Design and Dignity in Hospitals

Ian Clarke

Issue 392, vol.98, Winter 2009

We need to get away from the typical ‘no-place’ hospital corridors which resemble indoor motor-ways. The journey through the building should be experienced by the patient more as a stroll through the distinct parts or ‘places’ in a village, each with its own sign and character. Always to be avoided is perceived isolation – this leads to disorientation and anxiety.

There should be plenty of natural light, with views to the outside world. Even the physical materials encountered at close quarters should be more ‘natural’, and carry more substance and associations : too many of them are synthetic, characterless, ephemeral – from dressings and care-consumables down to disposable tea cups.

Design should promote this sense of connectedness with the natural world and with something bigger and ultimately more dependable than the self. The views to the outside and the natural light are of special help – since they enhance consciousness of the changing seasons, the weather, the cycle of day and night (and this is further enhanced where the gardens and good landscaping are incorporated).

The hospital environment will ideally help patients to gain confidence and motivation to get back on their feet, to want to move beyond the bed or chair bit by bit under their own steam – Consider, for instance, the potential of a simple window-seat in a patient room as a stepping-stone to the lounge down the corridor.

Appropriate levels of privacy and dignity are essential. A greater proportion of single rooms is called for, and a relatives’ room on the ward. Exposure to the distress or grief of others is detrimental (since distress is contagious).

In sum, there are several elements of the human experience which are conventionally considered to be limited to the fields of personal mood or interpersonal relationships. We know how each of these feels to us, but they are often described as ‘soft issues’ or ‘intangibles’ - the context implying that they are somehow vague or weak, and therefore not relevant to the bricks and mortar of hospital-building. But we would do well to heed Churchill’s dictum : “We mould or buildings, and then they mould us”.

Ian Clarke BA(Hons) Dipl. Arch RIBA FRSA is a Chartered Architect and Director of Jane Darbyshire and David Kendall Ltd, Chartered Architects and Landscape Architects, of Newcastle upon Tyne, UK (www.jddk.co.uk), where he is responsible for the practice’s healthcare portfolio. Unified by a user-centred approach, the practice has a particular reputation for the design of hospices, including St Oswald’s Hospice in Newcastle upon Tyne, UK (RIBA ‘Building of the Year’ 1989) and St Gemma’s Hospice in Leeds, UK (NHS Patient Environment Award’ 2003), amongst ongoing hospice work for clients throughout the UK including Marie Curie Cancer Care.

In Ireland, the practice has provided an advisory role in the new Curraheen Hospital in Cork, and are design consultants to the Irish Hospice Foundation. Their work was included in the Commission for Architecture and the Built Environment (CABE)’s ‘Healthy Hospitals Campaign’ in 2004 (www.healthyhospitals.org.uk), securing the largest proportion of votes in the public internet poll for visions of a future hospital environment. Ian Clarke is a member of the NHS Design Review Panel, and a CABE Enabler. Comment and discussion on this article are welcomed, via email to ianc@jddk.co.uk