ARCHITECTURE & DESIGN
Embedding culturaldiversity in healthcare design
Burkhard Musselmann, managing principal and healthcare architect at the UK office of architectural practice, Stantec, and Brenda Bush-Moline, an ASHE member who is healthcare design lead and senior principal at the firm’s Chicago office, discuss the need to consider cultural diversity in the healthcare design process, and suggest ways in which this can be achieved, drawing on cultural reference points of Stantec healthcare projects worldwide.
Healthcare design best practice has changed dramatically over the past 50 years. While a priority focus remains on efficiency for both operational management and patient care, today’s design best practice is also focused on the journey and experience of patients, families/companions, and the care provider team. This has promoted a much more holistic approach to designing for wellbeing, rather than concentrating on treatment regimes alone.
So, what does this mean in real terms? In the interests of patient dignity, we have relinquished ‘mixed’ male and female wards, and moved to models with private en-suite rooms, where patients can benefit from increased privacy and improved sleep, while hospital managers and clinical teams are better able to address infection control challenges. Arranging accommodation by condition and treatment type, rather than age and gender, has delivered operational benefits for hospitals, and simplified the treatment journey for patients, helping to make the experience of illness or injury, and treatment and recovery, less stressful. Interestingly, this creation of single room environments has now challenged notions of socialisation and the effects of isolation. A current focus is the balance of care protocols, infection control, operational efficiency, and environments that support a social network, and cultural influencers will be a key driver in this conversation. Therefore, patient demographics, social factors, individual preferences, and the cultural and religious influences that define whether an environment is suitable for an individual, have sometimes been overlooked. While better healthcare design has made a significant contribution
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The Stantec-designed South West Acute Hospital in Enniskillen, Northern Ireland, has 210 inpatient and 22 day case beds, and delivers a wide range of services to patients from Fermanagh and Tyrone ‘and beyond’.
to improved patient comfort, treatment outcomes, and operational efficiency, the question remains whether true patient wellbeing is being factored into a hospital project if the cultural needs of some of its users are not being met.
Why is cultural diversity important? If we look at the population of England and Wales as a whole, according to the last census, in 2011, those identifying as ‘White British’ still make up 80.5% of the population, suggesting that traditional British cultural and religious norms are still the dominant influence on healthcare users in the UK. However, if we look more closely at the information available, a different picture begins to emerge. The 2011 census records a decrease in the percentage of the population identifying as ‘White British’ from 87.4% to the most
Patient demographics, social factors, individual preferences, and the cultural and religious influences that define whether an environment is suitable for an individual, have sometimes been overlooked
recent figure of 80.5%. If we reasonably assume that this is a continuing trend in the lead up to the 2021 census, it’s fair to assume that traditional demographic patterns are changing.
When we look more closely at the figures, it’s clear that, as the proportion of ‘White British’ residents declines, the most significant population increases are among ethnic groups with distinctly different cultural sensibilities to Western European experience. The most notable population increases recorded by the 2011 census are among the Asian, Black African, and Arab communities, and as these communities continue to make up an increasingly large proportion of health service users, it’s important that we consider their cultural needs, as well as their physical care and treatment requirements.
An uneven dispersion
While the population percentages for these culturally diverse groups may seem relatively small – the Indian and Pakistani communities make up a combined 4.5% in the 2011 census, for example, and the Black African population is just 1.8% of
August 2019 Health Estate Journal 29
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