Mario Cucinella’s ‘Iceberg’ Ospedale San Raffaele emerges ethereal in Milan

Architecture for healthcare institutions requires a specialised level of care and technical finesse for them to be truly genial as well as being procedurally and spatially sound, instead of coming across as formidable and grim. The building's functional programme remains delicate and crucial, its design and planning advocating foremost, proper patient care and healing.  

Carrying similar beliefs, the prestigious San Raffaele Hospital began its own up-gradation by commissioning Italian architectural firm Mario Cucinella Architects, to add a new 10-storey building with a fresh surgery and emergency unit to its existing medical complex, located at the edge of Milan city centre in Italy. This comprises a highly specialised emergency room topped by roof gardens, specialised visitor lounges, as well as a pioneering 284-bed inpatient care facility tower. At its core, the design rethinks what a hospital can be and should not be, creating a focal point for the Milanese cityscape.

The firm led by Italian architect Mario Cucinella has displayed with their vast, much-celebrated oeuvre of built works, an avid interest in the natural world, to relate coherently with it and display "creative empathy". Similarly, for the design of Ospedale San Raffaele, they opted for a structure that creates an impact by emanating a sense of calm with its white, curtain walled, "ethereal" appearance, unlike the typical, boxy typologies of hospitals across the world. Vertical ceramic louvres front the striking building that earns itself a nickname, “the iceberg” because of its luminous, significant and tapering white volume. Tranquil yet robust, the building is conceived as “an inherently humane response to designing an energy-conscious hospital environment," relay the Italian architects.

One of the leading factors that led the project was the responsibility of the hospital building to lessen its impact on the environment and adapt rationally to the densely built urban site. The existing buildings date from the 1970s to 80s, ranging greatly in their styles of architecture – “There was thus a need to create a more coherent urban realm for this densely built-up site,” the architects reiterate.

San Raffaele Hospital is an internationally celebrated model for bringing together scientific research, teaching, and clinical activities. The harmonious, glazed elevations of the university hospital’s new building give it distinction, playing with daylight and illuminating beautifully at night. The elevation displays rhythmic punctuations with large ceramic fins over its top five stories, coated with titanium dioxide that break down smog particles upon impact and wash down with rainfall.

"The cladding of San Raffaele’s new Surgical and Emergency Department, the white ‘skin’ of the ‘iceberg’, is not a formal gimmick but a system of state-of-the-art anti-smog ceramic slabs,” ensures Cucinella. The white louvres exploit the photocatalytic properties of titanium dioxide which transforms simple ceramic slabs into eco-active materials boasting anti-bacterial, anti-viral, anti-pollution, anti-odour as well as self-cleaning properties.

The staff may have perhaps also nicknamed the hospital “iceberg” for its icy appearance that seemingly cools down the cacophony of the visually restless and hectic nature of the disjointed, compacted site. “The nickname or metaphor works well with the subtly organic shape of the new building. Its gently curved sail-like elevations compress and expand gently to express how it fits into its surrounding urban landscape,” says Mario Cucinella Architects.

Earthen coloured tiles make up the single storey, cubic as well as introverted base of the hospital that grounds the extroverted levels towering above, hosting wards, doctor’s offices, outpatient departments and patient rooms. This functional, textured podium is referred to as the “technical plate”, and houses the emergency room (ER), currently the largest in the country, intensive care units, as well as a surgical block with 20 operating theatres below ground level, including two of the latest generation neurosurgery units. A raised garden of shrubs and trees graces the podium's top, providing peaceful pockets of natural greenery for all the users of the hospital, including the staff and patients, beyond which the white iceberg arises. The designed roof gardens further extend connections to nature to give the building a softer, more organic setting, providing its users much-needed breaks from stipulated conditions inside. Strategically set rectangular light wells filter natural light into the ground floors from this point, illuminating otherwise dark spaces. A bridge connects the new addition to the existing hospital’s facilities.  

The idea of the podium also refers to the earth as the base of the project, grounding and affirming. This floor is also where ambulances arrive, so its function and placement make direct sense on the street level in terms of efficiency. The form is marked by pragmatism, ensuring flexibility and guaranteeing both recognisable and swift access and routes. 

