The Design Council sent groups into hospitals to experience first-hand what it’s like for patients, with a view to creating a more aesthetically pleasing and dignified hospital environment for them

Your bum sticks out of your gown for all to see as you lower yourself on to that ancient hospital wheelchair to visit the rather decrepit unisex toilet down the hall: ‘dignity’ isn’t the first word that springs to mind, is it? Enter the Design Council, a bevy of designers and architects and a handful of manufacturers and that scenario could start to become a thing of the undignified past.

Following on from its successful Design Bugs Out (DBO) programme, the Design Council – at the previous Government’s behest – again took on an advocacy role between design, manufacture and the arcane health procurement system to enhance the lot of the patient.

This time, improving conditions for those in mixed-sex wards was at the heart of the agenda, but those involved in Design for Patient Dignity (D4PD) took the briefs and ran with them. They have come up with a series of products and interior interventions that have the quality to make you ask: ‘Why has no one done this before?’

Witness Ben de Lisi’s gown where your bum doesn’t stick out – it’s not rocket science. Perhaps the answer to why some of these things haven’t been done before lies partly in the disjointed procurement process of the NHS. ‘We have worked in healthcare hospital design for many years,’ says Avanti Architects associate Joanna Marriott, ‘and the procurement process doesn’t give much opportunity to make the most of our knowledge and design skills, because it is often heavily dictated by regulations and doesn’t necessarily inspire or facilitate innovation.’ But she says it was a very different experience when they became involved in D4PD, where they effectively became the client, helping to form their own brief.

Avanti was one of more than 60 architects and designers that applied to be part of the scheme, more than twice that of DBO, says the Design Council’s programme manager for health, Chris Howroyd: ‘It really struck a chord. For DBO, we developed a model that brought together designers and manufacturers – an open innovation model – to address some of the problems experienced within the NHS. For D4PD, we commissioned four ethnographic teams to go into four hospital and to live and breathe the issues that staff and patients have to deal with every day. They came back with some very rich information.

‘We then worked with the design teams to ensure they had the correct support and appreciated the context of their design briefs. And we continued to work with them to ensure they were delivering to the brief.’

Each of the chosen consultancies or teams also received a £25,000 pump priming grant and contact with the Design Council included the input of an expert advisory panel ‘made up of clinicians, manufacturers, designers and other relevant stakeholders’. All the designers seem to have found this invaluable, both from a design development point of view and also, for some, as a kind of endorsement for their work, particularly in the eyes of potential real clients.

PearsonLloyd worked on DBO and D4PD. ‘DBO was a very successful project for everyone, not least the Design Council,’ says consultancy co-founder Tom Lloyd. ‘It developed a model that seems to work: the process and the advocacy between the public sector and private sector – bringing people together who might not otherwise be able to tackle these big markets – the brief development process, and then actually having some outcomes, because a lot of the council’s work is often based on documentation, but this is based on real delivery. And for the Department of Health, it seems the investment is relatively light. For the “X” amount it pays for the seed capital and the administration, it gets quite a lot out of it.’

D4PD gave the teams just under four months to come up with the goods to the prototype stage, and that they have certainly done. ‘As to where we go next, further support is important and we’re particularly looking at how we can support these products into procurement. That is effectively a difficult process, particularly as the NHS is so decentralised,’ says Howroyd.

‘One of the personal aims I have for this project is for some trusts to run the principle of it themselves, particularly the process we’ve designed. If we can influence that – for them to liaise with designers directly, that would be fantastic.’

Howroyd adds that the Design Council has been ‘inundated with requests from NHS trusts’ to take the final products. The next stage is getting these great ideas into production. When you talk to the designers you get nothing but unbounded enthusiam for the process, the final products and a belief that these things will see the light of day and give patients back a big slice of dignity.

