CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project
Abstract The study is aimed at identifying the elements in a hospital environment that allow for both the performance of the medical staff and the efficient recovery of patients, and the possible compromises that might arise between the needs of both parties. The research has been conducted at the Royal Melbourne Hospital in Parkville, and has investigated patients, doctors and nurses. The results have been analysed and evaluated against a set of theories and compared to a series of existing researches and current practices.
Introduction Over the past century, the design of hospital spaces has been largely focused around the patient. Lindsay Prior makes a mention of the miasmic theory of disease, where space had to be organised around the patient to allow the dissipation of miasma through the optimisation of airflow.1 On the same line, Laurence Nightingale stated that the primary purpose of the hospital is to ‘do the sick no harm.’2 This was over a century ago, and until recently, the focus on the patient was still very apparent in terms of research – most of the literature published in the past decades concerning the effect of the environment in the health sector was centred around the patients (in terms of post occupancy evaluation mainly). Even though in the past 30 years, claims have been made about the importance of both the patient and the medical care provided3, only recently have studies been conducted to collect a set of evidences to inform the design of a space. While this paradigm shift might help reinvent the organisation of the hospital, Sally McIntyre argues in her article that there still does not exist sufficient and adequate methodology to conceptualise the effect of the environment on the people occupying it.4 This research has been designed to specifically attempt to draw the bridge between patient and medical staff, and attempt to establish whether the century‐ long practice of prioritising the spaces for the patients is still relevant vis‐a‐vis modern medical practice.
1
Prior, P., ‘The Architecture of Hospital: A Study of Spatial Organisation and Medical Knowledge’. p94 Weeks, J. and Hoare, J., ‘Designing and Living in a Hospital: An Enormous House’. p.467 3 Duckett, S. J. and Kristofferson S. M., ‘An Index of Hospital Performance’ 4 McIntyre, Sally et al., ‘Place Effects on Health: how Can We Conceptualise, Operationalise, and Measure Them?’ p.126 2
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project
Methodology The primary source of information was obtained from a series of semi‐formal interviews. The people involved in the interviews included:
3 doctors
3 nurses
2 patients
The doctors and nurses were part of the same team operating in the same surgical ward. The two patients were also being treated in that ward and most of the information was collected there. The identity of the interviewees will not be revealed for matters of confidentiality. A thorough detailed observation of the ward and of other spaces was also conducted. During these detailed observations, the level of intrusiveness that was attempted to be maintained was kept quite low so as not to affect any behaviours and interactions that could happen among the observed subjects, but at the same time not too detached so as not to miss some of these said interactions. The level of intrusiveness that was adopted was one that would be described by Zeisel as a ‘Recognised Observer’5. During the observations, a few informal interviews were also conducted with non‐medical staff and two patients.
Interviews The purpose of the interview was to get an insight of what usually happens in the ward and obtain the reflections of those getting the first‐hand experience there. Some interviews were conducted individually in separate rooms, others conducted as group interviews at the doctors’ station itself. The interviews would also need to be backed with detailed observations since some of the information might be considered as not important by the interviewees, and not worth reporting.6 Moreover, some interviewees might not provide honest answers to present themselves in a better light, or exaggerate facts in an attempt to complain about their current condition. Doctors and nurses had the same set of questions, while patients had a different set (although some questions repeated in both instances.) During interviews some questions were added, removed or slightly
5 6
Zeisel, J., 1984. Inquiry by Design: Tools for Environmental Behaviour Research. p.117 Zeisel, J., 1984. Inquiry by Design: Tools for Environmental Behaviour Research. p.114
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project altered according to the response of the interviewees. The interviews were recorded using a recording device so that the interviewer could focus on responding to the interviewees’ feedback. Doctors and nurses The doctors and nurses were asked what they thought about the environmental quality of the space they were working in, and how they thought this affected their performance. Out of the set of 13 preset questions, those that generated the most amount of feedback were:
What do you think of the space you are currently working in?
Do you think that the design of this space contributes to increasing your stress levels?
When you have lunch/free time during the day, where do you usually go? Could you describe this space for me?
Do you feel less stressed there? And afterwards when going back to work?
If there was a project to rebuild your ward and you were part of the medical consultants’ team, what recommendations would you make?
