We are looking for potential in an atmosphere based on the human scale; the scale of social meetings; the scale that allows patients to be well orientated; the scale of sensory perceptions.

1. THE CHALLENGES OF ARCHITECTURAL HUMAN SCALE IN HOSPITAL
ENVIRONMENTS: BRAZILIAN HOLY HOUSE OF MERCY.
Moema Loures
PUC-Rio - Pontifical Catholic University of Rio de Janeiro
Imaginal Arquitetura
moema@imaginal.com.br
www.imaginal.com.br
Architect and Urban Designer. Founder of Imaginal Architecture, a Brazilian office focused
on healthcare architecture and design. Professor at the Architecture School PUC-Rio
(Pontifical Catholic University of Rio de Janeiro). PhD in urban design at Federal University
of Rio de Janeiro / École Nationale Supérieure d'Architecture Paris-Malaquais, France.
Master at Federal University of Rio de Janeiro / University of Seville - Escuela Técnica
Superior de Arquitectura, Spain.
We envision an argument that favours human senses in hospital ambiences. We are looking
for potential in an atmosphere based on the human scale; the scale of social meetings; the
scale that allows patients to be well orientated; the scale of sensory perceptions. We believe
that a human-scaled space is the path to encapsulate beauty and simplicity.
Thus, we turn our gaze to the sensitivity of colour uses, light intensities, temperature
variation, supporting orientation, way-finding system, and constant interaction of our bodies
and movements within the environment in the architectural experience. We take into account
the concept of a healing environment, improving sleep and reducing agitation and anxiety,
as well as, increasing social relationships.

2. Our reference-case is the Holy House of Mercy Hospital in Juiz de Fora - Brazil - and the
dialogue between architecture and ludic and its interfaces with art and design opposed to
rigid institutional routines.
Image 03: Endoscopy Centre. Stimulating a ludic atmosphere.
The Holy House is a philanthropic hospital founded in 1854. The main building was built in
1942, has 15 floors and represents the first vertical hospital in Latin America. It is a complex
with 508 beds, a consultation and diagnostics centre, emergency services, operating
theatres, intensive units, a nursing centre, knowledge, logistics and technical centres, an
industrial kitchen and laundry. In the Complex there is a chapel and House, both dating back
to the 19th century.
Image 03: Juiz de Fora Holy House of Mercy.

3. Over the past four years, the institution has been undergoing a period of big changes in its
physical infrastructure. Important refurbishments were made to the consulting centre for the
Public Healthcare System, the Hemodynamic and Endoscopy centre, the Centre of Sterile
Supplies and the Coronary Intensive Care unit. Beyond this, the refurbishment of the
hospitality sector includes 55 new rooms. The Holy House of Mercy also incorporates in its
complex a building that was refurbished to house the consulting centre for its private
healthcare system.
Image 04: Consulting centre for the Public Healthcare System. The green panel supporting orientation and way-finding
system.
Having “the detail” as a keyword, for each work, we were learning how to approach the
architecture on a human scale. The goal was always to awaken the playful in a rigorous and
complex hospital environment. We start from small to reach a large scale.
Just as the great masters of Dutch architecture taught us in the past, the major design
challenge is to master the urban, architecture or design scales. For us the most important
thing to remember in a large-scale complex is to not lose the human scale.
Image 05: Coronary Intensive Care unit. Image 06: Endoscopy Centre. Designing the details.

4. Technology and logistics are incorporated so that they function optimally but do not
dominate the atmosphere of the interior space. The first impression of the refurnishing
should be that it was easy to be done, and is simple and beautiful. In this project the patient
has no idea about all the fills, gases and infrastructures that are needed to keep them alive.
Image 07: Hemodynamic unit. Interior space atmosphere inside a operate theatre.
Image 08: Hemodynamic unit. Resting centre and the chairs panel.

