PATIENT-CENTRED DESIGN
n Innovative spatial solutions The 40 sqm footprint has been tested to accommodate all core equipment for five key assessments: kitchen, stairs, walking, physical, and front door. Among these, the full-height staircase is both the most challenging design element and an opportunity for innovative spatial solutions. By introducing a mezzanine element, the design makes partial use of the typical 4.5 m hospital ward ceiling height, creating a realistic stair environment without compromising headroom or safety.
n Spatial arrangement and zones The space is planned to support multiple patients undertaking different activities simultaneously with carefully zoned equipment placement to ensure sufficient circulation and activity areas. The internal layout separates more active, noisy activities from quieter, fine-motor or cognitive exercises, supporting simultaneous use by multiple patients without interference, specifically zones for: assessment, cardio and endurance, strength training, and functional training.
n Integrating nature into recovery The adjoining garden or terrace provides an important extension of the rehabilitation environment, offering direct access to outdoor spaces such as walking paths and landscaped areas for real-world mobility practice. Designed to be therapeutic, it broadens the scope of rehabilitation beyond the gym, enabling mobility assessments, functional exercises, and independent physical activity. Features such as level changes, varied walking surfaces, and planting schemes stimulate the senses while replicating everyday challenges patients may encounter at home or in the community. This outdoor link plays a vital role in supporting physical recovery, mental wellbeing, and patient motivation. Integrated with the gym and equipped with outdoor exercise stations, it transforms the garden into an active component of the rehabilitation journey.
Operational and clinical benefits Embedding acute inpatient gyms within ward cores offers substantial operational benefits. These include shorter lengths of stay for inpatients, improved discharge rates which impact positively on ambulance and emergency department waits, and reduced re-admissions linked to deconditioning. It also allows for more efficient use of staff time by reducing patient transfer distances. Case studies show that inpatient mobilisation efforts can result in a 37% reduction in falls, 86% fewer pressure ulcers, and an 80% decrease in patient complaints. These improvements have tangible implications for patient outcomes and hospital performance metrics. These spaces also have implications beyond patient care. AHPs and HSCPs often report feeling marginalised in healthcare environments, despite being the third largest workforce in hospitals after nurses and doctors. Creating visible, functional therapy spaces supports staff identity, facilitates interprofessional collaboration, and reinforces the essential role these professionals play in patient recovery and discharge planning. To maximise the value and impact of these therapy spaces, careful consideration should be given to their use outside of standard clinical hours. Opportunities include hosting group education or exercise sessions, enabling independently mobile patients, once clinically assessed as safe, to access the space autonomously, and extending use to staff wellbeing initiatives. While this study has focused primarily on older adults, there remains a subset of inpatients who, although hospitalised for medical reasons, are generally
fit and active – children and younger people. For these individuals, prolonged bed rest may result in a disproportionate loss of strength and function. Where clinically appropriate, these patients could benefit from structured access to the therapy space to reduce the effects of deconditioning during their stay. Additionally, the design should explore ways to support
staff health and wellbeing. With appropriate safeguards and an initial induction, the gym could be made available to staff during out-of-hours periods (e.g. 17:00–08:00), providing a valuable opportunity for physical activity either post-shift or during overnight breaks. This approach aligns with NHS workforce wellbeing goals and contributes to a more holistic and sustainable use of the estate. Although paediatric inpatients were not the focus of this
study, they were excluded on the basis that they typically require less support for discharge, and deconditioning is not a significant barrier to their hospital stay. However, we did explore opportunities within modern paediatric ward templates to promote mobilisation and physical activity during admission. A modern 32 bed paediatric ward is already designed with several dedicated spaces that could support physical activity and rehabilitation, including: breakout areas, adolescent lounge, play therapy room sensory room, and school room. With thoughtful design and appropriate equipment planning, these spaces could incorporate exercise or mobility focused equipment tailored to children’s needs and developmental stages. Furthermore, where outdoor space is available, the inclusion of a small, outdoor gym similar to those found in public parks could provide an engaging and age-appropriate way to encourage movement and support recovery during a child or young persons’ hospital stay.
A clear path to better recovery We have a responsibility as healthcare planners and providers to create spaces that promote health and independence, not just treat illness. Designing hospitals that keep patients moving is not only aligned with public health goals, but also is a clinical necessity. Ten days of immobility in hospital can equate to a significant irreversible muscle and strength loss in older adults. Nearly half of delayed discharges are linked to patient deconditioning, not medical need. We can change this. Embedding acute inpatient therapy spaces into hospital design isn’t just best practice, it’s essential to meeting the NHS’s goals for safe, efficient, and more personalised care. Now is the time to build, test, and scale these solutions
across our acute care environments. Mobilisation is medicine and our new hospital spaces must reflect that.
Annase Wu
Annase Wu is a qualified architect at MJ Medical, specialising in healthcare design. With a decade focused on planning and delivering healthcare environments, her international experience also spans commercial and residential projects. She has expertise in spatial planning within clinical settings, feasibility studies, and translating research-led theory into detailed design. Annase examines how environmental factors (such as façade design, daylight, and thermal comfort) affect patient wellbeing and recovery. Committed to evidence-based design, she develops solutions that balance operational efficiency with human experience, with a particular focus on dementia-friendly and elderly care environments, advancing patient-centred healthcare architecture.
Therapists from NMGH met to consider special design for therapeutic environments.
October 2025 Health Estate Journal 149
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