While they all had something different to say about these issues, some general similar comments were starting to emerge, and these were again seen during the detailed observations of the ward (that took place after the interviews). Some of these comments were:
No designated area.
o
Nurses and doctors share the same working area for activities that are different.
o
There is no designated area to prepare prescriptions and drop medications.
o
No easy way to check patients’ blood results since it gets mixed with other paperwork at the station.
o
Shared computers, meaning that nurses can’t always access the required database when the doctors are using the computers.
o
Office room doubles as meeting room, so ‘office activities’ stop when some people need to have a meeting.
o
All the above increase the risk of making mistakes.
Spaces too small o
Staff members bump into each other at the station.
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project o Patients’ room should accommodate only 1 bed ideally, maximum of 2 (instead of current 4). o
Proximity of beds create problems in the form of
Confidentiality.
Different schedules of medication.
Error when delivering the medication (risk of giving medication to wrong patient.)
Distraction (one doctor hearing another nearby doctor prescribing a different set of medication while himself/herself making a prescription.)
Lack of space while moving beds and equipment.
o
Not enough room to properly organise the range of activities happening at the ward.
o
Patients themselves do not have enough space to stretch.
o
Again, all of the above increase the risk of making mistakes since the multitude of
activities happening simultaneously prevents the staff from properly focusing on the task at hand.
Favourite place to go in the free time is either at the downstairs Zouki Cafeteria of the café across the road o
The cafeteria is a nice place to relieve stress and have a coffee
o
Feel of the place detaches from the hospital environment.
o
Some commented that they feel relieved while at the café, but not necessarily less stressed than before their break when they go back up to the ward.
o
Some claim the exact opposite. While they are perfectly relaxed down at the café, they feel even worse once they go back upstairs afterwards.
o
The café is too far from that particular ward, and it takes quite a long time to travel to there from the ward.
Some of the recommendations expressed were: o
Have dedicated areas for dedicated activities (dedicated relax space).
o
Less patients per room.
o
Arrangements of stations to allow better visibility of the patients.
o
Larger working areas
o
More open spaces with more natural light and more natural ventilation.
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project o Corridors need to be more alive, with features that can create an engagement with the patients when they are walking around.
Some of the more specific comments that have been recorded during the interviews:
o
“When you’re working in a room that’s crowded with chairs and equipment and all these other sorts of stuff, like a room with four patients, I think that induces stress, especially when patients are right next to another patient who doesn’t sleep at night, who is on oxygen suctioning all night then they are not gonna get any sleep so when patients are next to each other yeah this can affect particular symptoms.”
o
“I don’t know if you saw there but out on the bridge there they had some outdoor connectivity with you know tress and I thought that’s awesome, but then the doors are always locked, so we did not know where the people could go in the end. I always told my patients to go there for a rest because here it’s a bit gloomy. When our patients are stressed, we’re stressed”
o
“If you’ve got a grumpy nurse of course it’s not gonna help the patient, a nurse who had not had a break.”
o
“Yes I have been there [referring to New Children’s Hospital] and I love it! It’s so open you can breathe in the air and they have the beautiful aquarium at the front. We don’t need that but you just need something else to distract you from what’s going on at the hospital. A patient especially needs a place to go, they’ll do laps around the unit and it’s boring. It would be nice if they could walk down somewhere and relax.
o
“I guess it does [referring to the café acting as a restorative environment] but I think not as well into our interpretation because
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project we can’t just stop working just because, like do you know what I mean we have heaps number of jobs to do and the patients are unwell and we can’t leave the ward until that happens” Patients The patients were asked what they thought about the environmental quality of the space they were working in, and how they thought this affected their recovery. The interaction with the patients was less interview‐like and more conversational. In these instances, the format of the ten preset questions was dropped and the interview was approached as a discussion, with occasional references to the issues presented in the questions. Findings from these conversations were:
Patients were overall happy with the care they received at that particular ward. They were quite happy with the facilities and very satisfied with services of the staff members.
When they leave their room they usually go to the café to have a chat with the family or have some food.
One of the patients did not feel particularly different at the café as compared to the room, but had to have a change of environment (even just looking out of the window.)
One of the major problems they identified was the proximity of patients, the fact that some patients are annoying (not necessarily consciously) to other patients.
They also mentioned that the cafeteria area was too far from the ward and for some patients (not the ones interviewed) it might be impractical or even impossible going to these spaces without assistance.
The recommendations they made was to have more staff member per ward.
Owing to the delicate nature of discussing the built environment in relation to the patients’ condition, the interview towards the patients was not pushed too much and the level of specificity of the questions was kept quite low. As a result the response obtained from the patients did not prove as useful as that obtained from the doctors and nurses.
