Building Health

Gehry's Model Maggies Centre Dundee Model

Susan Mansfield reports on the Lighthouse Health exhibitions for the Scotsman.

Few new healthcare buildings have ever attracted the attention lavished in recent weeks upon the new Maggie's Centre in Dundee. Frank Gehry's small but dramatic building with its curving walls and concertina roof might be a modest support centre for cancer sufferers and their families, but it is inviting plenty of comparisons with his most famous work, the Guggenheim Museum in Bilbao.

Over the next decade some of the world's most eminent architects, including Richard Rogers, Zaha Hadid and Daniel Libeskind, who won the competition to replace the World Trade Center in New York, will design purpose-built centres like Gehry's. Later this month, the first ever Maggie's Exhibition at the Lighthouse, Glasgow, will explain the charity's design philosophy. How a centre looks, feels and functions is a crucial part of the blueprint for Maggie's Cancer Caring Centres, drawn up by the charity's founder, the late Maggie Keswick Jencks, wife of landscape architect and commentator Charles Jencks. Her vision was for centres which could provide information and support to cancer patients and their families in an environment which was domestic in scale and supportive in structure, a deliberate antidote to the institutional nature of most hospitals.

"In general," she wrote, "hospitals are not patient-friendly. Illness shrinks the patient's confidence, and arriving for the first time at a huge NHS hospital is often a time of unnecessary anxiety ... Patients who arrive relatively hopeful soon start to wilt." She went on to describe how she was given a diagnosis, told that she could have as little as three months to live, then politely asked to wait in a hospital corridor as the doctor had to see other patients. A Maggie's Centre is, in Frank Gehry's words, "a caring place to encourage courage". The Edinburgh centre - the first to open, in 1995 - is an imaginative conversion of a stable block by local architect Richard Murphy a stone's throw away from the sprawling mass of the city's Western General Hospital. It's full of natural light with domestic-sized rooms which are open, yet allow for privacy, and is set in an attractive garden.

Maggie's Exhibition is one of a several being hosted by the Lighthouse which showcase new ideas to improve both healthcare buildings and medical equipment. Stuart MacDonald, director of the Lighthouse, believes that with a projected £4.2 billion to be invested in health service buildings by 2008, there has never been a better time to get the message out. "Well designed hospitals and health centres can improve people's health. The opposite of that is bad design costs money, and can also be injurious to your health," he says. "We need to make a much more human architecture. A growing awareness of design among the general public means that people are demanding more now in their designed environment. It starts with the home, and then moves on to the workspace, hospital, school."

Graham Cooper, an artist with 20 years of experience looking at healthcare design, says research proves large hospitals, with their miles of windowless corridors, sparse, impersonal waiting rooms and harsh artificial lights, can be damaging to health. "A study was carried out in Japan where healthy volunteers were sent to spend time in hospitals. After a few days in an intensive care unit they were all ill. We have designed hospitals in which your health will tend to deteriorate rather than improve."

He says that, although hospitals commission a lot of art work, it does not always help the well-being of patients. "Art works are usually placed in public areas, to enhance the quality of very poor surroundings. Very little of this actually penetrates through to the patient spaces. In real terms, patient experience is very poor, and there is no evidence than the billions which are being spent at the moment will actually improve that. Hospital managers are concerned with throughput, with cutting waiting times, processing people in a mechanical way."

The result of this is that hospitals are stressfull places, and increased stress and anxiety will impair the work of the immune system which should be boosting recovery. What patients need instead are "positive distractions" to encourage relaxation: stimulation for the senses, a connection to the rhythms of the natural world. American architectural psychologist Robert Ulrich found that a patient who has a view from his or her bedspace to a natural landscape is likely to have an increased recovery rate after surgery over one who does not.

Cooper has curated Nature of Healing Art, a touring exhibition now at the Lighthouse which looks at examples of best practice from Britain and Japan for transforming the hospital environment by allowing greater access to the natural world. "We are embarking on a major theme for the 21st century," he says. "Some of the larger healthcare facilities may have missed the boat. In the next ten years, they might be considered obselete, dysfunctional. At the moment it is difficult to get politicians to look at these ideas. They are concerned with numbers, waiting lists. They don't realise that if the environment of hospitals was improved, people would be processed more efficiently and they wouldn't return."

Designers are also having significant input in the highly traditional world of medical equipment. Lightweight Medical, which was started in Glasgow by two recent graduates, Neil Tierney and Neil Farish, has made significant improvements to the design for transport incubators, used to carry premature babies. The first working prototype for their design will be shown at the Lighthouse as part of the building's CreativeScotland programme for showcasing cutting-edge design.

The transport incubators currently in use in Scotland weigh up to 225kg and need to be recharged every two hours. Working within tight legislation and constrained budgets, Tierney and Farish have produced a design which weights just 90kg, is easier to move and operate and can work without recharging for four hours. They now hope to find a company which they can licence to manufacture their design.

Tierney explains that an improved design can make a significant difference to some of the NHS's most vulnerable patients, and the people who care for them. "We weren't looking to change the technology but to present the technology in easier-to-use ways. Currently transport incubators are often difficult to use, difficult to move and difficult to sterilise.

"One of the biggest things was the weight of medical equipment, since 3,600 nursing staff have to leave the NHS every year with back injuries. Another key factor was reducing vibration and noise, particularly in helicopters, when noise and vibration can affect the baby and the intensive care equipment. What design can bring to these medical devices is quite considerable."

Nature of Healing Art is at the Lighthouse until 5 January; Lightweight Medical - Transporter Incubator, runs 28 November until 11 January; Maggie's Exhibition runs 29 November until 8 February.

Susan Mansfield Friday, 21st November 2003 The Scotsman


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