Single Floor Template Nucleus Main Entrance Study Pack NHS Estates DOHMain Entrance Matters
Single Floor Template Nucleus Main Entrance Study Pack NHS Estates DOH
First impressions last, but the dismal design of many hospital main entrances ignores the fact. Graham Cooper explains how they can be improved HD July1994
"The front entrance of a health building is a place of special transition, symbolising the first steps on the path of recovery, or of a new life of coming to terms with a condition": Critchlow and Allen'.
Wise sentiments indeed, but too often ignored. Upon arrival at an NHS hospital the visitor is accustomed to a complete dearth of good design principles and little in the way of hospitality. Complacency and low expectations foster an uncritical attitude towards the poor standard of hospital main entrances.
Entrance design has long been relegated to a peripheral position in the running of hospitals. The lack of priority given to front-of-house procedures gives rise to an indifferent profile which is contrary to the care and dedication generally found within. Such indifference can foster prejudices against the NHS and undermine the competitive profile of the unit as a whole.
'Improving Hospital Design", the recent King's Fund publication, highlights concern about the poor quality of main entrances. To attempt to identify the 'perfect' entrance in this article would be pointless. However, a rich source of reference describing more interesting examples of hospital entrances can be found in a recent NHS Estates Design Guide '. This publication contains numerous photographs, reference tables and useful plans, particularly of entrance forecourts.
This article draws on my contribution to a study pack completed for NHS Estates which identified aesthetic and design improvements to the quality of main entrances in Nucleus hospitals'.
Although the study was influenced by the rigours of the Nucleus planning system, the proposals described here are relevant to most types of hospital. A high percentage of returned questionnaires which were sent out to NHS trust chief executives indicate that there is a growing interest in how patients are received and handled. Visits to over 30 new hospitals revealed many serious shortcomings. For example, the area in front of the entrance often resembled a garage fore-court except that (unlike service stations) the majority of entrance canopies did not provide sufficient shelter. Automatic door systems failed to stop the draughts, and once inside the enquiry/information desks presented unimaginative barriers. They were often 'holes in the wall' which did not cater for wheelchair users.
The overall layout of entrance halls ignored the importance of external views and failed to take advantage of hospital grounds and courtyards. An excessive number of private doors signalled a confused relationship between the public and staff zones.
In addition, hospital executives indicated that there was generally an absence of art and indoor planting and that potential income generation facilities were untried. They also criticised the lack of trolley/wheelchair storage spaces.
In summary, to quote Critchlow and Allen again: 'The initial impact of a hospital entrance and the arrangements made to welcome and guide patients and visitors are clearly important. Entrances need to be reassuring and convenient for patients and to help them feel they are in efficient and caring hands'.
The following key issues and proposals are relevant to most of the hospitals visited.
The Main Entrance:
This performs two functions. It is the point of entry to other hospital departments and provides the key to the hospital's circulation routes. It is also the place to receive clients; an occasion for courtesy and hospitality. The study recommends that the main entrance should be the only point of arrival and departure for everyone (except for A&E casualties) in the hospital. The main door and canopy should, if possible, be visible or flagged from the site entrance of the hospital grounds. Before arrival the hospital's literature will direct the patient to the enquiry point beyond the main entrance. The design of hospital leaflets must include a hospital plan with the location of the relevant points of treatment clearly indicated.
The Front Door:
The doorway and forecourt should be free from parked ambulances and other vehicles. A greater emphasis must be placed on direct pedestrian access to the entrance. A generous canopy, which provides shelter from the weather will function as a landmark (as employed at City General Hospital Stoke, and the Lambeth Community Hospital). The canopy must be of an adequate height to cover an ambulance's aerial and allow high levels of daylight into the immediate interior of the entrance hall. The automatic door system and draught lobbies would benefit from the introduction of deeper, double-chambered lobbies or, in restricted space, large rotating doors.
The Entrance Hall.
