Hospitals are challenging environments – needing to deliver a high-quality patient experience despite increasing patient presentations, staff often facing change due to new clinical models and facilities typically maintenance heavy in a 24/7 environment.

Just the thought of incorporating any new ideas into the mix can be overwhelming for health agencies and the teams who design and manage these spaces.

But according to Julian Soper, leader of Arup’s health business in Australasia, when the new ideas – focused on people and nature – are proven to achieve significant benefits for patients and staff, reduce construction and maintenance costs, and also link into broader plans to make our cities more liveable and resilient, it’s difficult not to open your mind to the possibilities.

“In many hospitals of the past, commonplace was a blanket one-size fits all approach: confined rooms, low ceilings, glaring artificial light, plain walls, tiny unopenable windows, stark waiting rooms, noisy floors and the presence of medical odours,” Soper says.

“But for patients in hospitals where new design ideas have been implemented to help aid a speedier and more comfortable recovery, and reduce ongoing maintenance costs – such as Singapore’s Yishun Community Hospital, or various Aboriginal health facilities in Australia –  the experience is very different, and so too are the impacts.”

The Christie Proton Beam Therapy Centre

Room with a view, and fresh air!

It’s 24°C outside. Looking through the large double-glazed sliding door, open to let in fresh air, past the balcony and lush greenery springing from the building’s façade, the city stretches as far as the eye can see. Inside, daylight fills the room and there is less noise from outside traffic, dampened by the green façade.

For patients at Yishun Community Hospital in Singapore, this is their reality, and it’s one that is becoming more commonplace in an array of medical facilities around the world (such as Arup’s Octav Botnar Wing Great Ormond Street Hospital, The Christie Proton Beam Therapy Centre, Laguna Honda Hospital), driven by architects and health agencies better understanding the benefits/advantages of more sustainable design for the building itself and also by research that shows patients recover faster – and staff wellbeing improves – when they have access to elements such as lots of daylight, larger windows with views, green airy spaces, balconies and lush green facades.

According to many studies, integrating peoples’ needs and nature into hospital design produces benefits such as improved patient health outcomes, reduced length of stay, enhanced staff recruitment and retention, improved staff wellbeing and lower operating costs.

“Increased retention correlates with reduced turnover, saving dollars and ensuring smoother overall operations. Investments in improved energy and water performance lowers operating costs, resulting in more dollars that can be redirected to patient care,” according to leading healthcare design expert Gail Vittori in a recent presentation: “ A dose of sustainable design“.

Vittori said benefits also include a 3-8 per cent reduction in medication and a 40 per cent reduction in medication errors through having access to natural daylight in the nurses’ break room. To add further weight, a World Green Buildings Council report suggests designing with health and wellbeing in mind has been found to deliver 8.5 per cent reduction in hospital stays, 15 per cent faster recovery rates, 22 per cent reduction in need for pain medication and an 11 per cent reduction in secondary infections.

Government liveability focus another driver

Another key driver for the move towards putting peoples’ needs and nature first in hospital design, is a focus at a government level to make our cities more liveable and resilient.

“Singapore’s Sustainable Growth Strategy targets 0.8 hectares of green space for every 1000 people and aims to increase greenery in high-rise buildings to 50 hectares by 2030,” Arup’s facades team leader in Singapore, Michael Chin, says.

Integrating moss walls, hanging gardens and greenery into facades can help to reduce the heat island effect, filter fine dust on the streets and reduce noise levels, improve aesthetics, wellbeing, and the cooling potential of buildings.”

Hospitals and other medical facilities are playing a major role in achieving these broader city goals and, according to Chin, there are many factors contributing to success.

“From an experienced team who understand and can advise on technologies and materials to keep construction and maintenance costs down … to the design itself – innovative ideas for natural light, openable windows, green spaces, green facades, decent views, atrium spaces, vegetable gardens and calming outdoor spaces.

“Also, integral to achieving better health outcomes is making the spaces comfortable, inviting, not overwhelming, not intimidating, while at the same time maintaining the functional aspects of these technical and complex facilities.”

Octav Botnar Wing Great Ormond Street Hospital

Early consultation key to reducing high costs

Soper believes a common misconception is that a balance between functionality and comfort comes at a high cost and increased maintenance levels, “but if all the considerations are central to the design process from the early stages, high maintenance levels and high ongoing costs can be avoided”.

The leader of Arup’s work with Aboriginal and Torres Strait Islander communities, Kirsten McDonald, agrees.

“Through extensive and thorough consultation in the early stages of a project, design will be culturally appropriate and more people will be likely to use those facilities, resulting in better health outcomes,” McDonald says.

Through her recent work in regional Australia with Aboriginal and Torres Strait Islander communities, McDonald has seen first-hand how listening to the needs of the people using these facilities – through their engagement in participatory design processes – can inform design solutions that are culturally appropriate and, in doing so, improve and provide healthier, environments and better outcomes.

“Needs and outcomes will vary from facility to facility. A connection to nature and the outdoors is important for many Aboriginal and Torres Strait Islander communities. As is understanding the typical patterns of use such as caring arrangements and factors such as an entire family attending an appointment … these factors will inform design decisions such as the size and configuration of waiting and consultation rooms, and how seats are arranged to cluster and face courtyard and so on.”

McDonald says this approach also helps to encourage people to want to use the facilities.

“In some areas you might need to consider separate entrances for male and female or the association of medical professionals with past trauma … so we need to take that into account when considering the spatial layout. Through this approach to design, we help encourage these people to want to use these facilities and access health services … which will ultimately contribute to improving outcomes.”

The future looks bright

Whether it’s in regional Australia or a big city such as Singapore, hospitals can – and should – be designed from the outset to be meaningful for the community which they service. This might translate into a design with hanging gardens and green facades, natural light, fresh air and so on, or it might translate into deep consultation to understand the needs of people using each facility and designing with that in mind. Either way, better outcomes can be achieved and it doesn’t have to cost the earth if it’s done correctly from the outset.

“With an understanding of the value of true consultation, combined with robust research that confirms the critical importance of nature and natural systems in the built environment, we now have the opportunity to rethink how our hospitals can help achieve better outcomes for patients, improve wellbeing, speed patient recovery and reduce ongoing costs,” Soper says.

Putting people first. Isn’t that what healthcare should be all about?

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  1. Very encouraging to see the longitudinal studies coming out from buildings like the Octav Botnar Wing which opened 11 years ago. That approach informed a number of Australian projects like the New Royal Adelaide Hospital (2017), Sunshine Coast University Hospital (2016) and New Bendigo Hospital 2016 (a ‘tranquil’ hospital).