Healthcare By Design

Everything human speaks. This is moving definitely into the territory of the space that we occupy in our daily lives, right up until the end.

It is, and should be, a kind of intentional space that responds to our human needs. I’ve always felt that absolutely everything in the human environment speaks. Wherever you look, anything that’s human-made communicates a message.

That message can be very inspirational, engaging, exciting and motivating. It can also be the reverse. Certainly, the experience of lots of hospitals around the world has been kind of running separately from this concept, to say it politely.

Increasingly, when you are more at the threshold of life, it’s four walls that are surrounding you. So the real thing that I want to say is: Take control over what that environment communicates.

It could be a rich, empowering human experience, and it could also be missing that. When it comes to connecting with the soul, this is really a fundamental issue.

In thinking back about how to think about the archetypes of shelter, the tree came up as what preceded human shelter. We almost certainly lived and related to trees, and so much of our narrative-rich life actually references trees, branches, roots, all of the things that these amazing parts of our world symbolize.

This is an interesting image, and it was actually hugely influential in the 18th century on the development of architecture.

The drawn image on the right, Abbé Laugier wrote a criticism of what had happened to buildings and architecture in the early 1700s. The message was that classical history was in ruins, and I’m not sure whether it’s a saint, an angel or what, pointing to the primitive hut as a reminder that this is where we began. This is the essence of our relationship to shelter and nature.

This is actually an image taken from one of our projects recently, where we used the metaphor of a tree to characterize the inside of a very boring office building. We said that every silo effectively isolates the businesses and the groups on different floors, but we can find connective tissue. We can also segment the metaphor of a tree into something like a multistory building.

These images are actually from that project. Curiously, as much as the tree and looking upward into a tree is an inspiring kind of moment, the modern architecture proposal, which is Le Corbusier’s Dom-ino House of 1920, suggests the exact opposite, that life is going to be lived horizontally in a secular fashion henceforth.

Another aspect of what’s important to consider in care toward the end of life is: How is someone in that situation going to live their day? What is the day in the life of the patient who’s going through these experiences? How can an environment respond to the fact that a day needs to be more than a perpetual moment in a bed?

This is an illustration of what we do in workplace planning, where we look at the number of different types of activities that workers do in the course of a day and then attempt to create environments that support that multiplicity of actions.

Structuring an intentionally designed day, I think, is extremely important.

I want to talk about Maggie’s Centres. I wasn’t sure how well they’re known here in the U.S.

In the U.K., it started with Maggie Keswick Jencks, who, in the process of dealing with cancer, I think about 20 or 30 years ago, really wanted to transform the experience of cancer patients.

So she started a foundation that has been progressively building little buildings to specifically respond to patients who are going through cancer treatment and their particular challenges.

She wanted architecture to challenge the normal experience, and it produced, through a number of different architects, some really rather amazing examples of how you can create an environment that connects on a completely different level.

There’s a disruption that happens with the norms in a situation like this, and these buildings are disrupting norms. But I think, in the process of disruption, they’re actually opening the imagination.

This one is Frank Gehry’s, and it’s a very curious example of almost a banal cottage with this kind of crinkled roof. It’s interesting, too, that this almost literally relates back to that image of the tree.

Then there are programmatic modes to consider for the interior space, about how conversations happen within those spaces, how that space can support the conversations, what the nature of those conversations could be and the value of those conversations to a healing process.

Curiously, all the different Maggie’s Centres seem to have crystallized their designers’ views on the world. Here on the left, in particular, there’s this womb-like image, which is about the end of life as much as it is about the beginning of life.

The one on the right is actually a completely different project, but also projects this kind of womb image. Here’s one that is projecting a highly internalized but also very natural environment.

What’s interesting, too, is that every one of these projects is using wood in a powerful way.

These are images from some of our own projects, where the message is: Human environments must be human environments that connect with the soul.

Imagination is the primary activity of the soul. I think connecting to that, and having environments that stimulate it, is a positive healing process.

Now I’ll jump into the project that we did in Chicago for the Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago.

We were brought in to really change the patient user experience within the existing design of a new building that was already under construction.

We were considering the different ways in which the rehabilitation laboratories were dealing with thinking and speaking, brain trauma-related issues, arms and hands, legs and walking. Then there’s pediatrics as well.

This is the building. It became an exercise in creating space that spoke to the users in an optimistic, powerful way.

In order to inform how one actually does that, so it’s not an arbitrary creative exercise, we really started to look at the different types of physical challenges that the patients had, and then what types of environments and qualities were appropriate for those different types of challenges.

One in particular was the fact that perhaps half of the people who entered the hospital entered on their backs. So we asked the question: Why does the ceiling not respond to the fact that that’s their primary area of vision?

For people, that’s the entrance area as designed. Extending that through the interior of the hospital and the labs as well needed to have a very strong impetus of optimism, engagement, fun even.

There was also a very detailed program about designing all the different types of settings, work settings and others, because this was a hospital that was pushing, I shouldn’t say pushing, but fusing together clinical and physical care with science and research.

The intention was to shorten the distance, shorten the time period, by making the researchers feel the pain of the patients. It was really quite an amazing initiative from a very visionary CEO, Dr. Joanne Smith.

That’s a typical drawing illustrating all the different types of custom equipment to deal with unfamiliar challenges in how scientists, researchers and patients would interact.

The images on the left are actually renderings of the design process. The image on the right is the actual space.

Things like the ends of corridors became an opportunity to create places that people could retire to, and scheduled opportunities within the hospital.

Equipment within the space was also redesigned and refabricated in order to really be responsive to the types of ergonomic human movement that they are subject to.

In the brain trauma areas, quieting down the entire setting became a super important thing.

Lastly, design is a language to manifest inspiration.

I’m going to end there. Thank you very much.