Plea to architects to put 'patients before processes'

England urged to follow Scotland and Northern Ireland in championing patient-centred design

The IHEEM conference heard calls for healthcare designers to think more about creating patient centred environments

NHS trusts in England are being urged to follow the lead of health boards in Scotland and Northern Ireland in an effort to avoid creating ‘unsustainable, soleless buildings’ that put processes before people.

At last week’s IHEEM Healthcare Estates 2012 conference, Gareth Hoskins, design director at Glasgow-based Gareth Hoskins Architects, praised the Scottish Government for establishing a hospital design quality for the NHS that all boards have to sign up to. It puts the emphasis on the creation of healing environments that put the patient first. Northern Ireland’s health service takes a similar approach to estates and facilities management.

Hoskins said: “Architecture and Design Scotland is working with all boards talking up design. Key to the success is establishing a policy on design quality that all boards have to sign up to. They have to have a design plan and integrate this into all projects. A project does not proceed to the next stage of funding until the design has been signed off. It is not about box ticking, but about really understanding the benefits.”

The aim of architects is to create a clear, functional diagram, but more importantly to relate the site and the environment to the experience of the people using the building. But how often does it happen in reality. Often it is the clinical that strangles the real sense of place

He added: “The aim of architects is to create a clear, functional diagram, but more importantly to relate the site and the environment to the experience of the people using the building, whether they be patients, staff or visitors. So often this is talked about. But how often does it happen in reality. Often it is the clinical that strangles the real sense of place.

“If hospitals are thought of only as places where we sort out disease, then no one is going to want to go there. If you are talking about health and wellbeing, then it is a very different message.”

Rory Coonan, former director of architecture, design and planning at Circle Healthcare, said healthcare design should be more about quality and not just a ‘tick box of technical standards’. He added: “The things we value the most often cost the least. Imagination costs nothing, but buys everything.”

And he urged architects and trust estates managers to design for ‘care-full encounters, not meetings with machines’.

hospitals are currently designed to tell you what is going on in the kitchen. We need to think hospitals, not machines

Speaking about the tendency in the NHS to label everything in hospitals, he said: “There are notices alerting you to X-ray, to scanners and a whole host of other equipment. When you go to a restaurant as a customer, you don’t see signs pointing to the grill or the microwave. The machines are not your main reason for being there. This is the same in hospitals, but hospitals are currently designed to tell you what is going on in the kitchen. We need to think hospitals, not machines.”

John Cole, deputy secretary of the Health Estates Investment Group at the Department of Health, Social Services and Public Safety in Northern Ireland, said it had a set of design rules aimed at getting project teams to focus on how buildings can enable high-quality services to be delivered.

He told delegates: “We often design soleless buildings without the human element. This is not going to help anyone. In Northern Ireland we don’t always get it right, but there are a set of rules to stop that from happening.

“I feel passionately that design quality makes buildings something more than just the fabric and it is something we should be doing and every time we do not we miss a huge opportunity.”

Key to the success is establishing a policy on design quality that all boards have to sign up to and they have to have a design plan and integrate this into all projects

Also speaking at the conference was Omar Jomeen, a former nurse and framework manager for the ProCure21+ initiative at construction firm, Miller HPS.

He urged industry and NHS staff to work more closely together, and with patient representatives, to design buildings that would promote health and wellbeing.

He said: “When architects work with clinicians the clinicians are often new to the process and not used to designing healthcare buildings. You might have two orthopaedic surgeons on a user group who have always avoided each other and have never sat down together and you are asking them to agree on a design when they can’t agree on clinical practice.

“It is important that we spend a lot of time and effort thinking of the estate as a product and not a service and creating clinical environments that are fit for purpose.”

This approach to design means overcoming the ‘Hospital-land’ mentality, said John Cooper, chairman of Architects for Health.

There is a really big challenge facing us, not just about improving spending, but about being more informed about what design can do and how we can improve it

“Hospital-land you can feel and you can smell as soon as you walk into a hospital and, if we as architects are good at what we do, you should be able to get from the front door all the way through to your final clinical destination without having to go through Hospital-land.”

And Sarah Waller, programme director for The King’s Fund’s Enhancing The Healing Environment initiative, added: “I can’t understand why we are still designing hospitals with rows of chairs facing each other. We do not sit like that at home. We also have gardens with no access. We are all patients, so let’s design for ourselves.

“So often hospitals are stark with little humanity and there is confusion about where to go. We have wards with equipment everywhere because the design did not allow for enough storage, and we put the nursing station right in the middle so the staff chat and are not with the patients.

“There is a really big challenge facing us, not just about improving spending, but about being more informed about what design can do and how we can improve it.”

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