ARCHITECTURE AND DESIGN
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 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 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
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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.
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 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
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.
IFHE DIGEST 2020
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