How to Choose a Healthcare Architecture Firm in Cork (Without Relying on a National League Table)

The first thing a live hospital teaches you is that it has no particular interest in your construction programme.

At University Hospital Limerick, new ward accommodation had to be built in an enclosed courtyard between the Emergency and Paediatric Departments. There was no normal physical access to the site. The answer involved a light-gauge steel prefabricated system, with panels lifted by crane over the existing hospital buildings and carefully slotted into place.

That sounds neat when you put it into one sentence. It was not neat.

Every decision about access, lifting, noise, separation and sequencing had to sit around a hospital that was still doing what hospitals do: admitting patients, moving beds, running clinical services and dealing with whatever the day brought. Ask anyone who has project-managed a live hospital extension and they will tell you much the same thing. It is a little like renovating the kitchen while the family still expects three meals a day out of it — except the family is an emergency department, and getting the circulation route wrong has consequences beyond a late dinner.

Look, I’ll be honest: this is why league tables of “top healthcare architecture firms” only tell you so much. A large name, a glossy portfolio and a substantial headcount may look reassuring. What you really need to know is whether the people sitting across the table understand how a clinical building behaves when the drawings meet an occupied site.

That is the test.

A Corridor Is Never Just a Corridor

What is actually different about designing a hospital versus an office? Well… almost everything once you get past the fact that both have walls, doors and people inside them.

An office corridor mainly moves people. A hospital corridor moves people, beds, staff, equipment, clinical waste, clean supplies, food trolleys and, occasionally, a very anxious family trying to find the right department. Some of those movements should cross. Some absolutely should not.

You wouldn’t think a corridor width mattered this much. It does.

So do door swings. So does the position of a hand-wash basin. So does whether a nurse at a station can see a bedroom entrance without creating an institutional atmosphere. So does the few millimetres that looked harmless in an early drawing but become rather less harmless when a piece of clinical equipment arrives with its service clearances.

In a commercial fit-out, a late equipment change may mean adjusting a joinery unit or moving a socket. In clinical building design, it can affect ventilation, medical gases, electrical loads, infection-control measures, maintenance access and the safe working space around a patient. The room still has to be cleanable. The staff still need to use it efficiently. And the building cannot become obsolete the day a newer machine is wheeled through the door.

That is why experienced healthcare teams work with the Activity Database, or ADB, and tools such as dRofus. They are not glamorous. Nobody has ever stood in a finished ward admiring the database coordination. But the information behind each room — equipment, services, finishes, fittings and relationships — is where a great deal of the project risk actually lives.

The drawing is the visible bit. The discipline behind it is what keeps the drawing honest.

The Brief Is Only the Beginning

Clonakilty Community Hospital is a good example. The HSE brief could be reduced to a few lines: reduce the number of beds in existing eight-bed wards, provide more day rooms, and add 20 en-suite single bedrooms with supporting accommodation.

Simple enough?

Not really. Because the actual design question was not merely where to put the rooms. It was how to add capacity and dignity without making the place feel more institutional. The completed approach used two single-storey extensions, new and improved courtyards, daylight in the corridors, window seats, colour and stronger connections to outside space. The technical brief dealt with numbers. The architecture had to deal with how somebody might feel living there.

That distinction matters. Healthcare architecture is full of requirements that can be counted, scheduled and signed off. Bed numbers. Areas. Air changes. Sanitary fittings. Clearances. Yet a compliant building can still be dispiriting, confusing or awkward to work in. Compliance is the floor, not the ambition.

And then infection control joins the conversation.

A layout that seems perfectly sensible in the first meeting can change once clean and dirty flows are properly tested. A finish that looks robust may not tolerate the cleaning regime. A lovely recessed detail may turn out to be a dust trap. A maintenance proposal may require a technician to enter a clinical space that should not be interrupted.

Here’s where it goes sideways: these issues are sometimes treated as technical checks to be carried out after the “design” is substantially complete. By then, every correction has a cousin. Move one door and the bed position changes. Move the bed and the services move. Shift the services and the ceiling coordination starts muttering under its breath.

The patience required is not decorative. It protects the programme.

Where Hospital Projects Usually Lose Time

People assume the risky part is getting an interesting building through planning. Sometimes it is. More often, the trouble begins much closer to the ground.

The brief was not settled early enough. The equipment schedule lagged behind the room layouts. A department signed off a plan, then a different clinical group saw it for the first time. The decant strategy depended on space that was never really available. Enabling works were described as a minor package until somebody opened up the ceiling.

Anyway. That corridor…

In a live hospital, phasing is part of the architecture. Temporary routes, fire escape, infection-control barriers, contractor access, deliveries, noisy works and shutdowns all need to be designed with the same seriousness as the permanent plan. You cannot simply draw the final building and leave everyone else to work out how to survive the eighteen months before it exists.

This is one reason healthcare experience protects a budget even when an experienced fee initially looks higher. The expensive mistakes are rarely extravagant design gestures. They are late discoveries.

