Healing by Design
Architects discuss some of the best recent health buildings as well as the way forward for designing healthcare facilities. Martin Parley and James Parker report.
Healing design seminar focuses on the issues
HD editor James Parker chaired a seminar held last week at the Building Centre, London, which looked at a range of issues around achieving 'healing environments'.
Held as part of the highly successful Capital Health series taking place this month at the centre to co-incide with its exhibition displaying current key health schemes underway in London, the seminar was intense and focused, keeping the debate tied to real issues as opposed to hyperbole.
Parker introduced the event by alluding to the challenges of identifying what "healing spaces" truly were, why the patient space was seemingly ignored in the debate, and how PFI could well offer too many insurmountable challenges if left in its current form.
Designer Graham Cooper then gave a concise critique of health building types within the criteria of their 'healing'-ness, and the practical potentials for far greater healing design.
Richard Mazuch of Nightingale Associates looked at our sensory perception of healing design in emotional terms, how a 'Design Prescription' could be provided for particular patient types, and even smart cards to control all elements of healing design in rooms.
Martin Sutcliffe of BDP presented the puzzling statistics that his firm's study undertaken with French architect Groupe 6 had produced, namely that the cost of building hospitals in France was around two-thirds of that in the UK. And more startlingly, bed space was larger in France, and design quality often higher, yet M&E figures for the UK were far higher.
Mungo Smith of MAAP Architects gave a typically passionate talk about his struggles to try and realise guidance for creating a high proportion of flexible single rooms in the NHS, against a range of challenges, not least the inflexibility of current systems. He described how crucial ensuite bathrooms were to the debate, and how the issue of single rooms "cannot be dodged any more," because of infection control.
Lastly, Nigel Greenhill of Greenhill Jenner Architects described his practice's much-praised Breast Care Centre refurbishment at Bart's, and how it offered a more holistic, healing alternative to many of the larger schemes currently seen, by exploiting existing classical building features.
Full Report HD January 2006
Architects discuss some of the best recent health buildings as well as the way forward for designing healthcare facilities at a recent Building Centre seminar. Martin Parley and James Parker report.
At the latter end of 2005 The Building Centre in central London hosted the New London Architecture programme highlighting the 200 projects currently underway or completed in the city. Major developments such as those planned for Kings Cross, Elephant and Castle and East London's Olympic complex and regeneration were displayed under the title Capital Health. The exhibition showcased the modernisation and development of healthcare facilities in London. With an ever-growing population London is undergoing massive healthcare changes to meet the needs of the public. £7bn will be spent over the next ten years on new and old health buildings. The healthcare landscape is changing in many ways such as in the shape of more care centres being placed back within communities as well as the way the buildings are designed to optimise their medical benefits. It is therefore appropriate that the Centre should be the setting for a conference called The Healing Space - How buildings can make you feel better. This featured talks given by five knowledgeable architects in the field, and was chaired by HD editor, James Parker.
Parker opened the conference by reiterating the golden rule of hospital care as stated by Florence Nightingale in Notes on Hospitals: "The first requirement of a hospital is that it should do the sick no harm." He pointed to the fact that the reality of hospitals is they can be "uniquely uncaring places despite their stated healthcare aim." He went on to demonstrate how Nightingale's main ideas on what needs to be incorporated into a healing environment such as natural light are still not being properly addressed. In fact there is the assertion that hospitals have regressed when Parker highlighted the fact that, "privacy has received scant attention," and even potted plants have been removed for infection control purposes. "Often the healing elements of hospital design are the first to be sacrificed in any drive - be it financial or safety orientated."
"The basics of hospitals are seen to be the housings for beds and technology rather than the humanistic factors which sustain and indeed nourish sentient life," he said. This was re-enforced when Parker brought up the contentious topic of PFIs: "Where is the focus in PFIs on creating patient areas which respond to individual needs, to give them a comforting experience?"
"Adjustable beds and lighting, sensitively commissioned artwork, floor to ceiling windows and under floor heating - Why should we not demand this?"
Designer Graham Cooper elaborated on the patient's experience by discussing the importance of bringing art and nature into the healing process. Cooper, the curator of the Capital Health exhibition, believed that nature is linked in the patient's mind to a safe haven. He identified five factors that are key to a healing environment: Not doing the patient any harm, stress reliever, good diet, fresh air and cleanliness. He believes in the whole experience as the curative ethos. Both in the UK and in Germany: "We're into this mass cure industry where hospitals are built like factories."
"So we are up against forces that go against quality of care design," Cooper said. He illustrated the point by quoting one of the main doctors in Japan who said, "It is a combination of things, scientific knowledge with the environmental quality, not one or the other." Cooper said art and nature form positive distracters away from the preoccupation of the patient's condition. He pointed to the studies of Ted Hughes who said: "art is a psychological component of the immune system." Cooper mentioned a hospital in Japan conducted studies on whether hospitals have positive or negative effects on health, "They took healthy people and put them into the ICU of a hospital and after three days all had fallen ill."
