Informing Design: Alan Pert on health architecture

April 24, 2013

Director of the Melbourne School of Design and principal at NORD, Alan Pert, reviews Alan Dilani’s recent lecture ‘New Directions in Health Architecture – A Salutogenic Approach’.

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Professor Alan Dilani’s recent lecture at Melbourne School of Design reflects a growing area of research, which is shaping the future design of healthcare environments, but the lecture hints at a much bigger conversation surrounding the future shape of our towns and cities and the populations they serve. Professor Dilani spoke of the interdisciplinary application of architecture; design, engineering, medicine, public health policy, culture and psychosocial factors, which combined, are directly supporting improved health outcomes for society. Professor Dilani’s talk was supported by Lyons Architects who have been calling for greater emphasis on the design of healthcare and hospital facilities. Corbett Lyons began a conversation in 2010 at Melbourne University where he suggests: “Healthcare facilities and hospitals have too often become highly institutionalised and alienating environments”. Corbett suggests “the time is right for us to rethink how our major healthcare facilities are recast in a more humanist and patient focused way through greater cultural input”. Lyons are working on the new Queensland Children’s Hospital, which is expected to open in 2014 while in Melbourne we have recently seen the opening of The Royal Children’s Hospital by Billard Leece Partnership and Bates Smart Architects. Also under construction are the Peter MacCallum Cancer Centre and new cancer research and clinical services for Melbourne Health and The University of Melbourne, which is a partnership of Silver Thomas Hanley and DesignInc with McBride Charles Ryan (STHDI+MCR).

In 2011 at the Design & Health International Academy Awards in Boston a number of projects from Singapore and Australia were sited as new standard bearers for health facility design. Khoo Teck Puat Hospital in Singapore was awarded a double prize, with the Ballarat Acute Mental Health Facility in Australia by Billard Leece Partnership winning the Mental Health Design Award; high commendations were also awarded to the National Heart Centre in Singapore and the Brain and Mind Research Institute – Youth Mental Health Building in Sydney. All of these successes point to a very significant period of major health capital investment, with many new benchmark facilities across Australasia.

Alan Dilani’s talk as such reflects a growing interest in the work of practices and policy makers in Australasia but the conversation is so much greater than the need to improve the design of healthcare facilities. A preventative approach suggests a much broader understanding of societal needs and the changing patterns of everyday life in our cities but also across more remote and rural areas. Shifts in attitudes to health are now required as well as an understanding of the changing patterns of physical and mental wellbeing. For example Alan Dilani talks of the new ‘Google society’ and the unfamiliar health impacts technology might be having on a younger generation fully immersed in our digital economy. The spatial consequences of this new digital age are seeing companies like Google offering staff ‘sanctuaries’ or contemplative spaces within the workplace environment and we are seeing national rail companies offering ‘quiet zones’ for passengers trying to escape mobile phone users and the spillage of music from headphones. While we are witnessing the positive impact of the smoking ban on public spaces resulting in isolated ‘smoking areas’ are we also seeing demand for spaces offering an escape from technology signaling a growing threat to our mental wellbeing?

Beyond the hospital walls we are seeing a changing landscape of spaces responding to changing societal needs and changing patterns of wellbeing. My own practice NORD (Northern Office for Research & Design) is at the early stages of designing a new Maggie’s Centre at Forth Valley Hospital in the UK. The Maggie Keswick Jencks Cancer Caring Centres Trust was founded by Maggie Keswick Jencks in 1995 to provide support for people affected by cancer, their families, carers and friends to empower people to live with, through and beyond cancer. Since the first centre, designed by Richard Murphy, opened in 1996 there are now over 15 in the UK and a centre by Frank Gehry recently opened in Hong Kong. Another four are planned for the UK, one for Barcelona and possibly Melbourne. Maggie’s unique model transforms the way that people live with cancer and they were a direct response to the institutional nature of a Hospital environment when they first emerged. They were established so everyone who is affected by cancer has access to high quality, evidence based psychological, emotional and informational support. Inspirational architecture is integral to Maggie’s Centres and the brief to architects is to create a space that is both uplifting and protective, in which people can find the strength to live with hope and joy in the face of a cancer diagnosis.  What is interesting about the Maggie’s Centres is that they are all very different. Not one building is the same yet each new centre informs decisions about the next.

