Creating an hospital for well-being: space kit approach
Designing hospitals is a complex challenge. These buildings need to be flexible to adapt to changing medical practices and patient needs. At the same time, they must foster well-being for patients, staff, and visitors. To achieve this, we are developing a method called the Space Kit Approach (SKA). This approach ensures that well-being is considered from the very beginning of the design process, using a language that architects understand and can work with.
The Challenge of Hospital Design
Hospitals are not just buildings; they are environments where people come to heal and where healthcare professionals work under demanding conditions. Designing such spaces requires a balance between technical and medical requirements and the need to create a healing environment. This is where Evidence-Based Design (EBD) comes in. EBD uses scientific evidence to inform design decisions, ensuring that spaces promote health and well-being (Herweijer-van Gelder, 2016).
Improved well-being is found to help physiological health and cure disease. Additionally, supporting well-being is found to play a protective role in the course of physiological disease.(Lamers et al., 2012; Paddon & Kampman, 2023).
However, integrating EBD principles into hospital design can be challenging. Often, these considerations are only addressed later in the design process due to detailed nature of this knowledge. However, major decisions have already been made by then. This delay can limit the impact of well-being-focused design elements.
The Space Kit Approach
The SKA is developed to address this challenge. It integrates EBD principles from the very beginning of the design process. At archipelago, a large-scale hospital design starts by defining a grid as this offers flexibility and adaptable programming as well as standardized construction methods (Pilosof, 2021). Think of Herman Hertzberger or Aldo van Eyck, who in the 1960s and 1970s built large-scale hospitals based on a grid. Our aim is to introduce EBD in discussions early in the process, where the grids are determined. This allows us to use spatial and architectural qualities to foster well-being, instead of being limited to interior finishes and furniture in a later phase. See it as putting together a puzzle, where each part comes from another box, including a box with EBD knowledge.
The SKA will be applied and tested in our Helora Project. This project involves designing five new hospitals in Wallonia, totaling around 2,150 beds and 220,000 square meters of space. The project aims to create a network of hospitals that are not only efficient and functional but also supportive of well-being.
Key Qualities of the Space Kit Approach
01 – Early Integration of Well-being
Well-being should be a primary consideration from the start of the design process. The SKA integrates well-being principles early on by focusing on how spaces will be used and experienced. In the Helora hospitals, waiting areas and nursing stations were designed with the needs of both patients and staff in mind.
To understand these needs, we start from the framework for achieving well-being (Deci & Ryan 2012). This framework shows that we can design comfortable spaces to improve immediate hedonic well-being and eudaimonic well-being of users by supporting their basic psychological needs of autonomy, relatedness and competence. Furthermore, SDT shows that supporting these needs even lead to improved experiences of comfort.
Studies show that well-designed waiting areas can reduce anxiety and improve patient satisfaction (Bell et al., 2018). In Helora, waiting rooms are designed to be comfortable and inviting, with areas for social interaction and privacy. This approach supports the psychological well-being of patients, making their wait less stressful.
Nursing stations were also designed to foster well-being. They are positioned to allow nurses to monitor patients effectively while also providing a space where nurses can take short breaks and interact with colleagues. This design supports both patient care and staff well-being.
02 – Designers’ Language
Architects and designers think visually. The SKA translates EBD principles into a visual and spatial language that designers can easily work with. This approach involves creating visual representations of EBD data, such as diagrams and sketches, that convey complex information in an accessible way (Cross, 2006).
For example, in the Helora project, design elements like waiting areas and nursing stations were represented visually from the start. These visual tools helped designers see how spaces would function and feel, ensuring that well-being was always a priority.
03 – Flexibility and Adaptability (No Plug and Play):
It’s crucial to prevent the grid approach from becoming a rigid methodology. Instead of mindlessly repeating a set of elements, we must prioritize understanding the specific context, leaving room for improvement, and integrating new insights. We maintain from the outset. Each hospital design assignment varies, evolving over the years of development. This evolution is fundamental in design processes (Simon, 1969; Maier et al., 2014). By considering flexibility early on, we can ensure that the integration of EBD is both scientifically accurate and avoids a simplistic plug-and-play approach.
We’ve just started co-design workshops where we organize sessions with users like patients and staff. Designers and a representative from the contractor are also involved as observers in these sessions.
Future research
Future research will focus on refining the SKA to make it even more adaptable and flexible. We aim to incorporate more user-centered design approaches, ensuring that the spaces we create continue to meet the evolving needs of those who use them. By doing so, we hope to create a living catalogue of design principles that can evolve with each new project, ensuring that hospitals remain places of healing and well-being.
Although our project is still in its early stages, we can already see how the three key qualities are being integrated. Regarding the first two qualities, (01. Early Integration of Evidence, 02. Visual Language of Design) we are making good progress. Regarding ’03. Flexibility and Adaptability to Context we’ve just started co-design workshops where we organize sessions with users like patients and staff. Designers and a representative from the contractor are also involved – as observers in these sessions.
References
Herweijer-van Gelder, M. H. (2016). Evidence-Based Design in Nederlandse ziekenhuizen: Ruimtelijke kwaliteiten die van invloed zijn op het welbevinden en de gezondheid van patiënten. A+ BE| Architecture and the Built Environment, 6, 1–456.
Pilosof, N. P. (2021). Building for Change: Comparative Case Study of Hospital Architecture. HERD: Health Environments Research & Design Journal, 14(1), 47–60.
Bell, S. L., Foley, R., Houghton, F., Maddrell, A., & Williams, A. M. (2018). From therapeutic landscapes to healthy spaces, places and practices: A scoping review. Social Science & Medicine, 196, 123–130.
Cross, N. (2006). Designerly ways of knowing. Springer London.
Deci, E. L., & Ryan, R. M. (2012). Self-Determination Theory. In Handbook of Theories of Social Psychology: Volume 1 (1–1, pp. 416–437). SAGE Publications Ltd. https://doi.org/10.4135/9781446249215
Simon, H. A. (1969). The Sciences of the Artificial. MIT Press.
Maier, A. M., Wynn, D. C., Howard, T. J., & Andreasen, M. M. (2014). Perceiving design as modelling: A cybernetic systems perspective. An anthology of theories and models of design: philosophy approaches and empirical explorations, 133-149.