5. The idea is to arouse curiosity of those who experience the architecture. The drawings, for
example, are located in places where they are not evident, the patient will discover them.
The forms are not clear, they instigate sensitive imagination.
Image 09: New rooms. Drawings behind the door.
Another example is the Hemodynamic project: the focus was on the notion of logical,
chronological and topological time. Due to the objectivity of time on surgeries as well as the
relativity of time in patient recovery, we decided to enhance this concept by creating different
watches in which the exercise of seeing time becomes subjective, distracting the patient
from focusing on their pain.
Image 10: Hemodynamic watches. Distracting the patient and staff.
In each work we also take into account the context of the whole complex, trying to bring
inside the natural light. Daylight is essential for the quality and functionality of a hospital and
its adjoining inner areas. Architecture is especially the spatial experience that people
undergo in buildings; the relationship with the outside for us is crucial. We are always
interested in light, daylight, the light on things; it gives the feeling that there is something
behind all understanding.

6. Image 11: Central of Sterile Supplies. Looking for the health of the staff.
Image 12: New rooms. Natural light all over.
What made this possible was that the board of directors imposed no restrictions on the
spatial orientation and was always supporting the architects’ decision. The close relationship
with nurses and doctors translating their needs in architectural terms was also essential to
achieve our goals.
An integrated approach has resulted in our participation for the whole project process, since
the first ideas and desires of doctors, nurses and boards right up until the units had started
work. We have an architecture office inside the hospital and we work together with the
engineers and the construction team. We are immersed in the construction site and in the
hospital ambience.

7. This methodology of completed immersion in the hospital is giving us the opportunity to
sense the character that surrounds it, we are able to feel the Hospital behind-the-scenes.
Architecture not only to create functional and well designed spaces but also to
provide possibilities to animate human instincts and habits by interacting with all of the
human senses.
Image 13: Corridors. Architecture and engineering side by side. Illustrative image.
Image 14: Immersing in the construction site.

8. The most important aim of the architecture is the creation of an atmosphere inside and
outside the building that helps the patient to recover as quickly as possible and to make the
stay as pleasant as possible. We believe that the architecture can reduce the stress-levels of
a hospital, medical errors and hospital infections.
Gradually, we approach the concept of living. By inhabiting space, individuals can sense the
character that surrounds them. We argue that architecture and space are designed and built
for people to use and experience. This feeling of presence, well-being, harmony and beauty
is incorporated into the hospital ambience.
This year we started the first ideas to build a Holy House of Mercy Hospital extension. Our
main idea is to create a big boulevard that connects to the hospital. This space can give the
visitors, staff and patients a clear sense of spatial direction.
Image 15: Diagram of Holy House of Mercy Hospital extension. The big boulevard in red.
At the same time, the boulevard is not just a circulation area but also a public space. A
“between space” where you can stay to cast a quick glance outside, to talk with other
patients or just to have a coffee. A space for socialising, meeting places for family and
friends. The boulevard idea came together with a high level of daylight and a maximum
support for the professionals and minimum inconvenience for the patients.
Image 16: Juiz de Fora Holy House of Mercy Corridors. Place to take a break.

9. Some concepts came from an exchange trip we did to the Netherlands, vising more than 15
hospitals and some of the most important offices focusing on Hospital Architecture. What we
had seen was well planned and designed buildings, with similar costs of Brazil’s reality.
Unfeasible is the use of certain prefabricated elements with high technology and industrial
logistics of demountability and adaptability. This experience brings ideas and architectural
solutions that can be leveraged in Brazil, altogether with respect for Brazilian’s cultural
diversity, traditions and landscape.
Image 17: Den Bosh Hospital Boulevard.
Many questions about hospital architecture came to the forefront and were beginning to
influence our projects: How the aging population impacts on hospital settings? How
telemedicine impacts in reducing hospital beds? Why corridors are often narrow and
monotonous and can give rise to common areas for patients and visitors to meet, as a living
room? How natural light is utilised throughout the history of architecture and can drive design
decisions inside a hospital?
We ask ourselves how we are shaping the infrastructure of the future, knowing that
healthcare is changing very fast; a hospital that does not become outdated within a few
years but where, in the future, new care concepts and technical developments can be
added. At the same time, the only certainty we have is that the human scale will always be
essential in architecture and in promoting the speedy recovery of the patient. Human scale
will always be the challenge of architecture.

10. (…) what I am designing will be part of a place, part of its surroundings, used and loved,
discovered and bequeathed, given away, abandoned, and perhaps even hated - in short,
that it will be lived in, in the wildest sense.” Peter Zumthor1.
Image 18: A concept room based on human scale.
1
Peter Zumthor Works. Buildings and Projects 1979-1977.

11. Image 15: A concept room based on human scale.