At UHL, the restricted courtyard location, the extremely short programme and the need for rapid multidisciplinary coordination were not side issues. They shaped the construction system itself. Phase one — the initial ward accommodation and shell-and-core space — was set an eight-month programme, followed by a further fit-out phase. That kind of delivery demands decisions early, while they are still cheap enough to make.

Across hospital design in Ireland, the same truth comes up again and again: speed does not come from skipping thought. It comes from getting the right people into the thought early.

Registration Matters. Experience Still Has to Be Proven.

There is a reason procurement teams ask about registration. In Ireland, “architect” is a protected title under the Building Control Act 2007, and the RIAI maintains the statutory Register of Architects. That tells a client something real about education, training, competence and professional accountability.

Healy Butler Moffat is an RIAI-registered Cork practice, operating since 2005 from Farnham House on MacCurtain Street.

But registration is not a substitute for sector experience. If you are comparing RIAI-registered architects in Cork, keep asking. Who has delivered HSE work? Who understands ADB data and dRofus? Who has coordinated a project around live clinical services? Who will actually attend the meetings and make the decisions?

At our practice, the partners stay directly involved. That matters on healthcare work because difficult decisions do not arrive according to the organisation chart. They appear in a user meeting, during a site inspection, in an equipment query or five minutes before a planned shutdown. Passing everything up and down a long chain wastes time and, worse, loses context.

Design leadership, planning strategy and construction detail have to develop together from day one. Bolting the practical thinking on afterwards is how attractive concepts become expensive arguments.

Cork Is Not Just a Pin on the Map

As Cork waits for the proposed elective hospital at the St Stephen’s Hospital campus in Glanmire to move through detailed design and towards a planning application, the public discussion naturally centres on dates, access and delivery.

Fair enough. Those things matter.

But healthcare architecture in Cork is also shaped by less visible local realities: constrained estates, existing buildings of very different ages, busy access routes, planning discussions, clinical services that cannot pause, and project teams spread across operational and administrative roles. Local knowledge does not replace healthcare expertise. The useful combination is both.

We have been working in this field through projects including Clonakilty Community Hospital for the HSE, acute bed-capacity work at University Hospital Limerick, and the design of the new Regional Headquarters for the National Ambulance Service. Different briefs, different sites, different users. The common thread is that the building must work operationally before it can claim to work architecturally.

If I were appointing a healthcare architecture firm in Cork, I would not begin with the size of the logo wall in reception. I would ask to see comparable work and then ask awkward questions about it.

What changed after clinical consultation? How was construction separated from live services? Who controlled the room data? What caused delays? Which partner was involved when a difficult call had to be made? What did the team learn?

A good healthcare architecture firm will not pretend every project ran like a Swiss watch. Hospitals are too complicated for that, and Irish construction programmes have a habit of finding the one assumption nobody tested. What you want is a practice that can explain where the risk sat, what it did about it and how that experience changes the next job.

Proof is more useful than polish.

Before We Wrap Up, Here’s What People Actually Ask Me About This…

What should we ask a healthcare architecture firm before appointing it?

Ask for genuinely comparable projects, not simply buildings of a similar size. A live ward extension is not the same as a new office block, even if the contract values happen to match. Find out who led the work, how clinical users were involved, what digital room-data systems were used and whether the people presenting at interview will remain involved after appointment.

Does an architect need HSE experience to design a healthcare building?

It is not a magic badge, but it shortens a very expensive learning curve. Familiarity with HSE processes, healthcare room information, clinical adjacencies, user consultation and live-site constraints means the team knows which questions need answers before they become site problems.

What are ADB and dRofus, in plain English?

They help the design team manage the detailed information attached to rooms: what goes in them, what services are needed, which finishes apply and how requirements are coordinated. Think of them as the memory of the brief. On a large clinical project, relying on scattered spreadsheets and somebody’s heroic inbox is asking for trouble.

Can a general commercial architect handle a hospital extension?

Possibly. The more useful question is whether the client wants to pay for that practice to learn healthcare delivery on this particular project. Clinical buildings have different tolerances, stakeholders, technical demands and operational risks. Relevant experience is not snobbery; it is risk control.

When should the architect be brought in?

Early — while the brief, site strategy, phasing and budget can still influence one another. If the architect arrives after the clinical brief, equipment assumptions and programme have all been fixed separately, somebody usually discovers that the pieces do not quite belong to the same puzzle.

Does using a Cork-based practice really make a difference?

It can, provided “local” comes with the right sector experience. Familiarity with Cork’s planning environment, consultant network and healthcare estates is useful. It does not excuse a thin clinical portfolio. You need both sides of that equation.

Is healthcare design always more expensive?

The design process is certainly more information-heavy. But thorough coordination is not the same thing as waste. The question is whether you would rather pay for a clash to be resolved in a meeting or after walls, services and specialist equipment are already on site.

Hospitals have no patience for shortcuts. They simply keep operating until every shortcut sends the bill back.