Klaus Unger, a retired architect, has been a frequent patient in hospital over the last six years. He argues that a patient-centred approach to hospital design is essential to improving wellbeing outcomes.
Aesthetics and Design in Hospital Interiors
Well-designed hospitals lead to improved healing environments; I write from first-hand experience! Six years ago I spent many weeks in and out of hospital having treatment after surgery for cancer and, coincidentally, concurrent treatment for an autoimmune disease. I have been a constant and frequent patient in the years since my diagnosis, so that hospital appointments have become a regular feature of my life. My cancer diagnosis also coincided with my retirement from a long career in architectural practice, mostly in public service with the Office of Public Works. My training and experience as an architect have given me a valued insight into the design conditions of the various hospitals that I have attended in recent years. So, my observations here on hospital environments are informed by my position as both patient and architect.
The Oxford English Dictionary defines a hospital as “An institution for the care of the sick and wounded, or for those who require medical treatment.” The purpose of the acute hospital, therefore, is to ensure as far as is possible that patients are cared for and treated to the point where they can be discharged. It is a working environment where medical staff perform set tasks to achieve targeted outcomes and patients submit themselves to the prescribed treatment and to the care of the staff. There is not, however, an “equal” relationship between patient and medic and that “inequality” is borne out of a dependency of the patient on medical science and the know-how of experts; on the methods of treatment and care; and is frequently accentuated by experiencing unfamiliar surroundings and a strange environment of machines and sounds.
Medical professionals are trained to recognise the patient’s vulnerability in being ill or injured and dependent on others for help. I am not, however, convinced that all the design professions engaged in the provision of new hospital spaces, or the upgrading of existing medical facilities, are aware of the enormous impact and authority they can have in creating appropriate spatial environments which can give comfort and reassurance to patients and thereby assist in the healing process.
Harmony, proportion, scale and balance are some of the principal elements of design which contribute to creating the proper order of spatial enclosures. These characteristics are of particular importance to a patient whose experience of a hospital environment is mostly internal and often quite intimate, depending on the length of stay. Long periods of viewing surroundings from a horizontal position – lying in or on a bed – should be acknowledged by designers. An understanding of how best to arrange room shapes and circulation and sightlines centred on the needs of patients so that the patient can feel included and valued, is most important where individual rooms are provided.
On a recent visit to a newly opened public cancer centre, which I made in a professional capacity, I was struck by how the design of the individual rooms catered to both the patient’s comfort and sense of dignity. Large windows looked out onto landscaped gardens; the interior smart glass windows could be controlled by patients, giving them the choice of viewing life in the corridor or switching to frosted glass to protect their privacy; sliding doors minimised noise disruption for the patient as well enabling staff to move beds in and out easily. For many patients, of course, their experience of hospital is in a shared room or ward. Structured order and the rhythmic repetition of elements such as windows, doors, screens, furniture and equipment, should be designed to impart a feeling of confidence in patients that their situations are always under control no matter what activity is taking place in the space.
It is the positive emotional response of patients to their surroundings that is so important to the wellbeing and improved recovery time of being sick or injured. The strange experience of being too sick and tired to read, to watch television, to engage with the laptop, or even to converse with others, demands a special response to the patient’s condition which is quiet, calming, secure and dignified. This can be achieved by employing generous proportions and volumes; by ensuring that all the component parts of a space are acting together as a “family” to give a sense of harmony and peace; by the use of simple and robust materials and finishes, where quality is evident; by taking into account how colour, patterns, and textures on surface areas can impact on feelings of wellbeing; by the provision of natural light and a view of nature or of the world outside.
There is something particularly dispiriting about the placement of windows too high to catch a glimpse of the outside world, no matter what the outside world might look like. Indeed, during one of my hospital stays, my daily view was of a car park. I wondered about the people exiting their cars. Witnessing life happening outside the window made the curious phenomenon of never-ending time that takes hold in a hospital a little more bearable.
One of the afflictions of spending a significant amount of time in hospital is, as I have alluded to, sheer boredom – the patient either incapable of any meaningful activity or waiting for an activity by others to take place. It is in these seemingly endless moments that both the mind and the eyes tend to wander. The eye, when gazing at surroundings, will seek to resolve the geometry or the patterns on surfaces to satisfy balance and harmony in the mind. An external view from the bed or chair can engage the mind. However, best of all, in my opinion, is if there are selected works of art within sight – paintings in particular.
I believe that the response to and interaction with an art work can be of considerable benefit in raising the patient’s spirits. Keeping one’s spirits up is vital to a successful patient outcome and should be to the forefront of ambitions by both the medical teams and their professional design advisers in the provision of accommodation. Given the grand art collections amassed by the banks now in virtual public ownership together with committed implementation of the per cent for art scheme, I feel that greater opportunity exists to acquire and incorporate more works of art into hospital spaces most used by patients.
I acknowledge that hospital designers have to consider the wide variety of users in the course of design – medical staff, support staff, administrative staff, visitors and patients; though not necessarily contradictory, their needs are quite often divergent or different. I also acknowledge that a hospital is not a hospice, nor a nursing home, where the care of patients is the sole purpose of those environments. The fact that a hospital treats patients in order to return them to life outside again, suggests to me that there is an onus on designers to place the patient at the centre of their considerations and that the needs of the other users should revolve around the patient.
The emotional and psychological wellbeing of the patient is vital to the healing process. The patient’s awareness of both orderly surroundings and order in the surroundings helps to counter the chaos of pain. Security, dignity and confidence in the programme of treatment are feelings which contribute to a successful outcome for the patient. These emotions and feelings can be greatly helped by the patient experiencing the best environment in which to pass time and the architectural response to those needs is a critical part of the process.
Born in 1947, Klaus Unger, a Dubliner, son of Herbert Unger (1916-2002), followed in his father’s footsteps to become an architect. A UCD graduate in 1969, Klaus worked for a few years in London, Amsterdam and Vienna, before returning to Dublin to take up a position with the firm of Sam Stephenson and Arthur Gibney.
After being awarded a Norwegian Government scholarship with a sojourn in Oslo to study Regional Planning, Klaus later again returned to Dublin and shortly afterwards joined the Office of Public Works. Having worked on many prestigious state developments such as Dublin Castle, Government Buildings, Leinster House, National Gallery, National Library, National Concert Hall, Wexford Opera House etc. he eventually retired from service in 2012.
An elected Fellow of the Royal Institute of the Architects of Ireland and a member of the Royal Institute of British Architects, Klaus has maintained an active interest in architectural matters since his retirement, serving pro-bono in various advisory roles as well as serving as a director on the Board of the Alfred Beit Foundation in charge of Russborough House.
The emotional and psychological wellbeing of the patient is vital to the healing process. The patient’s awareness of both orderly surroundings and order in the surroundings helps to counter the chaos of pain.