A worrying diagnosis

Take a walk round your local Accident and Emergency Department (like I did this week) and you’ll begin to appreciate the scale of the problem facing creaky old mother NHS. It seems pretty clear that our hospitals face a design challenge as significant as their funding one.

Fortunately, all this has not gone unnoticed. What we mean by design, of course, is not spending money lavishly. Rather, it’s about making a difference at the conceptual level, the people level, the process level and the communication level of both hospital products and environments.

Whether it’s some careful thinking about the use of space; creating effective people systems and procedures; innovation at the technical and product design level; or signage and print, design is a vital force for doing actual good.

Colum Lowe, who has just taken the new role of design manager at the National Patient Safety Agency, thinks there are three simple rules to apply for effective improvements in the health service.

‘The first is about making the patient “king”, and ensuring the NHS is there to serve the patient, not the other way round,’ says Lowe . ‘The second is to instil a real user focus all the way through the system, to make usability imperative at every level. The third is to make [sure] certain staff are valued and feel valued, from the janitors right up to the doctors. It’s the best way to better performance.’

It seems that these planks of private sector practice haven’t quite filtered through to the public hospital sector. Foundation Hospitals might now be inevitable after this week’s House of Commons vote, but somehow their pros and cons seem insignificant next to these more fundamental concerns.

Environment plays a hugely important role, of course, not only in improving our general well-being, but apparently by helping patients to recover more quickly, says Ian Clark, director of architecture and interiors group Jane Derbyshire and David Kendall.

‘Places for the sick don’t have to be miserable,’ Clark explains. ‘All the research from the US is saying that in well-designed, well-appointed hospitals, people get better quicker. Design is helping hospitals treat more patients, because they don’t actually need so long to recover.’

His group (which picked up the RIBA Building of the Year in 1989 for St Oswald’s Hospice) has just participated in a piece of blue-sky thinking on hospitals for the Commission for Architecture and the Built Environment. The research, which was published on Monday, introduces environmental ideas from four architectural and design groups – Jane Derbyshire and David Kendall, McDowell & Benedetti, Fat with Demos, and Muf architecture/art with Rosetta Life – in an attempt to illustrate some very practical design-led answers for the health service (see far left column). These are being put to the vote this week at www.healthyhospitals.org.uk, where the work can also be seen.

‘One of the key concepts we’ve had is to do with the idea of a variable activity room,’ says Clark. ‘Anything that cuts down on patient transfers, reduces the risk of infection and uses space more effectively is vital in a hospital.’

Clark also helped to conceive a four-person hospital bedroom that breaks the stereotype of four people all opposite each other. ‘Each bed place is arranged in a gentle curve, with a direct view out of a large window,’ he explains.

As part of Cabe’s initiative (called healthy hospitals) nursing staff and doctors were quizzed about their attitudes to hospital design. The survey found that design has a critical place, but worryingly, and this goes back to Lowe’s point about people, 52 per cent of nurses feel they are not able to affect the design aspects of their workplace. In short, the people who know the systems best do not feel that they are being consulted for suggestions.

As well as environmental design, other disciplines such as product innovation and communications are also valuable fields of activity for design consultancies. Gloucester creative house Dark Horse Agency, for example, has worked in the healthcare sector for 12 years, but creative director Charles Gumbs points out that though the work might be saving lives, ‘it can be seen as less glamourous and so doesn’t seem to win design awards’.

Martin Johnston at Satellite says his group has just completed a training manual and video with the Department of Health’s Print Design Team for the self-administration of intrathecal chemotherapy. It sounds like a mouthful, but if it helps prevent the five deaths a year in the UK from badly performed intravenous injections, surely this is design at its best.

For the most part, design is a drastically underused skill in hospital land. The cynics might argue that we couldn’t expect all NHS hospitals to look like the Chelsea and Westminster, with its impressive, modern atrium and collection of assorted artworks. They might just have a point. But some constructive creative input could still go a long way.

Take London’s Middlesex Hospital, which is opening a new wing at Euston in 18 months time. It’s all very well designing modern, clean lines and calming colourways, but according to one radiologist at University College Hospital, someone forgot to build sleeping space for the night shift.

Features of good hospital design

• an uncluttered, calm entrance

• bright, spacious interiors with direct and ambient daylight (not artificial lighting)

• adaptable and versatile interiors with appropriate storage facilities

• well-conceived patient-consultant treatment rooms

• effective, visible signage and wayfinding

• internal and external landscaping, rest areas and suitable furniture

• a building well-integrated into its local environment, with good parking and transport links

Attitudes to design for hospitals*

• Privacy, bed space and natural light are priority design issues, according to more than 95 per cent of nursing staff

• 64 per cent of nurses and 74 per cent of managers believe patients behave better towards staff in well-designed wards

• 74 per cent of nurses believe that hospital interiors make a significant difference in choosing a job

• 52 per cent of nurses believe they have no influence over hospital design issues

• 87 per cent of nurses believe that better-designed hospitals would enable them do their job better

* survey of 500 nursing staff undertaken in August 2003, published by Cabe