HEALTHCARE DESIGN
upon revenue and staff resource seems to be clear and perhaps supports the idea that some increased short term capital spend (which increasing the size of isolation facilities would likely entail) would have demonstrable benefits in reduced post-treatment rehabilitation and revenue costs.
Closing remarks Recent advances in medical treatment have introduced some alternatives to conventional isolation treatment for blood cancers. Chimeric Antigen Receptor T-Cell (Car T-Cell) therapy has emerged as an alternative to stem- cell transplant for some patients. Here, isolation may not be routinely required for treatment. There is also now an increasing prevalence for some stem-cell transplant patients to be treated on an ambulatory basis, with care taking place either at home or in a hotel close to the hospital. However, almost all UK hospitals still use inpatient isolation as a means of protective care for some cancer patients and, based on current clinical thinking, this need is certain to continue. It is also worth remembering that the use of isolation facilities is not restricted to patients with blood cancers. Isolation can be needed for other types of inpatient, too. The use of isolation in clinical treatment is an unfortunate
An overlay of potential activities within an isolation bedroom.
An exercise in overlaying all the various activities,
personal items, equipment, and furniture provides an interesting analysis of the space – something which has rarely been done in normal design practice. Much effort and time is often spent in locating all fittings and furniture within a space, as part of the traditional detail design process in healthcare. The focus is on ergonomic fit, function, and compliance, and yet analysis of activity, movement, and use of space is rarely illustrated and analysed. This is surprising, especially in the context of initiatives such as the government’s New Hospital Project, where prototyping and optimisation figures highly in settling upon finalised layouts. The patient voice (the way they behave, the things they use, the space that they need) seems to be diminished somewhat in the face of pure function and clinical efficiency.
Jamie Brewster
Jamie Brewster, architect at MJ Medical, thought he had amassed all the knowledge needed after 25 years in healthcare design. Only through experience in an isolation room receiving treatment for leukaemia did he begin to question his approach. His PhD research seeks to understand the inpatients’ experience of isolation and, through a refresh of design standards, whether there might be new solutions.
Initial research findings In 2025, I commenced ‘pilot’ interviewing with a number of clinicians and former patients. The full interview phase of the study commenced in March 2026, and is expected to complete in October. A full analysis of interview data is not yet available, therefore, but some useful feedback is already available, with two common themes emerging. Firstly, the room size needs to be larger, recognising
the length of time the occupant must spend in the space and the activities that would ideally be possible given that patients might not feel unwell for the entire duration of the process. This points to the need to refresh guidance and reference to recommended area allowances in particular. Secondly, early clinician feedback confirms that
the room environment and its impact on patient well- being does have a direct physiological consequence. According to initial discussions with some clinicians, there is a high likelihood that a patient whose wellbeing is low will take longer to recover and will need more post-treatment care and rehabilitation. As has been highlighted many times by Roger Ullrich and others,10 there is a correlation between a patient’s response to the environment and physical wellbeing. The impact
48 Health Estate Journal September 2026
necessity. Sometimes it is the only way to manage risks during treatment. So, designers and the guidance that inform their work need to better recognise the unique circumstances faced by the confined inpatient. Not only are there some important technical and ergonomic issues to address, but also some more affective and experiential matters to recognise. This study represents a significant opportunity to address a gap in the research and to suggest some improvements which while small in nature will be of enormous benefit to both patients and the staff who engage with them.
References 1 HBN 04-01 Supplement 1
https://www.england.nhs.uk/ wp-content/uploads/2009/12/health-building-note-04- 01-supplement-1-july-2025.pdf
2 HBN Note 04-01
https://www.england.nhs.uk/publication/ adult-in-patient-facilities-planning-and-design-hbn-04-01/
3 Hsu T, Ryherd E, Persson Waye K. Noise pollution in hospitals: impact on patients. Journal of clinical outcomes management: JCOM. 2012;19:301-9
4 Eusebio L, Derudi M, Capelli L, Nano G, Sironi S. Assessment of the Indoor odour impact in a naturally ventilated room. Sensors (Basel). 2017;17(4)
5 Annibali O, Pensieri C, Tomarchio V, Biagioli V, Pennacchini M, Tendas A, et al. Protective isolation for patients with haematological malignancies: a pilot study investigating patients’ distress and use of time. Int J Hematol Oncol Stem Cell Res. 2017;11(4):313-8
6 Biagioli V, Piredda M, Alvaro R, de Marinis MG. The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis. Eur J Cancer Care (Engl). 2017;26(5)
7 Coolbrandt A, Grypdonck MH. Keeping courage during stem cell transplantation: a qualitative research. Eur J Oncol Nurs. 2010;14(3):218-23
8 Digby R, Kramer S, Yuan V, Ozavci G, Bucknall TK. Patients in isolation, their physical, environmental and mental health: An exploratory study. J Clin Nurs. 2024;33(9):3526-38
9 Wigglesworth S. The Disorder of the Dining Table. UOU Scientific Journal. 2022;4:122-7
10 Ulrich RS. Effects of interior design on wellness: theory and recent scientific research. J Health Care Inter Des. 1991;3:97- 109
J Brewster
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