ARCHITECTURE AND DESIGN
Stantec has been involved in the design of a number of cancer centres, such as the Guy’s & St Thomas’ Cancer Centre in London.
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 accommodation for patients with similar clinical requirements. The exception to this is the specialist units for patients with varied physical conditions who also have dementia. Rather than designing inpatient accommodation around communal wards, however, the most commonly adopted model for new-build inpatient care is for single occupancy rooms. While it is less space-efficient and more costly to build than the traditional communal ward model, this design strategy supports patient wellbeing by affording individuals increased privacy and greater
IFHE DIGEST 2020
opportunities for uninterrupted sleep. It also reduces infection risk, and enables more thorough infection control regimes, for a safer, more efficient, hospital environment. However, for patient groups with less acute conditions, there remains a question mark over whether the positive benefits of single occupancy accommodation really do outweigh the potential negatives.
Gender separation and socialisation In the drive to prioritise treatment pathways, privacy, and infection control, however, two fundamental areas of cultural diversity risk being overlooked. The first is gender separation: although each patient has their own room, the common areas in the ward are usually mixed, which does not truly address the needs of cultures where women remain covered in the presence of men. The second area is socialisation, or rather, the lack of it. With the provision of bedside entertainment, and the availability of en-suite toilet and washing facilities, there is no incentive for patients to leave the social isolation of their private room. If we consider that a lack of gender segregation in the common areas, and a lack of space for social gatherings within their own patient area, compound this isolation, it is clear that common, progressive patient accommodation models are far from inclusive for cultures built on social interaction. Paradoxically, therefore, in some patient environments the single occupancy rooms designed to support improved wellbeing could actually be detrimental – by exacerbating disconnectedness from the outside world. Stantec’s work on major hospital
projects in Qatar and Abu Dhabi highlights the cultural differences between the expectations of patients and healthcare providers in the UK, as opposed to those in the Arabic world. Whereas we accept the limits placed on the number of visitors to a bed, and have little choice in doing so, due to a lack of space and seating, in the Gulf states the ability for the patient to remain involved in social gatherings during
their stay in hospital is embedded in hospital design, layout, and space allocation, because it is culturally integral to their wellbeing. At our Abu Dhabi project, there is even provision for ‘VIP’ patient accommodation in the wings of patient rooms that splay out from the ‘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
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