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sense of reassurance or to many shades of grey between the two. Our approach to this transition from the real world to the hospital is twofold: first, to use soft playful forms that reduce the scale of the building and invite visual and mental exploration without being overly complex. Second, to ‘dissolve’ the point of entry by ensuring that the entrance lobby, atrium (if there is one) and foyer are light and airy strongly connected to landscape, and maintain views to external space (figure 10).

Waiting An inevitable activity for every patient is waiting. Rarely does one enter a hospital and walk straight into a consulting room or imaging suite. More likely, one arrives in the building, finds the appropriate reception point, then sits and waits until called. Waiting areas are scattered throughout the hospital - in out-patient clinics, day surgery admissions, imaging departments, emergency departments and at the entrance to in- patient units. They are of huge importance to the care experience despite the fact that nothing clinical actually happens in them (ignoring signing in and collecting basic information, which of course are not unimportant at all). Seen through the lens of family dynamics, the waiting area can foster cohesiveness and mutually supportive behaviours if designed in the right way. We provide a variety of seating types and

arrangements to offer choice to children of different ages and to families. We use colour, natural materials and art to distract and even entertain, avoiding over stimulation. As always, daylight and external views are essential to maintain connection with the outside world. Access to a landscaped external space from the waiting area can provide a powerful antidote to the ill-effects of waiting. Some hospitals are experimenting with pagers which they hand to families once signed in, allowing them to wait in other parts of the hospital of their choice – cafe, garden, performance area, play area (figure 10).

CliniCal spaCes Clinical spaces are of a very wide variety – treatment rooms, imaging suites, induction and operating rooms, recovery areas, intensive care rooms – and present multiple challenges. The drawing of Matt’s Room highlights the potential for medical instrumentation to instil fear. If budget constraints prevent high

quality integrated art features, we prefer to concentrate effort on designing out clutter to keep spaces simple and calming. We avoid the use of applied cartoon graphics when they are not part of a considered spatial concept. Ideally, natural finishes, calming lighting installations and plenty of built-in storage to keep medical gadgets out of sight should all be key components of an integrated interior design concept. Provision for parents to be with their children for as long as possible is crucial. This relies on adequate provision of space as well as design strategies that blend social and clinical functionality. We recognise that separation is a moment of emotional pain. Older children actually worry about their parents when they are separated from them and want to know where they are. So the provision of small lounges for parents and other family member as close as possible to interventional suites and intensive care areas is very important to both keeping families intact and facilitating mutual support between families (figures 1 & 9).

Heart Every children’s hospital needs a heart space. This can take many forms including quite modestly scaled spaces. What is important is that they are focal spaces, which engage and offer relief and distraction. Creative play, art and learning can all be components of the design concept for the heart space. Our current work explores the theme of discovery by creating a highly participatory environment incorporating interactive installations, which can be used by groups and individuals. Provision of choice to be 

 IMAGE CAPTIONS Fig 1: PeaceHealth. Sacred Heart Medical Centre, Oregon - Intensive care suite domestic in feel and family friendly Fig 2: Women and Infant’s hospital of Rhode Island - family centre links two floors of PICU Fig 3: Great Ormond Street Hospital, London - social area at the heart of each ward is naturally lit and supportive of play, activity and learning Fig 7: New Children’s Hospital, UK - different seating choices for younger children and adolescents Fig 8: Green patient room for kids explores many innovative features including interactive digital communications at the bed Fig 9: Great Ormond Street Hospital, London Fig 10: Doernbecher Hospital, Oregon - informal moveable seating in natural setting Fig 11: Bloorview Hospital, Torono - central social space like a ‘den’.

Fig 8

Fig 9

Fig 10 Hospital Build Issue 4 2011 35

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