Nightingale Associates and Billings Jackson

(With manufacturer Sas International)
‘Everybody wants more single rooms these days, which is an answer to single-sex separation issues, and we saw this as an opportunity to make a difference and give estate and facility managers an answer to their problems and help them reconfigure their estate,’ says Nightingale Associates director of design, research and innovation, Richard Mazuch.

To that end, the design practice has developed a modular bed pod – a virtual flatpack solution that contains everything needed from the clinical gases to built-in lighting – while also tackling issues of privacy, both visual and aural. ‘We started with a dot in the middle of the page, which is the patient in really simple pictogram terms,’ explains Mazuch.

‘In the past we have talked about creating intimate, private and social spaces, which can be drawn as concentric circles. They are also the stages of healing and recovery: for example if you’ve had an operation, sometimes you hardly want to see anyone.’ Those circles have been translated directly into an intimate electronically controlled screen around the bed and a larger main screen which can provide a range of privacy configurations. The curved design also helps privacy, deflecting voices down towards the patient and the bedding, where they are absorbed – around a 20db noise reduction.

‘One of the big ideas is that it is designed as a “plug-in bed” – that is the magic of it,’ enthuses Mazuch, pointing out that any spare space, such as a storage room, could quickly be converted into a single room with this pod. It can also be used to reconfigure wards: by using this option in a temporary space, changes can be made to wards without losing any beds, which is often a current inhibitor to change.

Mobile zones

PearsonLloyd

(With manufacturer Kirton Healthcare)
‘Our analysis suggested you can go around the hospital in one of two products: a bed or a portering chair. Often, you are too ill to sit in a portering chair and you’re slumped forward in this awful Victorian object, or conversely you are not ill enough to be put in a bed, but are forced to lie down on one while you are moved around the hospital,’ says consultancy co-founder Tom Lloyd.

These observations inspired PearsonLloyd to create the hybrid mobile reclining chair. Apart from using it for moving around the hospital, it’s also particularly aimed at day procedures, where people walk in for everything from a minor op to dialysis, then need time to recover and are discharged the same day. An associated screen (linked in with a diagonal layout) was also developed, based on pop-up kite technology, which provides a higher level of personal privacy – you are never staring at the patient opposite you – while also allowing patients eye contact with passing staff.

‘We are in a post-launch review process at the moment: we have had feedback from the Design Council and, because it is a new product type, not a like-for-like replacement, we have to prove the business model to make sure the market understands it and recognises its value,’ adds Lloyd. ‘A bed might cost £2,000 to £3,000, but this will only cost £600-£700, so you could buy four or five for the same price as a bed. These issues are as key as work on ergonomics and understanding patient care.’

Wash and brush up

Azhar Architecture

(With manufacturer Grant Westfield. Smart Mirror by Slider Studio)
Now a director at Conran & Partners, Azhar – the full name he goes by – started this project in his own practice and has brought it with him to Conran, where he is confident it can be fine-tuned.

He has created a capsule washroom that is a kit of parts, whereby you can install some – say just the handwashing station – or all of it. ‘It is designed as a series of components that can be assembled to make a bigger component,’ says Azhar. ‘We have been adopting technology from areas like yachts, aeroplanes and caravans. For example, the toilet pan is not ceramic, it is a composite.We also worked with renowned services engineer Prof Max Fordham on creating a comprehensive strategy for deploying a capsule.’

The capsule can be deployed quickly and temporarily in an emergency and run off a cassette system, or more permanently connected up to the services.

And Azhar believes the product has life beyond the healthcare system: ‘There are a lot of typologies of businesses that just can’t shut down, for which this would be relevant. Hospitality is another area it could be deployed in; some people are OK with the “Glastonburytype” external loo, but for other situations it is just not appropriate.

‘This suggests two different business models: one is where a hospital trust would buy three or four to use as and when among its hospitals; the other is a lease model, where it can be installed when and where it’s needed.’