Another NORD project reflects the changing nature of palliative care where we are working on a new purpose built 18-bed Hospice in Glasgow, Scotland. As treatment shifts from curative to palliative we are seeing huge changes in the role of the hospice and its position in society. There are a lot of misconceptions about hospice that are still prevalent, despite its rapid growth in the past two decades. One of those is that hospice is a place people go to die. While this isn’t exactly wrong, it’s not exactly right. The building carries a weight of seriousness due to the circumstances of the people who arrive. However, a balance of dealing with these serious aspects and necessary care provision alongside the social, spiritual and emotional needs of the patients has resulted in a complex building typology that adds days to peoples lives and offers hope and bereavement support to families. New technology is also being embraced within this new facility as a way of changing how care is delivered. The nurse’s station no longer relies on a fixed object and instead wireless technologies, free nursing staff from static observation stations, allowing a rethinking of ward environments and patient bed position. Improved drugs and new technologies are extending lives while buildings and the delivery of care are having to adapt to meet this new 21st century condition.

Cancer, heart disease, stroke, respiratory and liver disease might still be dominating hospital environments but we are also witnessing the emergence of new building types and new technologies that respond to changing needs of patients, carers and medical services.  We have access to a wealth of new information sources, new services, new ways of connecting with each other, and new “health apps” (applications), which are demanding a radical rethinking of our built environments and the buildings that support wellbeing.

As Professor Dilani points out through the Lance report published in 2012, the health status of people living in Australasia is one of the highest in the world, with rising life expectancies. Australia is 3rd in the report behind Spain and Italy however, an Australian Institute of Health and Welfare study published in 2006 found the number of years Australians spent suffering from a disability was rising. “As people are living longer, they are living a greater part of their life with a disability,” author Dr Xingyan Wen reported. Men could expect on average to experience 18.6 years of life with some disability, while for women the figure was 20.7 years. This suggests the region’s healthcare systems face similar challenges to the rest of the developed world, characterised by increasing cost pressures, an ageing population and a rise in the level of lifestyle diseases, most notably diabetes and obesity.

In 2010 an Intergenerational Report projects that by 2050 the population will increase to 35.9 million Australians. But it also predicts that the proportion of Australians over 65 will grow to more than 20% of the population from 2.5 million to 7.1 million by 2050.

These are frightening statistics and beyond the economic implications on healthcare and pensions. This data suggests there will need to be a radical rethinking of the built environment capable of serving the needs of this growing population who are less mobile. Professor Dilani does not discuss the specific challenges of population ageing but Philip Goad’s introduction to the talk at least acknowledges the work of Professor Brian Kidd who has worked tiresley in this area over a prolonged period. Brian is part of an interdisciplinary research group working on best-practice design guidelines for future aged care environments as part of a national initiative. The lecture hints at this much bigger issue, which will require a similar interdisciplinary approach to tackle the future shape of our homes, streets, neighbourhoods, and public and civic spaces. We risk the burden of ill-health and dependency, as well as lost social and civic life that comes with social exclusion and the associated ill-health and withdrawal of older populations.

Planning for an Ageing Population is an area of growing concern but it is a reality, which will require designers to consider more than just ramped access and a lift core if we are to fully embrace the future and understand the spatial consequences of the published statistics. This is an area of research, which requires innovative partnerships and creative solutions if we are to embrace Professor Dilani’s ‘holistic’ approach and build on the previous work of people like Professor Brian Kid. The world Congress in Brisbane could be a perfect opportunity to expand on this global issue, as without adequate attention, opportunities for imaginative new developments will be left behind, with issues of environmental planning and climate change dominating discussions.

Alan Dilani at the end of his talk dismisses ‘evidence based-design’ as a marketing opportunity but he agrees that we now have a unique opportunity to gather evidence from these recently completed projects, which can inform the future design of health related facilities. There is also increasing pressure on architects to validate our work in the context of a more competitive and risk adverse construction industry. So their remains a question over what architectural (design) evidence is but there can be no doubt about the important role research evidence can play in capturing the ‘story’ of these projects. There needs to be more dissemination of these projects and others and it needs to be unbiased, pointing out what works and what doesn’t through post-occupancy evaluations. There is still not enough published research on the analytics that go into designing a space. Too often design is reduced to aesthetics within mainstream architectural press when attention given to decisions based on costs could go a long way to informing future decision making. Critical writing and design dissemination desperately needs new platforms for encouraging debate amongst practitioners, academics and health organisations and the Academy has an important role to play in this regard.  If we consider that by the end of this decade we will be completing thousands more facilities across the globe – building, retrofitting, infilling, extending, demolishing for new and rapidly shifting purposes then, just like the labs that inform clinical practice, we require new design ‘labs’ that will challenge not just practice but design teaching, research and the focus of research funding bodies.

Alan Pert is Director of the Melbourne School of Design, and an acclaimed architect, researcher and teacher, who has headed up his own practice, NORD (Northern Office of Research and Design).


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