ARCHITECTURE & DESIGN
residents in England and Wales – it’s also important to remember that dispersion of culturally diverse groups is not even across the country. London has long been a ‘melting pot’ for people of all ethnic and cultural origins, and continues to provide a home for a huge spectrum of people. That characteristic is increasingly shared by all the UK’s major cities, and there are also pockets of specific communities in some urban locations where the population mix is far from the headline figures in the national statistics.
So, what does all of this tell us? When we consider the demographics of service- users, it is important to understand the local context of population groups, and to build this understanding into the design criteria for the hospital to ensure that the needs of the majority of patients are met. Given that most acute facilities are located in larger urban areas, where patient demographics are most diverse, this creates a significant design challenge. One thing is certain, however – designing hospitals around standardised ‘White British’ assumptions does not create a respectable patient experience for all service-users, or their families.
Accommodating diversity – the story so far
Clearly, while we’re seeing an accelerated rate of change in the diversity of service- users, a diverse patient population is nothing new, and many NHS Trusts already successfully consider this in some elements of the patient experience. The reality, however, is that current approaches to accommodate cultural and religious diversity are largely centred around ‘softer’ services, such as catering, chaperoning, and end-of-life care, as opposed to being built into the design of the physical hospital accommodation. Let’s take catering as an example. The common practice of bringing meals into the hospital from an outside caterer, rather than having them cooked on site, not only frees up valuable space on the hospital campus, but also allows food to be acquired from third parties certified to answer specific dietary requirements, such as Halal or Kosher. This answers patients’ fundamental dietary restrictions, but does not address wider cultural norms, such as social practices associated with sharing meals or breaking of fasts. In order for patients to build the social elements of eating with their families into their catering provision, the hospital needs to be able to accommodate family members bringing food into the patient’s room, or purchasing it on site and sitting comfortably to share the experience.
Multi-faith rooms
The other key area that is already embedded in contemporary hospital design best practice is the provision of a
30 Health Estate Journal August 2019
The South West Acute Hospital chapel’s design drew on knowledge and insight from Stantec’s ‘international and culturally diverse’ team, many of whom have worked on healthcare projects worldwide.
multi-faith room that allows patients and families of all denominations (or none) to access a space for quiet contemplation, prayer, and worship.
There are many examples of multi-faith rooms that have been provided to accommodate multiple faiths in a sensitive and informed manner. For instance, the multi-faith centre at Stantec’s South West Acute Hospital in Enniskillen project is a generously proportioned facility with distinct spaces for Christian, Jewish, and Muslim patients and service-users, designed both around the needs of the hospital’s catchment area, and the consultation work carried out as part of the design process. An understanding of the needs and priorities of patient groups and members of staff – gained through consultation – was embedded into the project brief, and supported by knowledge and insight from Stantec’s international and culturally diverse team, many of whom have worked on healthcare projects around the world. This knowledge was instrumental in both the design and the layout of the multi-faith centre, not only in delivering separate and culturally appropriate spaces for each group, but also in specific details, such as orientation to Mecca.
The challenge for both architectural practices and health estates managers is to apportion sufficient priority to the spatial and layout requirements of this non-clinical accommodation, while answering the patient journey and treatment pathway design requirements of the wider brief. Fundamentally, however, faith, normality, and a feeling of belonging, are often central to patient wellbeing, particularly for those patients that actively practice a religion which characterises their day-to-day routine and world view.
Patient accommodation Typical hospital layout models for inpatient treatment and care have evolved considerably over the past 50 years. While it was once standard practice to design accommodation around a multi-occupancy ward model – where conditions and treatment types were mixed, but genders were separated – a drive for increased efficiency and infection control shifted this model towards grouping patients by condition and treatment. For some hospitals, this led to mixed male/female wards – a practice that compromised patient dignity, and certainly didn’t address the cultural needs of many demographic groups. These days, where possible, patient stays in hospital are limited or, ideally, avoided completely, as this reduces infection risk, and supports wellbeing, by enabling patients to recover in their own environment with their loved ones. Indeed, Stantec has been involved in the design of a number of cancer centres, such as the Guy’s & St Thomas Cancer Centre in London, and the Cleveland Clinic’s Taussig Cancer Centre in Ohio, which have been designed around an ‘outpatient only’ model.
Single occupancy rooms
Where an inpatient stay is required, we are still primarily designing hospitals around a treatment pathway model, by grouping
The design and the layout of the multi- faith centre at the Enniskillen hospital not only ‘delivers’ in terms of separate, and ‘culturally appropriate’, spaces for each group, but also in specific details, such as orientation to Mecca.
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