Design special report: Glenfield Hospital's paediatric intensive care unit expansion

Gelder and Kitchen architects reveal how they approached the design of the paediatric intensive care unit at Glenfield Hospital in Leicester

The backlit sky window is one of the key design features of the extension to the paediatric intensive care unit at Glenfield Hospital

Hospital environments for children are some of the most challenging when it comes to architecture, and few facilities require a more sensitive approach than paediatric intensive care units (PICUs). In this special report, we speak to the team behind the refurbished PICU at Glenfield Hospital in Leicester, which has revolutionised the care of very sick children at the same time as providing a more welcoming environment for parents and staff

On paper the decision to extend the paediatric intensive care unit at Glenfield Hospital in Leicester seemed relatively simple – expand the space from five bays and three side rooms to eight bays and four side rooms. But, in reality, the project was challenging, both in terms of the vision for a world-class clinical building, and the fact the transformation was to be carried out while the existing unit was in operation, treating some of the area’s sickest children.

With construction broken down into four phases so as to create the minimum of noise, dust and disruption to the hospital, the £500,000 expansion project was designed by architects from Gelder and Kitchen in close conjunction with staff, parents and patients.

Architect, Alessandro Caruso, said of the project: “This was a small scheme in terms of value and size, but it was really interesting from a design point of view.

There is a different sensitivity when you are working with children and the design was developed with an emphasis on creating an environment that could be perceived as being inviting and warm, but at the same time making it clear that it is a place of clinical excellence

“The challenge was to make it less clinical and more welcoming. There is a different sensitivity when you are working with children and the design was developed with an emphasis on creating an environment that could be perceived as being inviting and warm, but at the same time making it clear that it is a place of clinical excellence.”

The team held discussions with patients, staff and parents from the beginning of the design process, speaking to those who had spent time on the ward about what they wanted and the restrictions and problems encountered in the existing environment.

Lee Appleton, Gelder and Kitchen’s project lead for the unit, told BBH: “We brought some design proposals to the table and spoke to parents who had children there, as well as the staff who work on the unit. We then put together some mood boards and came up with a scheme based around colour.

“We wanted to bring in colours like yellow, which is peaceful and calming, and a lot of the existing areas in the unit were blue, so we took that into the new extension in order to link the two spaces. Yellow was a big step forward in terms of bringing a sense of vibrancy and playfulness that did not previously exist.”

The interior design is very much about creating a total healing environment using evidence-based design that gives the view of clinical excellence, for which the facility is known, but also meets the needs of the users

The team also decided that one of the best canvases for bringing light and colour into the unit was the ceiling, and the main ward features a LED backlit sky window, giving patients, who are often lying in their beds for long periods of time, the idea of looking at the sky.

Yellow and blue hues were used to link the new extension to the existing building and to bring vibrancy into the unit

“Usually in hospitals you gaze up at white ceilings, so the feature is something to keep patients interested and take away that feeling of being in a clinical environment,” said Appleton.

The importance of stakeholder involvement early in the design process was particularly evident when the team considered taking this sky window concept into the parents’ quiet room. The facility is often the place to which anxious parents retreat or where they meet with staff, often to hear bad news about their health of their children.

Nigel Bond, assistant director of facilities at the University Hospitals of Leicester NHS Trust, said: “The sky ceiling in the ward seemed to have such a positive impact that we wanted to do the same in the quiet room. However, when we engaged the parents they did not want it. They said the quiet room was the place they sometimes went to hear bad news and they did not want the image of the sky because it looked like they were looking to heaven. We had not seen it from that point of view and without their input we would have thought the sky ceiling was a wonderful idea. Instead the parents asked for wall images of pebble beaches. This was a real eye opener for us about the importance of involving users.”

Artwork like this is used throughout the building to create a sense of space and normality.

Caruso said: “The interior design is very much about creating a total healing environment using evidence-based design that gives the view of clinical excellence, for which the facility is known, but also meets the needs of the users.

“The artwork is very much inspired by the elements such as sky and water and, because the ward does not have access to a lot of natural light, we have tried to integrate this into areas through the use of backlit images and ceiling tiles.”

Appleton added: “We have used colour on the floors and, while we have kept it quite neutral for cleaning purposes, we have managed to make it appear a lot less clinical.

The environment we have created is a world of difference compared to what we had before. We have not just added beds; we have enhanced the experience, particularly for parents

“Previously, the unit had been designed with the staff in mind and they will always have a job to do that is driven by medical procedures, but parents also spend a lot of time at the facility, sometimes many months, and they are not there to work. Often they are frustrated and stressed and anxious and are looking for something to relax them and take them away from the fact they are in a clinical environment.”

This opportunity for retreat is provided by a quiet room and parents’ lounge and kitchen, which means families can make refreshments, or just sit and relax.

Appleton said: “They need somewhere they can have a break, so whereas before they had a small room with no windows, they now have a kitchen, lounge and quiet room. These have been designed to be very homely so they provide a contrast to the clinical environments.

“While this was not a high-value scheme, the impact it has had on the users is significant.”

Bond added: “The environment we have created is a world of difference compared to what we had before. We have not just added beds; we have enhanced the experience, particularly for parents.

“You might think on a ward like this the focus is purely on the child, but the parents are there for a very, very long time and despite their concerns and anxieties, they are aware of their environment.

“The environment we have created does not offer additional challenges as it did in the past in terms of being cluttered and overcrowded. We have challenged the norm for everyone’s benefit.”

What we have created is an environment that feels nice to be in. The parents, staff and patients say they really like it and it is helping them to relax. We are so pleased with the outcome and hope it will create a benchmark for similar facilities

Construction work was carried out by Manton and as each phase was undertaken, the operational clinical wards were sectioned off.

Caruso said: “We came up with a very compact and simple layout for the ward spaces, with the focus on enabling observation of all bays and giving easy access to clinical facilities.

“To keep the rest of the unit operational while the work was carried out, we broke it down into four phases and isolated those areas using boards and partitions. From an access point of view we used a system of airlocks so we were always reducing the risk of dust spreading and we minimised noise as much as possible.”

Bond concludes: “What we have created is an environment that feels nice to be in. The parents, staff and patients say they really like it and it is helping them to relax. We are so pleased with the outcome and hope it will create a benchmark for similar facilities.”

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