Focus: Hospitals


Stantec’s Velimira Drummer looks at the principles of interior design in modern healthcare environments.


Words by Velimira Drummer

When I begin the process of designing a hospital interior, I do so in the knowledge that sometimes a healthcare environment can be an extremely stressful place for patients, visitors and staff. The design challenge in these environments is not just to combine function, comfort and aesthetics, but to do so in a way that supports wellbeing, reduces anxiety, and allows the efficient and effective treatment of patients to optimise positive outcomes.

In short, we have to design an interior that operates like a hospital, but doesn’t feel like a hospital.

To achieve an uplifting healthcare environment, there are two main design challenges we must address. Firstly, the size and scale of a project, and secondly the needs of different user groups. Large hospitals share some similarities with small towns. Patients move around the space daily for varied purposes, some staying for diagnostic tests and/or treatment. Hospitals are also workplaces for hundreds of staff, who either work in the building or visit it for educational purposes.

Different user groups and individuals have a wide array of emotional states and needs. The challenge is to direct and streamline the flows of different users and create successful communities for the varied occupants. Consequently, ‘town planning’ design considerations are the key to successful interior architecture in large hospital buildings.

Newcastle New Victoria Wing – town planning design principals were used to organise the large public atrium which includes shops, dining and MediCinema. Image Credit: Timothy SoarNewcastle New Victoria Wing – town planning design principles were used to organise the large public atrium, which includes shops, dining and MediCinema. Image Credit: Timothy Soar

Increasingly, large hospitals are becoming destinations in themselves, with people visiting them to use the amenities, not just to be treated or to visit a sick friend or relative. For instance, at the New Victoria Wing, located on the Royal Victoria Infirmary campus in Newcastle, there are several public facilities enjoyed by the local community, including a cafe, shops, gardens and cinema. For the interior designer this demands careful consideration of the needs of all user groups to create vibrant environments that also take inspiration from hospitality and workplace design.

So, how do we go about creating healthcare interiors that address the needs of each user group and deliver a human scale? We begin with an integrated and collaborative approach between design teams and user groups to enable spatial organisation that supports less stressful patient journeys, more efficient workflows and inclusive community engagement.

Cancer Centre at Guy’s Hospital, London – colour-accented artwork includes Gitta Gschwendtner, Genius Loci chair and Karel Martens’ The Mountain mural. Image Credit: Morley Von SternbergCancer Centre at Guy’s Hospital, London – colour-accented artwork includes Gitta Gschwendtner, Genius Loci chair and Karel Martens’ The Mountain mural. Image Credit: Morley Von Sternberg

Ideally, interior architects should be involved in hospital-design projects from the concept stage. In global design practices, where we can call on expertise from our international network, a collaborative approach also underpins knowledge sharing and integration of learnings from previous projects. We also bring together varying experience and understanding of cultural requirements based on user feedback.

Zoning and landmarks

At its core, every project requires a clear vision and a strong organisational design concept, which is seamlessly integrated within its context. In the design of large hospitals, it is important to create a clear spatial organisation from the beginning through the creation of hierarchies and development of a constellation of landmark spaces. This helps wayfinding for each user community.

National Centre for Cancer Care & Research, Doha – integration of medical equipment into the interior design to create humanised, comfortable, patient roomsNational Centre for Cancer Care & Research, Doha – integration of medical equipment into the interior design to create humanised, comfortable, patient rooms

A zoned approach also enables the design team to address a very human impulse: the desire for variety. Developing a varied series of landmarks within a healthcare interior provides an antidote to an institutional aesthetic, engaging building users’ emotional responses to support their wellbeing and providing visual cues for wayfinding. Zones also play a vital role in separating the front-of-house patient from the back-of-house work areas to safeguard patients’ privacy and dignity.

For example, in the new Cancer Centre at Guy’s Hospital, the design concept reflects the two complementary yet different aspects of cancer care: the ‘Science of Treatment’ that houses clinical and technological facilities, and the ‘Art of Care’, which has more social and interactive areas.

Naufar Wellness Centre, Doha – culturally appropriate colour palette in the lobby of the main clinicNaufar Wellness Centre, Doha – culturally appropriate colour palette in the lobby of the main clinic

The 14-storey building is divided into smaller, humanscale operational units, known as villages. Each village has an Art of Care zone at the front and a Science of Treatment zone at the rear. The Cancer Centre also has its own unique landmark space: a double-storey atrium or ‘village square’, which has its own distinct identity, reflected in the wayfinding strategy and articulated in the facade colours.

As we develop the design detail of each hospital zone, the drive to camouflage the clinical purpose of the building must inspire design ingenuity. Functional requirements must be integrated into the interior design to reduce clutter, and clinical areas can be humanised by minimising the impact of medical equipment with design touches such as screening, lighting, art and innovative use of colour and texture.