Richard Mazuch, director of design at Nightingale Associates, discussed the issue of light in his presentation titled Sensory Design, Design Mapping and Design Prescription, which he has been researching for over seven years. Here Mazuch claimed that there are 21 senses rather than just five and because sensory receptors absorb our environment "light is life." Pictures from the early 1900s show patients beds at St Thomas hospital moved out onto the embankment to get fresh air and sunlight. Just as Florence Nightingale said that fresh air and natural light were important in the recovery process, it is known that light makes the body release the feel-good drug seratonin and also gives it vitamin D. Conversely, "If there is no natural light Melatonin is released which tells the body to log off," said Mazuch. He referred to the Benedetti study, East West Aspects 2001 relating to severe depression where high levels of morning sunlight reduced stays by 3.7 days. Smell and sound can also have effects on the body. "Smell lingers longer in the memory than visual images," said Mazuch "The air conditioning in Japanese offices release different smells according to the time of day, like citrus in the morning to aid waking up." He believes that in the future patients will have smart cards that will hold their preferences for room settings and a single swipe of the card will activate them.
In France this kind of technology may not be far away said Martin Sutcliffe of BDP, because the French are already using sophisticated automation robotics. His talk on learning from French hospital design was based on the Groupe 6 Hospital Design Study. "In France PFIs have a higher quality design at a lower cost per metre2," said Sutcliffe. "Hospitals are cheaper to build in France than in the UK, they are cheaper per bed and have more beds per population." At a half to two thirds the cost of UK hospitals their preference in building lots of smaller hospitals contrasts with the UK where they go for large hospitals that cost more. The smaller, French buildings are not only cleaner, but they also have daylight regulations to ensure that both patients and staff get their required amount. Value comparisons have been conducted into the benefits of smaller buildings showing that operating cost is the same, but infection cost, patient outcomes, staff levels and morale are all better in France. "They have better design in France with single rooms, natural light, better art and more space per bed," Sutcliffe said.
MAAP architect Mungo smith picked up the topic with his talk called Working with NHS guidance - Single rooms and their importance. "The evaluation process was not done properly because in Health Building Notes '04 it recommended building significantly more single rooms, but it was ignored due to the cost," said Smith. 100% was the goal and currently there has been a compromise to 50%, yet this is not good enough according to Smith, "Control of infection means we cannot dodge the issue of single beds." Using ergonomic studies undertaken at Loughborough and Sheffield Universities Smith outlined that with good design 100% single rooms can be achieved along with the required space around beds at only a slight increase in cost. The NHS costing study 2003 showed that a 'T' shaped layout with single rooms would not be significantly higher than multi-occupancy rooms. "Problems when designing multi-bed rooms such as noise, patient transfer, admission and discharge logistics among others outweigh the problems of isolation and social engagement found in single rooms," said Smith. "The isolation can be reduced by installing glazed walls to service spaces with internal blinds for privacy."
The penultimate presentation was given by Nigel Greenhill from Jenner architects on the west wing redevelopment at Barts. Faced with a fixed building plan situation, designing rooms to fit around the immovable structure in the centre of the wing was problematic. Luckily they had: "Ample budget, time to design it, resources to research and time to consult clinical staff," said Greenhill. Money was set aside for art projects, which amounted to 3% of the wings total cost. 30% of the original building was retained and used including, "The mysterious volume in the centre of the building which is enchanting with its lights and yellow colouring round the windows."
They tried to make it as welcoming as possible from the moment people go through the entrance. "The snack bar by the entrance not only acts as a meeting or social area but also spreads the enlivening smell of sugary coffee around that area," said Greenhill.
Art within the wing is very modern he said, "There are silver candelabra and gravy boats suspended from the ceiling reflecting the view of the garden also forming artistic shadows on the wall."
Air and water are motifs of Barts because they always believed in their healing properties, as can be seen from the fountain in the grounds where they used to take patients out in the summer.
Jencks continues Maggie's legacy
Husband of the late Maggie Jencks, who was founder of the burgeoning UK network of Maggie's Centres for cancer patients, renowned US architect Charles Jencks provided a highly personal viewpoint on the purpose of healthcare facilties, to close the day. Together with Ivan Harbour of Richard Rogers Partnership he also presented the design for the new Maggie's London at Charing Cross Hospital, which has now received planning permission. With its "floating" roof, protective walls and landscaping it looks to embody the design innovation as well as the caring ideals for which other Maggie's Centres have been lauded.
Jencks reasserted the importanance of architecture for clinicians, saying one had told him "if it's a bad building, we don't show up for work." He also made some very bold claims for Maggie's Centres, such as "I believe they extend lives," while outlining their main functions; (reducing stress, providing information to often distressed patients, fostering self-help, and "an art gallery that's not an art gallery.") The centres, with their expert staff, are sorely needed, he says, as "doctors can't take the role of confidant."
Jencks neatly summed up the importance of design in the centres, not least for reflectiong the centres' asipirations: "If the architect can't take a risk then the patients can't." One of the key design features of many centres is their simultaneous "openness" providing a welcoming and social ambience, and subtle "closedness" in some areas to provide the necessary spaces for contemplation and to cry when necessary. The new Maggie's at Charing Cross seems to embody the realisation of this delicate balance well.
Also in the pipeline is Zaha Hadid's Maggie's Centre in Fife, Scotland, which "looks like a piece of origami" according to Jencks. With such top-flight architects as Hadid, Rogers and Gehry (Maggie's Dundee, completed 2003, see HD October '03), this strand of healthcare architecture has seen the industry finally enter the mainstream spotlight. And, as Jencks says, it offers hope and a sign of potential future smaller, more beautiful facilties: "There is a grass roots movement in hospitals across the world - people want a different metaphor from the 300 years of factory hospitals." In bringing his wife Maggie's inspiring practical yet patient-focused words to life in his talk, Jencks proved an inspiration for the audience.
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