In April, we were delighted to ’virtually’ gather over 150 guests from 21 countries for a session focused on Scandinavian patient environments, comparing and contrasting these with the UK.
Joining us for the session were:
- Cristiana Caira, Partner and Board Director, White Arkitekter
- Stig Versterager Gothelf, Senior Partner at 3XN, and
- Teva Hesse, Head of Branch, C.F. Møller Architects, UK
Our chairs for this session were AfH Board members, Alice Green, Associate at P+HS Architects, and Gareth Banks, Regional Director of AHR.
Understanding the patient’s ‘hierarchy of needs’
In approaching the design of the new 54,000m2 North Wing extension to Copenhagen’s largest hospital, Rigshospitalet, the starting point for Stig Gothelf at 3XN, was ensuring the physiological needs of patients, visitors and staff are met. Patients first need to feel safe before they can feel connected – or a sense of belonging to a place. Creating this sense of belonging that supports good self-esteem is the foundation on which growth, development, recovery and wellbeing can be created.
With 200 patient rooms, operating theatres, intensive care and outpatients, Denmarks’ only ‘national’ hospital is designed with future flexibility in mind. The design also considers three contexts:
Individual: how to allow patients privacy; make them feel comfortable and safe.
Social: how to provide a support framework around the patient, creating places for family
Cultural: how does the hospital embody our values and create a sense of place that contributes to its identity, adding value.
This approach is even more apparent in the design of the neighbouring Children’s Hospital.
Built with a central defining characteristic: it is a building symbolically shaped like two hands with fingers stretching out, supporting all aspects of paediatric care under one roof. Here, specialists come to the patient – not the other way around, with treatment, care, research, education, technology and architecture, unified in a holistic ecosystem.
The design is playful, recognising the benefits of play in stimulating healing and as a coping mechanism for stressful situations. In the main central area, two vertical cores take people up through the building into the fingers of each hand. Spreading outward, these contain 6-bed wards with gardens and terraces at the end. There are ‘destinations and journeys – all of which feel safe, homely and appropriate in scale and support development of:
- Cognitive Skills
- Emotional Skills
- Imagination and Motivation
- Physical Development
- Social and cooperation skills
Designing for Children and Families
The idea of playfulness is equally evident in the design of the Queen Silvia Children’s Hospital in Gothenburg, Sweden, an extension of an existing university campus hospital with multiple separate buildings and clinics set within a beautiful park.
As Cristiana Caira notes,
“Playfulness is the red thread throughout the building. Comfort is key: children stay for up to several months and we need to provide places for calm and as well as play, just like we would at home.
We also need to reflect the diagnostics and treatment happening within the building. It feels professional – so that you feel this is the best place to be cared for and recover.”
The project has been designed with children, for children, and there is an ambition to look and feel different: to be clearly perceived as a children’s hospital.
As with the Rigshospitalet, the structure is broken down – each wing has a double corridor structure – giving shorter distances between staff bases and patient rooms. Corridors are broken up by a large dining room and playroom and complete with balconies at the end of each wing. In between, other spaces provide more private areas for teenagers to socialise.
The arrangement of 16 patient spaces, mostly single rooms, within the ward is shaped for a high level of future proofing, particularly in terms of infection control. The capacity to create lobbies for each bedroom is built into the design.
Co-Design and Co-Creation: creating a shared library of experiences.
In a similar vein, the Psychiatric clinic at Sodra Alvsborg Hospital, was designed in partnership with the clinical team, with the aim of destigmatising by normalising patient environments to be more domesticated. The team’s passion for overcoming the typical constraints of mental health design, ultimately resulted in a better balance between healing and safe environments.
Physical factors that have a strong impact on how patients feel and heal within ward environments were considered as part of the theoretical backdrop to the design for this project – along with best practice, co-design and dialogue with clients. Mock up rooms were built and study tours undertaken to create a common library of experiences and lessons learned.
The resulting design has a strong focus on daylight and orientation. Bedrooms are a universal design, and nested – with full accessibility and a balcony – a complex consideration achieved through a huge team effort – and commitment – to finding different ways to solve ‘risk’ issues, without compromising the quality of the patient environment.
It’s a challenge we’ve often had to solve differently in the UK, where trust in professional skill sets rarely rules out over compliance.
Teva Hesse’s experience, working extensively in both Denmark and the UK, suggests a stark contrast in approach.
“The key driver for the NHS is compliance. No-one wants to do anything non-compliant – going outside the guidance causes anxiety. In Scandinavia there is a greater trust in the skillset of architects and the design team. Compliance isn’t so rigorous and architects are freer to explore concepts and proposals that would potentially provide a better result.”
Teva Hesse, C.F. Møller
Typically, ‘Value for Money’ wins out over design quality. But who are we designing for? The patient (and their improved recovery) or the price tag of the building?
The UK faces a greater challenge in terms of its population diversity – both economically and culturally. It’s harder to put yourself in the shoes of the patient, when there is a much greater range of perspectives to consider.
Designing out risk vs. focusing on positive outcomes
A myopic focus on the risk register is hard to escape., but in doing so, we miss many of the positive outcomes – and opportunities for design. As Teva notes, facilities such as Springfield Hospital in Tooting Bec, now nearing completion, are complex. The entire environment is designed for people whose choices are heavily restricted – providing for their welfare, safety, recreation and residential needs. As a result, the design needs to work hard to promote freedom of choice and a variety of space for activity where it can.
Two of the biggest challenges are boredom and violence. The C.F. Møller team studied 20,000 incidences over a period of 5 years and discovered that by attempting to eliminate risk, patients are left with nothing to do – and this is a huge part of the problem.
”None of us would thrive in these environments. We have got to do better.”
So what questions do we need to ask?
The C.F. Møller approach suggests we challenge ourselves, asking:
Q. Might our design approach inadvertently cause the types of incidence we seek to avoid?
Q. How can designers improve the quality of life for mental health patients?
Q. Why do we focus on risks and incidents as opposed to benefits and positive outcomes?
Q. What positive benefits do patients receive daily?
Clearly, regulations are applied in very different ways in Scandinavia – much more as guidance, rather than adherence, but we need to continue to strive to do better.
At Springfield, derogations stretch to more than 40 pages, but the design team have worked hard to deliver above and beyond the standards.
The Ground Floor of the new ‘non-forensic’ building delivers a vibrant cafe and community space where service users, visitors and local residents can comfortably co-exist – reinforcing the reference that mental health is ‘all of us, not just some of us’.
Landscape is brought into the calming atrium space through clever use of tree pits – creating an ‘inside-out’ feeling, while shared spaces such as lounges and dining rooms are oriented towards the gardens. The obligatory TV lounge is present, but separate so the focus can be elsewhere.
The team have also looked closely at corridors – often the scene of violence, where there is no chance to avoid unwanted encounters. At Springfield these have been made active spaces – with places to sit (still under observation), read, play chess, safely and comfortably.
The goal of guidance and regulation is to provide minimum uniform standards, but it shouldn’t be the end-point. Scandinavia shows us that more is possible, and in the UK, we need to continue to raise our game.