Daylight is introduced generously into the building, and was considered one of the most integral processes for the healthcare architecture, both for the benefit of the patient care, but also to augment wellness for the medical staff working long hours. As the structure's most distinct element, the louvred façades, both clear and painted white, are all about allowing natural light to penetrate the hospital levels in a copious yet controlled manner. The paramount importance given to the amount of natural light perfuming the building is in response to the understanding of how draining and detrimental both persisting and fixed artificial lighting can be for occupants, over prolonged periods of time. The sunshades that define the facade were selected for their environmental benefits and their colour displays with vigour, how the building repairs its restless context, uniting and calming disparate settings.

The design team employed, for greater efficiency, "hospital-grade materials" that boast sustainability credentials for the interior design, that not only promote hygiene but are easy to clean, and reduce resources required for maintenance in the long run. “Overall, operational systems in the building are all about reducing waste and bearing in mind that hospitals, in particular, consume exceptional amounts of energy due to their 24-hour workload,” they continue.

The ceramic louvred façades of the San Raffaele Hospital also help reduce heat gain by diffusing the impact of direct sunlight, their depths varying in a way that responds to the daily path of the sun. The ceramic was specially conceived to disintegrate smog particles and preserve heat, cutting energy consumption by 60 per cent. “And although not immediately apparent to the eye, some 60 per cent of the elevations are, in fact, made up of opaque insulation panels that improve the energy performance of the building’s envelope. The opaque part is made of back-painted glass with an insulating back. The transparent parts have a screen print on top for privacy and shade,” explains Mario Cucinella Architects.  

Cucinella reveals that the simplicity of the virtually rectangular plan of the 40,000 sqm sustainable architecture, as well as its circulation routes, were carefully thought out, to minimise the time required for accessing vital critical facilities. Internal site lines were also maximised with consideration for staff members to monitor patients' needs with ease. The privacy of patients is also given utmost importance, with dedicated rooms for receiving visitors carefully accompanying the post-surgery and treatment care rooms. “These reunions take place within a less clinical, home-like spaces located within the wards which have the added benefit of enabling largely bed-bound patients to vary their surroundings. These “visitor lounges” as well as the reception areas for visitors and outpatients are located on all levels and within the building’s corners, allowing for generous external vistas,” the architects share.

The post-operative and treatment rooms for patients as well as spaces for visiting families are given a simple yet pragmatic colour palette of calming greens and soft whites, ensuring a welcoming environment with healing and relaxation at its heart. All rooms face the sun, increasing a sense of well-being. Spacious hallways allow nurses and all medical staff to traverse the floors with ease, while all corners are spacious and receive ample light.

The welcoming and comfort of patients have been principal in the way the luminous San Raffaele Hospital was designed and built, as well as the efficiency and discreteness of its clinical operations. As Cucinella elaborates, "We worked with the clear intention of creating a well-designed building that would greatly improve comfort. A building that needed very little energy for heating, retaining heat, and generating little thermal gain required very little cooling. San Raffaele’s new Surgical and Emergency Department is certainly one of the projects that best illustrate the studio’s commitment to sustainability. Its iconic façade is a clear symbol of this.”

The binding force that leads to the essence of the hospital’s contemporary design is that it does not necessarily look or feel like a strictly clinical space. It is further characterised by its attention to detail regarding research between function and aesthetic led design. Cucinella’s architectural intervention humanises the technicality and uneasiness associated with hospitals of this scale and nature, and it finds further success in its curated features of practical sustainability.

Project Details

Name: Ospedale San Raffaele
Location: Milan, Italy
Area: 40,000 sqm
Year of completion: 2022
Client: IRCCS Ospedale San Raffaele
Architect: Mario Cucinella Architects
Design team: Mario Cucinella, Marco Dell’Agli, Giulio Desiderio, Michele Olivieri; Emanuele Dionig, Martina Buccitti, Alberto Menozzi, Laura Mancini, Giuseppe Perrone, Matteo Donini, Lello Fulginiti, Daniele Basso. Bioclimatic design: Andrea Rossi. Modelli: Yuri Costantini, Ambra Cicognani, Andrea Genovesi. Concorso: Eurind Caka, Stefano Bastia
Facades: Aza Aghito Zambonini Srl
Sanitary Layout: InAr Ingegneria Architettura
Structural Engineer: Ballardini Studio di Ingegnaria
Services Engineer: Deerns Italia SpA
Fire Engineers: Ranieri Studio Tecnico Associato
Contractor: Itinera