The London Clinic Cancer Centre – humanising the impact of hi-tech medical equipment through the use of integrated joinery and art. Image: Edmund SumnerThe London Clinic Cancer Centre – humanising the impact of hi-tech medical equipment through the use of integrated joinery and art. Image: Edmund Sumner

At The London Clinic Cancer Center, for example, the radiotherapy-treatment spaces have been designed with integrated light-panel artworks in the ceilings above where the patient lies. These panels incorporate images of nature and provide the patient with a relaxing ambience and positive distractions to promote reduced anxiety.

In another project I was involved with, the National Centre for Cancer Care and Research in Doha, the imperative for bringing elements of the home environment into the hospital setting was evident. Here, the patient room was a high priority, with integrated joinery for personal items and areas for personalisation, along with high-quality finishes and ample space for a family zone.

Materials and colour

A further important factor in the creation of a successful hospital interior is selecting the right materials and colours. The material palette selected must be appropriate for each individual facility. A neutral base palette can be a unifying factor across the various interior spaces, from public to back-of-house areas, and from patient treatment to staff work areas. Additional accent colour palettes and speciality materials and textures can provide unexpected splash of colour and interesting elements to create a hospitality-style environment despite the clinical setting.

It’s also essential to ensure that colours are appropriate to the space: too much colour could over-stimulate the patient, even in a paediatric setting. Conversely, the use of accent colours alongside a neutral base palette can add interest, achieving the design goal of variety, while aiding wayfinding and zoning. This is an approach we used successfully at the Hospital for Sick Kids in Toronto to create an interactive and age-appropriate environment.

Meyer Children’s Hospital, Florence – spaces in a fully glazed atrium creates connections between inside areas and nature outside. Image Credit: Richard JohnsonMeyer Children’s Hospital, Florence – spaces in a fully glazed atrium create connections between inside areas and nature outside. Image Credit: Richard Johnson

As designers on a global portfolio of projects, we also have to remember that colour has cultural connotations. For example, in Naufar Wellness Centre in Qatar, the main patient clinic used a pale, almost white, colour palette, which symbolises purity in Arabic cultures. However, in the Chinese culture, a similar colour palette would have connotations of death and grief.

Nature

Aligned to the spatial organisation and interior palette selection is the need to connect the indoor environment with the outdoor space wherever possible. Access to the exterior and natural environment has been proven to accelerate healing processes and it also supports wayfinding and wellbeing for patients, visitors and staff.

Integration of nature into the interior design requires access to filtered natural light and external views, which may include a visual connection to sky, water and vegetation.

For instance, at the South West Acute Hospital in Northern Ireland, all patient circulation routes benefit from natural light. Glimpses of the beautiful landscape of Fermanagh are possible from all locations in the hospital, including patient bedrooms, consultation and examination rooms, cafes, and public amenities.

Similarly, at the Meyer Children’s Hospital in Florence, the large atrium space creates a visual dialogue between inside spaces and nature, and the design of the atrium’s structural columns takes the shape of trees, providing a further connection with the natural world.

Hospital for Sick Kids, Toronto – Emergency waiting area uses a neutral material and colour palette with accent colour to offer interestHospital for Sick Kids, Toronto – Emergency waiting area uses a neutral material and colour palette with accented colour to offer interest

Where a genuine connection with nature is not possible, artworks and technology can be a viable substitute for views and daylight. For example, at the London Clinic, to overcome the lack of views, we designed digital technology into the waiting area, which help patients to relax with live, virtual views of Regent’s Park. In the Cancer Centre at Guy’s Hospital, meanwhile, a digital art installation in the lifts gives the patient the experience of travelling from a forest floor up through the tree canopy.

Art Research has shown that the arts have the capacity to produce positive health outcomes. Evidence for art as a healing modality includes not only the visual arts, but also music and performance, media and interactive art, and art therapy in which patients, family and staff benefit from the participation in creative expression. The arts are a counterbalance to the stress-creating aspects of a medical environment; they provide opportunities for respite, make spaces more personal, and add elements of discovery and delight. They are also a key component in creating a culturally relevant environment in a building design driven by international standards.

It is also within the remit of the interior architect to ensure that the spatial layout enables wider integration of performance arts with wellness-centred design principles. The success of the multipurpose atrium at the South West Acute Hospital as a venue for performance and exhibitions corroborates the value of this approach.

Redefining hospital interiors

Hospitals are functional buildings and, as an interior architect working in the healthcare sector, I can never lose sight of the practical requirements of the space that I’m designing. But, if we are to redefine hospital interiors by focusing on wellness and positive outcomes rather than succumbing to illness and fear, we must think beyond the medical and remember the impact of design on people, including patients, their loved-ones, their clinicians and the wider community.





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