Fig 5
Fig 6
A child’s journey In our evolving design philosophy we have begun to conceive of the child’s experience of the hospital as a journey of discovery. Along the way are challenges of different kinds, transitions and milestones, which can create anxiety and fear. Thinking about this journey as a narrative can be very helpful in creating a seamless sequence of spatial experiences which elicit positive responses – what Bishop would call ‘coping strategies’ – to equip the child with emotional resilience. Consistency and connectedness are important, just like in the theatre, where lapses in dramatic competence can result in loss of authenticity and credibility. Another way of describing this journey is
Fig 4
of isolation features high in the child’s imaginary world of anxieties. Figure 4 shows a drawing by a 14 year old boy that dramatically depicts him alone, connected only to tubes and wires that penetrate his body. An empty wheel chair can be seen on the left, and two ominous needles on a table on the right. Contrast this with two images (figures
A sense of
anticipation arises well in advance of the hospital visit’
5 and 6) showing a child actively engaged in creative activity in the presence of a supportive adult. Note the single child playing with a horse is consumed in his own world, whilst the adult, perhaps his parent, is standing nearby offering encouragement. Provision of furniture of appropriate size and groupings is key to facilitating positive interaction between children. This theme is addressed in the work of James, Curtis and Birch in a compelling way in their studies of waiting areas. At UCSF children’s hospital (San Francisco) we learnt that parents of young children often do not want to expose them to inappropriate behaviour of adolescents interacting with each other, supporting another of James, Curtis and Birch’s recommendations that the behaviours of younger children and adolescents require specific spatial provision (figure 7).
to think of the child, young person or parent as a ‘detective’ searching for clues from an uncertain environment. Over time, a picture is constructed from evidence provided by the spatial attributes of the building, engaging all five senses. Once this complex impression has been established, it will colour all subsequent experiences and remain a lasting self-perpetuating state of mind. A carefully constructed narrative of spatial hints will help families to discover the hospital as a positive experience. Let’s now look at some key moments in
the family’s journey.
entering the Building A colleague with whom I am working on the design of a new children’s hospital remarked that his toddler son can sense the possibility of something unpleasant happening the moment he is told to get ready for a visit to the doctor. It is as if the child is intuitively picking up subtle signals from the tone of his father’s voice, which may contain hints of concern for his young son’s wellbeing even if there is nothing really to worry about. So a sense of anticipation arises well in
advance of the hospital visit. As thresholds are crossed from approaching the site, to parking, to walking through the front door, anticipation may turn to anxiety or to a
Fig 7
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