Embedded Design


Graham Cooper asserts that healthcare buildings must be embedded into the nature surrounding them in order to fully realise the benefits of therapeutic design. Final Account HD Journal of Healthcare Design & Development Sept 2003 Wilmington Press

During his recent UK lecture, respected American architectural psychologist Roger Ulrich gave the view that artists and designers can contribute to improved medical outcomes. He presented a considerable amount of design research including a persuasive business case for his evidence based "Fable"hospital. Ulrich sees the hospital environment as being highly stressful, impacting on the quality of medical service, patient care and safety. Controversially, he concluded that the latest stream of public-private partnership UK hospitals are unlikely to deliver satisfactory levels of positive medial outcomes due to such issues.

Ulrich¹s previous findings that patients with a view of natural landscape are likely to benefit from increased recovery rates underpin the Nature of Healing Art* an exhibition touring the UK, that was recently launched at the Dorset County Hospital. The timing was ironic as the West Dorset NHS Trust, like many others, was recently warned by the Health & Safety Executive to significantly reduce stress levels in the workplace. The exhibition forms part of the larger Nature of Health Design programme, which together with its partners is building momentum. It re-asserts that the delivery of healthy environments will lead to more effective care and better quality of life. According to the Centre of Healing Environments in Tokyo, existing clinical accommodation has a detrimental effect on health, and it is widely recognised that distress and fear inhibit the immune system. It is believed that by working as positive distractions, art, music and especially nature reduce levels of stress by encouraging shifts in mood and relaxation.

The Nature of Health Design project focuses on an integration of art, architecture and garden design to bring natural phenomena nearer to the patient's experience, in the context of the notion that the presence of nature can nourish the sensibilities and reduce levels of anxiety. The exhibition presents recent key hospital projects across the UK and Japan, which attempt to engage the users with the natural ecology. The panel presentation follows the patient journey, through the threshold, and interior pathways to the reception, ward and garden spaces. Each panel offers a potential mediation space where the building connects the patient to the rhythms and changing patterns of nature. It contains a selection of approaches and benevolent interventions, which, animated by occurrences in the elements help stimulate the main senses of the user. It offers a fresh insight to health design where nature is fully incorporated, within reach of the patient¹s personal space.

Case study visits for the project revealed shortcomings in the quality ofservice at the care end of the patient¹s journey. Ward accommodation and bed space provision, with the exception of leading lights the Lambeth Community Care Centre and the Glasgow Homoeopathic Hospital, largely failed to connect the inpatient with the natural habitat or surroundings. Day rooms and conservatories offered potential but all too often are used for trolley and wheelchair parking. The quality of departmental reception and waiting spaces is alarming these are where care commences and where it is most appropriate to reduce levels of apprehension and tension. However the Ystradgynlais Community Hospital near Swansea and at the Central Middlesex¹s ACAD project offered hope in this area. Also, Exeter Health Care Arts lively ward garden enhancements demonstrate what can be achieved in the courtyards generated by Nucleus templates.

The largest healthcare building boom in the history of the NHS, with a projected £4.2bn worth of investment by 2008, offers a rare opportunity for designers to dramatically enhance the delivery of healthcare. The current investment in 33 new hospitals must be applauded, but healthcare will always be lacking if collective indifference to the impoverished patient and nursing care areas is allowed to continue. Measuring up to the challenge of the patient¹s demand is critical. Over the last 20 years more creative opportunities have been taken in the communal areas of hospitals but there has been insufficient emphasis on the care of the individual patient. The geography and emphasis of the hospital structure (as with ACAD and BECAD at the Central Middlesex, HD July/August 2003, p10) is about to change. There is now beginning a shift from the universal white treatment space to a post-modern contextual approach based on the specific needs of the patient and their particular choice of care.

Designers in healthcare may consider such shifting requirements away from mass public consumption to reflect on what feelings and associations the individual end-user experiences and takes away with them. Evidence-based design has established the platform, but a fusion of art, nature and healing is needed to drive innovation. Blurring the demarcation between the outside surroundings and the ³interiorscape² will dissolve the barriers, increasing connectedness with nature, rendering the edifice of the institution itself invisible.

Graham Cooper is director of Nature of Health Design.

*The Nature of Healing Art exhibition continues at the Architecture Centre Bristol (21st Oct - 10th Nov.), the Lighthouse Glasgow (21st Nov - 8th Feb 2004), and St Mary¹s Hospital, Isle of Wight (Feb-Mar 2004).


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