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Boston Society of Architects

Well Feature

3 takes

An architect, a designer, and a doctor walk into a hospital room…

WELL Winter 2015


The Akershus Hospital, from a series of hospital illustrations originally created for Mosaic magazine.

Illustrations by Elena Boils


Create a space, and control it

by George A. Takoudes AIA

Hospitals are places of profound human activity: exuberance and solace, solitude and community, interaction and introspection. Prognosticators tell us of a future full of wearable technology and real-time biometrics delivering big data to medical centers. Telemedicine will allow surgical teams to collaborate with robotic surgery across the globe. Such innovations, we are told, will transform hospitals and improve medical outcomes. Future spaces for healing will challenge this generation of architects to accommodate technology’s warp speed and invent patient spaces that synthesize these complexities of human-centered design.

But health, quite simply, is about people: a caregiver’s compassionate touch, a parent’s concerned gaze, a moment of courage in the face of a diagnosis. How do architects translate the patient experience into spaces for healing? Perhaps it’s in the way recent projects offer wireless control that allows patients the choice to leave their room white or “paint” it with LED lighting technology. Or how simple, uncluttered rooms void of beeps and buzzes will have flexible furniture systems tucked into walls to allow family to comfort an expectant mother. Or the way a young cancer patient — dressed up as Batman or a Disney character — receives chemotherapy in an active, open space that looks more like a living room than a sterile hospital space.

Healthcare architects readily consume complex guidelines and metrics that establish many of the necessary and inevitable rules of engagement in design and planning of our hospitals. But in our future, successful healthcare spaces might be more about the nuanced interplay between patient and physician, technology and structure, regulations and creativity. Even within the highly regulated world of healthcare design, architects will create spaces that protect and heal, are private yet open to possibilities, and express the passion and optimism of architecture to affect not only the built environment but also the human condition.


Sit up, then head on out

by Lee Moreau AIA

The inpatient room is all about getting out.

What’s the goal of the inpatient hospital stay? Ultimately, it should be a speedy and full recovery — and, to that end, we need to reconsider the design of our inpatient facilities. There needs to be a clear pathway in a patient’s mind (and through the clinician’s processes and tools) out of the hospital and toward the patient’s home. Many elements of contemporary hospital design conspire to obstruct that pathway: shared hospital rooms that have been proven to lead to increased infection rates, a lack of calming artwork or views of the outside, or the location of supplies and equipment requiring nursing staff to enter and leave a room multiple times.

Our team at Continuum has been working with Herman Miller on a range of healthcare projects focused on the inpatient experience. Ethnographic researchers talked with clinicians, hospital administrators, architects, and designers and realized that a key aspect of the journey to recovery involved getting people to transition out of their beds, where they often feel immobilized and helpless. Patients recover faster when they can start moving.

One outcome of our research process is the Nala Patient Chair, designed to propel the user upward and outward, to help speed recovery. Functionally, the chair helps caregivers minimize the risk to their health, as well as the patient’s, when transferring the patient from bed to chair. Emotionally, its welcoming design encourages the patient to get out of bed and continue the healing process. Once seated, the patient is comfortable and can relax; the body is well supported, and movement is easy and natural.

According to a 2010 study by the US Department of Health and Human Services, an estimated 27 percent of patients suffer an adverse event or an experience that results in temporary harm while hospitalized. Although modern medical breakthroughs abound, the physical space of a hospital is statistically more dangerous than a typical county fair. There are times when a stay in a hospital room is unavoidable, of course, but whether it’s a chair, a room, or a supply closet, there’s much we can do to advance hospital room design and help accelerate recovery.


Design a better system

by Walter Robinson MD

I have worked as a doctor in every manner of hospital room: 12-bed open wards for men stabbed by a stranger outside a bar, single-bed private rooms for a hospital trustee’s kidney stone, delivery rooms with a crucifix positioned so that the laboring woman could not help but gaze upon her suffering Savior, spaceship-like intensive care units with rows of blindfolded infants in brightly-lit plastic wombs, and drab rooms full of the sorrow of a dying teenager and his family. There is a hard but human truth about hospital rooms: They are better or worse not because of the amenities they provide or the money they save, but for their ability to help the staff ease the suffering of the sick and cure the illnesses that can be cured.

The best hospital rooms can make it easier for a nurse to console a fearful child, easier for a housekeeper to clean quickly so that the next occupant need not linger on a stretcher in the ER, easier for a physical therapist to assist an elderly patient into a comfortable and washable chair, easier for everyone to do their work without having to enter and leave three times, easier for patients and clinicians to get help when needed. The best hospital room is one that helps all the people who care for the sick do a difficult job in a compassionate manner, and that may not be the most private, the most comfortable, or the most visually appealing room. To think of a hospital room as a hotel room with nurses is to miss the modern truth that being well enough to care much about amenities should mean being well enough to leave the hospital; a hospital room today must help facilitate compassionate human contact with the seriously sick who have no other refuge.

Designing a better hospital room means designing a better healthcare system, one that provides skillful and compassionate care to the sick wherever they may be. We need a system that values the work of caring over the profit of promising luxurious cures, one that would give caregivers at all levels the space to do their job well and the respect to do that job with pride. We really don’t need better hospital rooms; we need a better approach to healthcare that will work in all the rooms we have now.