The John C. & Sally Horsfall Eaton Ambulatory Care Centre at St. John’s Rehab Hospital

Reno/addition creates new image for healing organization

This project consists of a two-storey, 4700m2 addition to an existing rehab hospital on a treed 9.5 hectare site in North Toronto. The hospital was originally owned and run by the Sisters of St. John the Divine who purchased the property in the 1930s so that the hospital could enjoy the benefits of the rural surroundings outside of the city centre. Since that time, the city has grown up around the hospital, but the large park-like site has been largely preserved.

By Terry Montgomery and Tye Farrow

The master plan and new building expansion reinforces the hospital’s image within the community and integrates the new building seamlessly within its beautiful and mature gardens. The redevelopment will provide advanced treatment space, allowing the hospital to care for 40,000 outpatient visits each year.

The design helps to promote the organization’s vision to be at the forefront of rehabilitation care and to rebuild the lives of adults recovering from life-changing illness or injury by involving them in individualized rehabilitation programs focussed on the whole person.

The addition consists of two large new rehabilitation gyms and associated clinical offices, a new therapy pool, and a new central entrance and drop off for the hospital. Also included in the project is a realignment of the loading dock so as to conceal it from view, as well as the reinstatement of the original entry court, which is on axis with the existing tree-lined entry drive, and expansion of the therapy gardens.

The hospital has continued the exploration of creating simple “shoebox” flexible and adaptable ambulatory space that provides a robust “future-proofing” layout for health environments. It concentrates primary circulation along the exterior of the building using  two single-loaded concourses in an L-shaped arrangement, while also borrowing daylight and views for  all occupied areas. The design continues to incorporate generous and prominent stairs to encourage those who  are able to “ambulate”.

The addition brings a new vitality and a sense of place to the existing institution by reconnecting it to its remarkable natural surroundings. The primary circulation for the addition consists of generous concourses which provides access to a wide range of functions. At the same time, these offer an ideal setting for patients to regain their mobility and confidence. Generous glazing allows for views of the ever-changing landscape as well as ample natural light.

The design helps to transform the hospital from an internal clinical environment to one that is fresh and inviting. This will serve to enhance the hospital’s reputation for providing excellent care and rehabilitation. It will also serve to transform the hospital into an inviting setting for patients, and also for staff and families who play such a key role in patients’ rehabilitation. Careful placement of the addition on the site minimized impact  on the existing vegetation and natural embankment landform of the ravine to the south of the property.

Specific sustainable strategies include mechanical systems with high performance and variable speed chillers, a dedicated air handling unit for pool heating, ventilation with energy and humidification controls and air handling units, with energy recovery wheels. A building automation system provides an effective energy operation and monitoring program.

Lighting energy demand is reduced through the use of high efficiency direct/indirect lighting with energy-efficient fluorescent lamps with program start ballasts combined with recessed LED accent and compact fluorescent luminaries. A combination of photocells and occupancy sensors provide lighting control. All public areas are controlled through the building management system. Exterior lighting is Dark Sky rated, using metal halide full cut-off luminaires with pulse start ballasts. Outdoor lighting is controlled by photocells and  a time clock. These measures result in a lighting power density of just 10.75 watts/m2.

In addition, the project incorporates concrete, steel, carpet, drywall and linoleum, all of which contain recycled content.
While these strategies contribute to quantitative improvements in building performance, it is the qualitative aspects of the design that will have the most lasting impact, illustrating the potential for the hospital to be more than just a clinical setting.

Terry Montgomery is a Partner with Montgomery Sisam Architect. Tye Farrow is Principal at Farrow Partnership Architects inc.


  • Client St. John’s Rehab Hospital
  • Architects Montgomery Sisam Architects and Farrow Partnership Architects in joint venture
  • Structural Engineers Halcrow Yolles
  • Mechanical and Electrical Engineers MMM Group
  • Landscape Engineers Vertech Design Inc.
  • Photos Tom Arban


- Concrete and steel construction with aluminum frame, triple-seal windows, wood doors by Lambton Doors. Local companies Horton of Ontario supplied and installed the automatic doors, and Ontario Acoustic Supply the acoustic wall panels; siding by Vicwest
- Variable speed chillers , a dedicated air handling unit for pool heating and ventilation, energy recovery wheels in air handling units, energy operation and monitoring via a building automation system
- High-efficiency direct/indirect lighting with energy-efficient fluorescent lamps and recessed LED accent and compact fluorescent luminaries; photocells and occupancy sensors control corridor lighting, exterior lighting is Dark Sky rated, metal halide full cut-off luminaires with pulse start ballasts.

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