cover feature design
First, they cater to a wide age range, from
neonates to adolescents and even young adults. This in itself presents a complexity of different and specific demands on the physical space in response to differing medical, physical and social needs. Second, we find in children’s hospitals an extraordinarily wide disease range reflecting the stages of physiological and social development of young humans. Better treatments for conditions such as cystic fibrosis and congenital heart disease are allowing many children with chronic life-limiting conditions to survive well into adulthood. This population remains associated with the children’s hospital and the specialists who work there for life. Finally, the child and young person bring
his/her whole life into the hospital. Parents and siblings are ever-present and must be included as an integral part of the care programme. NACHRI argues strongly that inclusion of parents in the care package has important clinical benefits and improves outcomes (figure 2).
THe case for evidence- informed innovaTion A comprehensive literature review carried out by NACHRI clearly demonstrated that the physical environment of paediatric settings impacts clinical, developmental, psychosocial and safety outcomes among patients and families. So the physical environment represents a key component in providing family centred care, which as noted, is a key factor in improved clinical outcomes. Design strategies must, however, be
informed by an understanding of how children and young people relate to the hospital environment. A number of researchers are now offering useful evidence based on studies in live hospital settings. Two examples are: Professor Allison James, Dr. Penny Curtis
and Dr. Jo Birch (The Centre for the Study of Children and Youth at the University of Sheffield, UK) have carried out a series of observational studies of children, adolescents and parents in key hospital spaces such as waiting areas and bedrooms. They have derived a range of recommendations from these studies to improve and enhance the experience of being a child in hospital, social relationships and getting around the hospital. Dr. Kate Bishop, a researcher at Sydney
University (Australia) has written extensively on the experience of being a child in hospital and how to elicit positive coping strategies.
Fig 2
Dr. Bishop argues that children are not necessarily intimidated by hospitals, and treating them as completely helpless and vulnerable is unhelpful. This is evident in symbolic displays of child-friendliness designed to ‘cheer children up’, such as the extensive use of cartoon graphics and bright colours on floors, walls and ceilings. We believe that this is counterproductive, resulting in overstimulation followed quickly by disengagement and boredom. Rather, the environment should support the expression of a full range of emotions that a child may be feeling, including anger and sadness at times or contemplation and self-reflection at other times. The work of James, Curtis and Birch
supports Bishop’s conclusions. Their observations suggest that children are acclimatised to institutions through school attendance. They have found that children dislike certain ‘scary features’ of hospitals, such as needles and conspicuous medical equipment that they do not understand, effectively showcased on open shelving in treatment rooms. Children dislike clutter and untidy neglected corners and corridors that contrast starkly with the areas that have received special attention. So designing storage and built-in casings that conceal and play down scary equipment is essential, as is maintaining a consistency of spatial quality in all areas frequented by children and young people (figure 3). From our own engagement with
children, families and carers during briefing consultations we have learnt that fear
Hospital Build Issue 4 2011 33
IN SHORT
■ Design strategies for a hospital for children must be informed by an understanding of how children and young people relate to the hospital environment
■ Good design is an art, but the effectiveness of our efforts can be greatly enhanced if we can think about and experience the spaces we create through the eyes of a child
■We need to make good use of the evidence around us if we are to craft responsive child-friendly environments that can help carers deliver genuine family-centred care in our hospitals
Fig 3
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