ARCHITECTURE & DESIGN
‘palm’ of the treatment facilities like ‘fingers’. Ideally, therefore, a UK hospital that aims to deliver a wellbeing-based approach to improving accommodation for a wider cultural mix of patient groups should consider the possibility of providing larger rooms with seating, and even overnight sleeping areas for multiple family members.
Challenges associated with the vision There are a number of challenges associated with this vision, however. Not only does a move towards bigger rooms and family gatherings create issues of cost, space availability, and infection control; it also raises questions of fairness. It is not viable for two patients with a similar prognosis and treatment pathway to be offered different levels of accommodation on the basis of race, religion, or culture, because the hospital would be seen to be prioritising one group over another.
Designing in greater diversity So, what’s the solution? For private hospital groups it seems clear there is an opportunity to offer different types of patient accommodation based on varied cultural models, and to develop a pricing structure that takes into account the space and facilities on offer in each room type. For NHS Trusts, there might then be a route to offering more culturally appropriate accommodation to patients via ‘bought-in’ services from the private sector, which already form a significant element of the NHS’s capacity extension strategy.
For families who want to stay close to loved ones during their hospital stay, the common practice of sleeping within the patient’s room – which is often designed into hospitals in the Gulf states and the Middle East – is unlikely to be accommodated in hospital design in the UK, beyond the facility for parents of sick children to be offered a ‘put-me-up’ bed to comfort their child. This is because the presence of additional overnight guests carries infection control, security, and operational implications, and the drive for a more culturally aware and inclusive hospital environment must always be secondary to the facility’s core purpose of caring for the patient and maximising the potential for positive clinical outcomes.
32 Health Estate Journal August 2019
Like the Guy’s and St Thomas’ Cancer Centre in London, the Cleveland Clinic’s Taussig Cancer Centre in Ohio has been designed around an ‘outpatient only’ model.
‘Hotel-style’ accommodation for relatives
As a ‘next-best-thing’ alternative, many hospitals incorporate hotel-style accommodation for visiting relatives. This is particularly prevalent in hospitals that offer specialist treatment and expertise for which patients may need to travel some distance from their home. However, there is an opportunity for hospitals to enhance their diversity provision by offering on-site accommodation to relatives, and this would enhance the wellbeing of patients who feel isolated when they do not have their family around them. Meanwhile, the on-site hotel would provide a source of revenue generation for the NHS Trust. Beyond patient and visitor overnight accommodation, there is a clear rationale for creating communal social spaces where patients can gather with friends and family, or relax on a socially inclusive basis, defined by gender where appropriate. This concept extends the premise of the multi-faith centre, where diversity is based on religious definitions, to a social equivalent, based on cultural inclusiveness. While it would require the allocation of space to create these multi-purpose areas, the space investment would be much lower than creating larger patient rooms to provide social spaces on an individual patient basis.
Addressing varying cultural norms Design teams must also consider how cultural diversity can be accommodated within all aspects of a hospital’s facilities. An excellent example is the way in which the design of toilet facilities addresses varied cultural norms. Our Western preference for toilet basins and urinals
as a standardised approach does not consider other cultural notions of hygiene, which make a latrine and washing facilities much more acceptable than a standard toilet and toilet paper for some. Including a variety of toilet and washing facilities not only offers patients and visitors the ability to select their preferred option, but also communicates an inclusive environment, where diversity is understood and accommodated where possible.
Improving understanding
One of the major elements of transitioning healthcare design to progressive models that prioritise the patient experience alongside operational, financial, and clinical drivers, is the consultation process that all healthcare specialist architects use to fully understand the brief and the needs of all user groups – patients, visitors, clinicians, management staff, and ancillary services. As an international, interdisciplinary design practice, Stantec uses consultation with a variety of stakeholders to inform every element of the project; from planning and masterplanning, through to concept, detailed design, and interiors. Sharing the insights from consultations across projects and across teams within Stantec’s global network ensures that we build a knowledge base of cultural diversity, and what it means to different user groups in terms of facilities aligned to their cultural experience or religious beliefs. As a result, we can embed the expectations of service-users in the Middle East into the design development process of hospital facilities in the UK or the US, to ensure that, as a design team, we constantly question whether common assumptions are being rigorously tested against a more diverse and inclusive outlook.
Minority groups can be hard to reach This international experience is a significant factor in considering diversity as part of the design process, because it can be notoriously difficult to incorporate diverse stakeholder groups in the consultation process for UK hospital projects. Minority groups are often ‘hard to reach’ when it comes to user engagement for the consultation process. Often, it is possible to gain some insights into cultural and religious reference points of patient groups from discussions with clinical and managerial stakeholders, but, while their cultural or religious
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