New Hospital Design

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words David Taylor and Lucy Stehlik

Four young architects have been asked to develop concepts for hospitals amid mounting concern that the poor design of new health facilities is harming both patients and staff.

Government architecture watchdog the Commission for Architecture & the Built Environment (Cabe) asked the four practices - McDowell & Benedetti, Jane Darbyshire & David Kendall Architects, Fat and Muf - to come up with ideas as part of its new Healthy Hospitals initiative.

Cabe has launched the campaign to persuade politicians, healthcare professionals and the public - plus members of the PFI (Private Finance Initiative) consortiums that are building most of the new hospitals - that it is worth investing in better architecture.

There are plans to build 100 new hospitals in the UK before 2010, making it the biggest healthcare building project in UK history, but most are being built under the controversial PFI initiative which, critics argue, leads to badly designed facilities.

"We have a once-in-a-generation opportunity to make sure that new hospitals are built to the highest possible standards and also take account of healthcare needs in 25 years," says Cabe chief executive Jon Rouse. "Investment in design is insignificant relative to the lifetime costs of the building. However, the benefits to patients and staff are huge. Cabe's research demonstrates how good design can increase staff morale, patient well-being and even reduce the use of pain killers."

According to research conducted by Cabe and the Royal College of Nursing, 91 per cent of all nurses and 100 per cent of directors of nursing believe that a well-designed environment is significantly related to patient recovery rates, while· similar numbers say that badly designed hospitals contribute to stress. In addition, 87 per cent of nurses say that a well-designed hospital would help them to do their jobs better.

Muf "Time spent in hospitals is precious," says Liza Fior of Muf. "But there is the potential for this time to be exceptional and creative for all who use them and work in them." Muf believes hospitals should be considered as important public spaces, which could be enhanced with botanic gardens, galleries, performance spaces and sports facilities. Hospitals should strive to understand their patients - or "audiences" - in the same way that other cultural institutions do, says Fior. "They should offer alternative funding models that recognise that hospitals are full of the diverse audiences that other public cultural institutions bend over backwards to attract," says Fior, who argues that public facilities in hospitals should be separately managed. Muf also calls for the greater empowerment of patients, who should be treated as stakeholders, and for hospitals to be places of emotional exchange.

Fat "It's the general atmosphere of basicness in hospitals that I hate," says Sam Jacob of Fat. "They are mainly focused on delivering a service, so they're like an infrastructure, rather than being focused on the experience of the patients, staff and visitors." Fat's concept involves integrating hospitals with the surrounding city so that they become extensions of the high street, with shops, leisure facilities and activities such as language classes. "Hospitals are very insular places," says Jacob. "We're trying to help patients get into a more positive relationship with this gigantic building they're in, so they don't feel like an invalid, but a real person." Patients will be given more control over their environment, with wheel-away furniture in wards, and business facilities on tap. "If I was struck down by a mystery illness, I'd still want to be able to do things - like be connected to the office," says Jacob.

Mcdowell & Benedetti "Hospitals make me feel uneasy and ill," says McDowell & Benedetti partner Renato Benedetti. "They're lacking in the human touch. They're alienating. We've tried to provide a bit more of a human touch and make spaces that make it easier for people to feel comfortable in so they feel more domestic, like at home. In other parts, we wanted them to feel more welcoming, lively and engaging, like a public space. Benedetti says that the entrance is crucial: "The important thing is that the experience is like entering a good hotel. People should be there to physically greet you. It's a management issue. It's important to be received by a person. Benedetti also proposes more natural light and abolishing waiting rooms: "They're the bane of our lives - a bunch of chairs and people looking extremely anxious."

Jane Darbyshire & David Kendall Architects "Hospitals often make patients feel like tiny cogs in a large machine," says Ian Clarke, director at jane darbyshire & david kendall architects. Hospitals tend to induce anxiety in patients, so Clarke's concept involves making them feel more like places that people associate with being at ease. Institutional corridors are replaced by spaces akin to meandering streams, shabby forecourts are laid out like parks, and oppressive entrances are made to feel like the welcoming entrances to department stores. Wards are redesigned to give all patients relaxing views: "Imagine lying on a beach," says Clarke. "This is how our four-person ward is organised. Each bed rests within a small, curved alcove - a 'bed place' that discreetly houses everything from the patient's personal locker to the nurse-call, telephone, curtains, oxygen system and TV. It could even have a video-link so a loved one could be at the touch of a button."

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