In Persuit of Excellence

MacKenzieCen Hospital Interior Architecture

An insight into the most distinguished healthcare centres across the USA, Graham Cooper reviews a new book from the US which describes how healthcare designers can create environments that support the healing process. HD November 1992

US interior designer, Jain Malkin, has made a bold and ambitious attempt to document and collate a vast amount of recent material into her excellent and informative book on 'Hospital Interior Architecture'. This attractive volume manages to deal with the potentially dull subject of hospital environmental design in a very stimulating and thought provoking way. One reason for this is that in North America during the '80s there was a concerted effort to produce medical facilities which are quiet unlike modern hospitals as we know them in the UK. Ms Malkin's articulate manuscript focuses attention on the design considerations associated with particular patient groups. The photographs within testify to a level of confidence and budgets that are the opposite of our experiences here in the UK during the same period.

Healthcare, the book jacket tells us, is the fastest growing sector of the US economy and the need for experienced design consultants has never been greater. Despite this there are few books which explore the relationship between the environment and healing. Ms Malkin, who has her own design consultancy, is evidently well equipped to present a survey of outstanding health facilities and to present the case for excellence in this form of institutional design She has written extensively on the psychological effects of healthcare environments and has taught medical space planning at Harvard. For as little as £100 the publisher assures us, the reader will gain a leading edge in a highly competitive field.

In the US for a decade now, through increasing demand for patient centred services, there has been an emphasis on centres of excellence. This may threaten the outpatients and inpatients structure as we know it, and it suggests that it is no longer acceptable for healthcare designers to be generalist. To address the different needs of patient populations, such as the elderly (especially those with dementia), children, cancer victims and critical care patients, a more specialist knowledge is required. To accommodate this each chapter of the book outlines the particular needs of selected patient groups and directs the reader to useful references on current research and published writing.

Most rewarding for the designer is the extended coverage of particular establishments such as the Corinne Dolan Alzheimer's Centre, the Cedars Sinai Comprehensive Cancer Centre, and the Menninger Foundation for Psychiatric Care. However, the book's attempt to mix and match theory with real, completed projects is not entirely successful as there aren't always satisfactory examples to back up the theory.

The purpose of the book was to provide much needed, quick-access design guidance which is supplemented by illustrations from over 300 design professionals, all willing to share their knowledge for the greater good. The compilation and cataloguing of this material, an epic task, provides a wonderful insight into some of the most recent and distinguished healthcare centres across the US, with even the odd example from the rest of the world. Originally, projects representative of all sectors of the healthcare market were gathered, but unfortunately most of the low income public and veterans military hospitals were too austere and bleak to include. This makes direct comparisons with our own NHS difficult, a closer examination of the specialist, 'venerable' institutions reveals a closer relationship with the UK private sector.

Not surprisingly, the well-staged, colour photographs resemble those found in glossy brochure" and are remarkably uninhabited by the clutter of people and trolleys - a reminder that we are only seeing a selective, picturesque view of facilities, which a high proportion of Americans are too under-insured to use. Nonetheless it is a treat to see what the cream of American talent can provide with design budgets of which we can only dream.

This extensive collection of imaginative, and occasionally innovative schemes form the basis and structure of the book. Two conditions had to be met for inclusion: true integration between architecture and interior design; and the successful response to the needs of a special patient population. The challenge of excellence meant the merely competent was overlooked in favour of solutions which exceeded standard client expectations.

The author believes excellence will evolve and he shaped by exposure to a large number of good projects, but she warns that aesthetic qualities are but one measure of a project. While the perception of excellence becomes more focused with this book, it remains to be seen if the examples it contains within will provide the benchmarks for good practice in the future. Rather than aspiring to the more glamorous aspects of these projects, UK hospital designers would he wiser to address the more important, underlying design principles.

'Hospital Interior Architecture' aims to provide future guidance on medical architecture. It has two excellent general chapters on the creation of environments that support healing, and the quest for excellence. The book is at its most useful when it describes particular schemes such as the Planetree model hospital, the VidaKliniken in Jarna, Sweden and the Yukon-Kushokwin Delta Hospital in Alaska.

Other fascinating topics include hospital stress factors, with a description of the effects of the glandular secretion of adrenaline hormones on the nervous system and the subsequent effects of stress on immunology competency. The reader is introduced to holistic therapies and the psychology of colour, including the theory of the 'chakras' energy centres, through which colour is said to affect the physiology of the body. There are useful technical guidelines on full spectrum lighting and we are informed that light is the most important environmental input, after food, in regulating bodily functions. Designers on restricted purses are advised to spend a disproportionate amount on good quality light fittings.

The section on ambulatory care, despite showing a side range of daycare amenities and regional variations, is disappointing. There seems to be more emphasis on marketing and front of house activities than on innovative plan- ning solutions, with the notion of specialism appearing to break down. Ms Malkin states that hospitals without beds are consumer- orientated and therefore sensitive to the vagaries of market demand, and that consumers are fickle and easily influenced by public relations and marketing techniques targeted at patients for specific product lines. The innovative aspect of ambulatory care is to determine what services people actually want, The provision of patient-centred care, as in the hotel industry, requires staff who are customer service orientated and trained to view the patient as a healthcare consumer, choosing from a number of provider organisations in a highly aggressive market. With this type of language, 'Hospital Interior Architecture' is all set to adorn the shelves of the new NHS trust chief executives' offices. Although the book is unlikely to put a provider unit significantly ahead of its rivals, it should fumish a trust with a useful and graphic indication of the quality of service and environment it should he aiming for.

The book clearly shows the contribution that the interior designer can make to the public domain of hospitals in a market-led health service. Less evident, in this otherwise comprehensive book, is progress in the clinical and examination areas, where there is most scope for improvement. According to Ms Malkin the new frontier for healthcare design is in the creation of healing environments. In her opinion, ten years from now hospital administrators will he demanding that their design consultants can design environments that support the healing process. Her contribution signals a major step in this direction.

'Hospital Interior Architecture' is published by Van Nostrand Reinhold; price £109. For copies contact Chapman and Hall, 2-6 Boundary Row, London SEI SHN.

Graham Cooper is a director of Medical Architecture and Art Projects


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