On the fast track

Helen Hamlyn Centre

The Helen Hamlyn Centre – part of the Royal College of Arts made up of three post-graduate students – had a slightly different brief from the design and architect teams, in that it was a ‘Fast Track’ academic partner and not linked up with a specific manufacturer. Instead, it had the opportunity to be more wide-ranging in its thinking; that said, the results are thoroughly pragmatic.

The designers developed products for four briefs in all: a patient information sheet, a gown and intensive care unit cover, a ward screen and a signage system. The centre was also involved in the initial research for the project and had previously worked on DBO.

‘In some ways this was more challenging than Design Bugs Out because that was quite specific and tightly defined, whereas the patient dignity context is very broad,’ says senior associate Maja Kecman.

Retractable screen

A lot of wards have a notoriously difficult layout and are quite difficult to manage,’ says Kecman. ‘So we were looking at how you maintain a single-sex environment when the ratio of male to female patients can vary, even throughout the day. The top-level brief was that we were trying to eliminate mixed-sex accommodation, because patients don’t like it.

‘We spoke to lots of people, such as bed managers who allocate the beds, and nurses, to understand the extent of the problem and see what kind of separation device would work. It became quite apparent that curtains are not good because they are flimsy and can be easily opened up. A good separating device is a stud wall, but that costs a lot of money and is not flexible.

‘We wanted to create something that was in between a wall and a curtain that could be deployed by the ward staff. What we came up with was a retrofit separation device [pictured far right], which offers the flexibility and ease of installation of a curtain and the degree of separation of the stud wall. The system draws on a double layer of fabric in tension between two pillars, which lock in place when they are deployed. When not in use, the system is easy to store away and takes up a minimum amount of space.

‘When deployed, it offers a high degree of visual separation and a greater level of sound insulation, and, because it’s fabric, it can be easily removed and washed.’

Signage system

‘In our research we found so many examples of inadequate and conflicting signage used within hospitals – confusing ad hoc solutions,’ says Kecman. ‘We worked with a graphic designer to develop iconography that’s really easy to understand and consistent for everything, from toilets and showers to male-female bays We also developed directional signs.

‘And one of the key things we wanted to do was to make the design modular and easy to change, though not so easy that the patient might do it.

‘We also used colour to differentiate between male and female. We had lots of debate, internally, with the expert advisory panel, and with experts around the UK about whether we should use colour. We looked at airport signage – yellow and black for the best contrast. In the end, we went with a blue and orange because it followed the NHS wayfinding guidelines and gave the biggest contrast with the white icons.

‘There is also some low-energy lighting on the protruding signs so that they can be seen at night. It is so simple that we are asking ourselves, “Why hasn’t this been implemented anywhere before?”’

Avanti Architects

(With manufacturer Panaloc)
Operationally for many hospitals, closing down a toilet to refurbish it properly often simply isn’t an option.

Avanti Architects has developed a washroom pod where all the services are brought together, and can be retrofitted into existing facilities (it takes up the space of one bed), or even stacked one on top of each other and attached to the outside of the building to provide additional facilities.

‘We have a lot of experience and have worked on a lot of innovative projects for the NHS, with inspiring clients, and we really enjoyed this opportunity to solve the same problems but with a slightly broader remit and more flexibility,’ says Avanti associate Joanna Marriott.

‘A major problem with hospitals with old building stock is the inadequate provision in this area. You cannot focus on separating men and women unless you have enough washrooms. It’s a pretty straightforward equation – you simply need to provide more. The question is where and how. The bathroom pod is like a microbuilding with four walls and all the services.We decided to challenge the presumptions. The standardisation and quality of the product is also key.

‘For most clinical visitors it was quite shocking that it looks so good. There were comments like, “It’s like a luxury hotel”, or, “I wouldn’t mind having it in my own home”.

We tried to move away from the perceived NHS standard in design terms. We wanted to make it not only technically sound, but to make it not look like medical equipment or an instrument of torture!’

This article was first published in FX Magazine.