The hospital should provide the visitor with a rendezvous and transport rest space immediately inside the entrance hall. Orientation maps, trolley storage and toilets for ambulant and non-ambulant people should be accessible from here. Clearer views out to the transport point and more overall daylight are recommended. The entrance concourse should fulfil its role as a substantial public place with a satisfactory height and volume (eg. facilities at the Royal Brompton Heart and Lung Hospital London and Bournemouth DGH). The location of doors to staff spaces with no public function or doors to private rooms and cupboards must be discouraged in this area.
The Route:
Circulation to the information point and onwards to other departmental reception points should be obvious and intuitive (see Ealing DGH and Stoke City Hospital, for example). Orientation will be aided by clear, interesting views both inside and outside the entrance hall. More efficient, shorter public routes will encourage closer links between hospital departments and are easier to control and maintain in a high decorative order. For more distinct orientation, hospital maps need urgent attention and barrages of signs must be resisted.
Enquiries and Information
These must be easily identified and located en-route to any main junctions. The information point should be of a reasonable scale and must occupy a prominent position along the path of the visitor. It must also create a distinctive image from where an efficient service can be offered (see Maastricht, St Mary's Isle of Wight, Kent & Canterbury hospitals). The desk should be accessible for wheelchair-bound patients and, for the protection of personnel, it is proposed that the counter is wide enough to avoid violent or abusive encounters.
Flexible Layout.
In the interests of local needs and future demands the study pack incorporated an adaptable and changeable planning module into the Nucleus discipline. To aid legibility a central linear circulation spine was established, diverging from which were regular, well-proportioned accommodation modules. Cushioned between the circulation route and the accommodation was an intermediate transition zone sited at the interface between the public and private staff accomrnodation. This planning module concept, which incorporated both the open common activity spaces and the closed clusters of cellular staff spaces has potential, not only for the main entrance template but for all Nucleus departments and most other types of hospital.
Art
The presence of art and craft works conveys the impression that managers have made an effort to create a pleasant and interesting place. Well arranged artworks contribute to the spirit and psychology of a building and affect the way in which the space is experienced. The integration of works of art and fine vistas is desirable not only in their capacity as significant and pleasing individual forms, but also as visual aids to the interpretation of spaces. Finishes.
Details such as well-designed furniture (particularly seating), subtle combinations of lighting, fresh natural ventilation and vegetation, and general cleanliness will help elevate the mood of the users. The appropriate use of materials, finishes and colours is clearly important in improving the public's experience of hospitals and to prevent damage from extensive daily use. The large numbers of people passing through the main entrance demands the use of robust materials within the public spaces of the hospital.
Income Generation:
Though the demand for income generation schemes in hospitals, such as shopping malls, has recently decreased, they still have the potential to act as a useful amenity for both patients and staff. To provide a service, retailers will prefer a single main front hall in which to trade, through which everyone passes. Experience suggests that businesses are only likely to be rewarded if they deliver a service for which there is a clear staff demand. It is generally accepted that there is only scope for four or five retail outlets. Other imaginative ways of raising income include an appeals shop and the use of existing facilities such as hospital catering services. A mixed-use restaurant and coffee bar at the entrance will perform a necessary social role.
'Unfriendly' hospital main entrances are typically a result of service demands and staff convenience taking precedence over the interests of the patients and their visitors. Creating a caring impact requires more than skin-deep gentrification. It has implications for the whole planning and design process of healthcare premises. If hospitals are to win public esteem, main entrance concerns should be elevated from their peripheral status to a more central position on the agenda. Managers beware main entrances do matter.
Reference 1 Critchlow & Allen /Kings Fund The Whole Question of Health
2 Iden Wickings Kings Fund Improving Hospital Design
3 Charles Jones Park & Miers NHS Estate Design Guide-The Design of Hospital Main Entrances 1993
4 The Nucleus Main Entrance Study Pack has been replaced by a bespoked service from the consultancy arm of NHS Estates.
Graham Cooper is an environmental artist/design consultant.