Raising the quality of life


Raising the quality of life by bringing natural phenomena nearer to the patient's experience. Nature of Health Design Art & Architecture Journal Issue No 59

The largest healthcare building boom in the history of the NHS, with a projected £4.2 billion worth of investment by 2008 offers a rare opportunity for designers to dramatically enhance the delivery of healthcare. Procurement by means of robust twenty-five year PFI facility packages signal a further commodification of the health service, with prescriptive aesthetic and caring decisions requiring the involvement of creative partners at the outset. Designing in an aggressive bidding atmosphere has achieved attractive front of house marketing statements but is it compatible with the evolving status of the patient from a passive object to demanding consumer?

Beyond the bold facades and grand entrances often lies the familiar configuration of a featureless and windowless regime of corridors and departmental spaces. Characterised by a banal uniformity and a dearth of materials with insufficient levels of natural lighting this accommodation will do little to benefit the health of the users. Contrary to demands for improved care areas, such low expectations and budget priorities are unlikely to satisfy the needs of nursing staff and result in inferior quality patient accommodation. Thwarted by a fear of risk taking with such a restricted role for the designers the commercially chastened consortia by default are likely to adopt the familiar and orthodox formula of the institution.

Evidence Based Design

According to the American architectural psychologist Roger Ulrich during his Architecture Week lecture, artists and designers can contribute to improved medical outcomes. As proof he presented a considerable amount of evidence based design research including a persuasive business case for his Fable hospital. Ulrich describes the hospital environment as highly stressful, impacting on the quality of medical service, patient care and safety. Controversially he concluded that the latest stream of Public Private Partnership are likely to under perform delivering unsatisfactory levels of positive medial outcomes. It is Roger Ulrich's finding that patients with a bedscape view of natural landscape are likely to benefit from increased recovery rates which underpins the Nature of Healing Art in the UK & Japan exhibition *1 also launched in Architecture Week to a full house at the Dorset County Hospital. The modest exhibition forms part of the larger Nature of Health Design programme, which re-asserts the delivery of healthy environments will lead to more affective care and better quality of life and wellness. According to the Centre of Healing Environments in Tokyo, existing clinical accommodation has a detrimental effect on health, and in ideal circumstances stress and anxiety is alleviated. Patients at the very least must suffer no harm, but it is recognised distress and fear will inhibit the immune system, the body's natural resistance to disease. As positive distracters, it is reasoned that art, music and especially nature all reduce levels of stress by encouraging shifts in mood and relaxation. Although Ulrich failed to emphasise it, the bodies own defence mechanism, the immune system appears to play a significant/key role in the state of complete physical, mental and social wellbeing. According to the late Poet Laureate Ted Hughes, "Art is in general the psychological component of the immune system. As the body tries to heal itself from any stress or shock or infection, the corresponding harmonic in consciousness is art."*2

Bringing nature nearer to the patient

A blueprint for better quality care 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. Considered is the notion that the presence of nature can nourish sensibilities leading to reduced anxiety and improved emotional comfort. The Nature of Healing Art exhibition presents recent key hospital projects across the UK and Japan, which attempt to engage the users with the natural ecology. As mapped out on the panels the presentation follows the patient journey, through the threshold, interior landscape and pathways, the reception, the ward and garden spaces. Each panel offers potential mediation space where the artifice is the vehicle connecting the patient to the rhythms and changing patterns within the natural flow. It contains a selection of approaches and benevolent interventions, which animated by occurrences in the elements help stimulate the main senses of the hospital user. It offers a fresh patient orientated insight to health design where nature is fully incorporated within reach of the patient's personal space. Over the next year the panel and video loop exhibition will tour to various hospitals and architecture centre venues and while at Royal Devon & Exeter Hospital, there will be a day conference, Grounds for Health. *3 Discussed is the role nature can play in improving the patient's experience, their quality of life and medical outcomes.

Case study visits for the Nature of Health Design project revealed shortcomings in the quality of service received at the care end of the patient's journey. Ward accommodation and bed space provision with the exception of 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. Alarming is the quality of departmental reception and waiting spaces, the point at which care commences and where it is most appropriate to reduced levels of apprehension and tension. In this pivotal location along the patient's path the Ystradgynliais Community Hospital near Swansea and at the Central Middlesex's ACAD project offered hope. Based on direct nursing sightlines, the Nucleus template with its horizontal footprint generated the highly valued courtyards, which are the focus of the Exeter Health Care Arts lively ward garden enhancements.

The current investment in thirty-three new hospitals must be applauded but the provision of healthcare will always under achieve by the collective unconsciousness or indifference to the impoverished patient and nursing care areas. Measuring up to the challenge of the patients demand for improved medical outcomes and nursing comfort is vital, if designers are to improve the quality of healthcare. Over the last twenty years most creative opportunities have been undertaken in the communal areas of hospitals but with 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 is about to change. There is now a perceived shift from the universal white plaster treatment space to a post modern contextual approach based on the specific needs of the patient and their particular choice of care. Artist and designers in the heath-care setting may consider shifting requirements away from mass public consumption to reflect on what feelings and associations in particular does the individual end user experience and take away with them. The Disability Arts lobby for example advocates the arts by raising self esteem help erase social exclusion and aid personal growth. The Nature of Health Design project combines these powerful value-added agents to transform health care in the context of cultural diversity, the arts, and patient wellbeing. Evidence based design has established the platform, and the fusion of art, nature and healing will drive innovation to push the envelope. Blurring the demarcation between the outside surroundings and the interiorscape will dissolve the barriers increasing connectedness with nature, rendering the edifice and institution itself invisible.

For those entering the aggressive bidding climate and attempting the challenge of formulating an art and design package for PFIs a new NHS practical handbook, Improving the Patient Experience The Art of Good Health *4 is now available. Considerable foresight will be required when justifying the Outline Business Case, to avoid predictable iconography endorsing the old regime, which reinforce the clichés of the institution in favour of space for fresh thinking and artistic intervention.

1. Exhibition Venues. Nature of Health Design: Dorset County Hospital, June-September 2003; Royal Devon & Exeter Hospital, October 2003; Architecture Centre Bristol, October-November 2003; The Lighthouse Glasgow, November-December 2003, St Mary's IOW, February-March 2004.

2. Ted Hughes. Poet Laureate, 1984. "For myself I formulated a little notion that art is in general the psychological component of the immune system. As the body tries to heal itself from any stress or shock or infection, the corresponding harmonic in consciousness is art. And so our constant struggle to pull ourselves together and deal with difficulty and with injury and with illness and with threats and fears manifest itself at the psychological level of art. We may not think at the moment it's the most valuable thing we do, but of any past civilization, the one thing that we want to preserve is their art. Because it still operates for us as medicine."

3. Grounds For Improvement. Bringing Nature Nearer to the Patient. Symposium. The Royal Devon & Exeter Hospital. Contact: Exeter Health Care Arts. t.01392 402366.

4. Improving the Patient Experience The Art of Good Health. A Practical Handbook. Published by NHS Estates


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