with the right people to see it through,” Patitsas says. “De-stressing the hospital experience takes clever design and a team to deliver it.”

Footscray Hospital’s Evidence-Based Design Sets Healthcare Benchmark

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