Observations Owing to privacy and confidentiality issues, no picture was taken during the observations. Areas that were under the focus of observation were:
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project Zouki cafeteria
Ward multipurpose room
Doctors’/nurses’ station
One of the patients’ room adjacent to doctors’ station.
3‐South Wing corridors
Waiting room of the trauma and emergency department
Zeisel’s observation techniques have been extremely useful while conducting these detailed observations. It was sometimes hard very difficult to understand what was happening by simply observing at the surface. The identification of physical traces, relationships, by‐products of use and displays of self7 helped complement the observations. Zouki Cafeteria Zouki is the first area encountered when entering through the main entrance of the hospital. The café is a very relaxed space, very detached from the clinical hospital environment prevalent in the other parts of the building. It was not difficult to tell people apart (patients, doctors, visitors) ‐ features such as the dress, and accessories led to the conclusion that most people at the café were visitors (most of them were carrying hand bags/rug sacks). Doctors and nurses were identified through their credentials hanging from a lanyard and from the medical scrubs they were wearing, and patients were identified from their dressings, hospital gowns and portable IV poles. It was not uncommon to see to doctors seated with patients and/or relatives sharing a coffee or a meal. People usually sat at the tables next to the walls, and the middle tables were always the last ones to be filled. Ward multipurpose room The multipurpose room attached to the ward is a small 4mX4m room with a large table in the middle. The room is used as lunch/dining space, a preparation room and a meeting room. The team operating in the ward has definitely made the room ‘their own’ in the sense that there are physical traces of long‐term occupancy (stacks of paper that have obviously been sitting there a long, nurses feeling very comfortable and familiar with the spatial arrangement of things). The light is dimmer and softer than the main areas of the ward, but is fully enclosed, and has no windows opening towards the outside. 7
Zeisel, J., 1984. Inquiry by Design: Tools for Environmental Behaviour Research. Chapters 7‐8
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project Doctors’/nurses’ station The station is close to and provides relatively easy access to the adjacent patients’ rooms. The ward appears to be quite old, and no see‐through material has been retrofitted to the patients’ room or the desk. Therefore, although the rooms are quite close to the station, it is hard for doctors and nurses to monitor what is happening in the patients’ room from the station. Moreover, the station is shared between nurses and doctors (computers, desk space, storage space) which makes the space very crowded. Nurses and doctors were often seen bumping into each other or having to move away from what they were doing to allow another nurse or doctor to access a file/drawer/computer. The space is quite enclosed with very few windows Patients’ room Each room fit 4 beds and was left open to allow the medical staff to easily monitor and intervene. The beds are fitted with monitoring devices and all pieces of equipment required by the patients’ condition. The space around the bed is large enough to fit a chair for family and visitors. Some of the patients were sitting on the adjacent chair instead of on the bed. There is no solid separation between the beds and the latter are separated from one another by curtains only. While this provided some visual privacy, it was easy to overhear conversations happening at adjacent beds. There were some windows towards the outside, but depending on the position of the beds, some patients might not have access to an outside view. No other special feature was identified in the room. Corridors The corridors, both within a specific wing, or connecting main areas were devoid of any form of treatment. Apart from occasional staff pictures, historical images and signs, the corridors were quite plain. Wayfinding was quite difficult – the wings are joined by a blue line running on the floor, but comprehensive signs were found only in the central area next to the entrance. The only circulation section that was different was a glazed corridor surrounded by plants and trees. That corridor section is only 5 to 6 metres long and the windows and doors did not appear to be operable by the public.
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project Trauma/emergency waiting room. The waiting room of the trauma/emergency department was spatially no different from any regular hospital waiting room. The only observed difference was that the area could be directly accessed from Grattan Street instead of having to go through the main area. The most overwhelming sensory stimulus was the strong smell of chloroform. At the time of the observation (around 6pm on a Thursday) the emergency room was quiet (only two people waiting) so there were not enough activities to observe any useful forms of interactions. Informal Interviews The 2 patients interviewed did not know that a research was being conducted. They were simply asked courtesy questions in relation to their activity – the selection of these two patients was made because they were both pulling their IV pole (one of them was equipped with what appeared to be very sophisticated monitoring pieces of equipment) out in the cold to have a cigarette. When asked why they liked to go to this area, they both said that this was the only place where they could smoke. No question was asked about this practice and their seemingly serious health conditions.
Analysis Since most of the information (interviews and observations) has been gathered at that specific ward, the analysis and interpretation of the information will be done in relation to that ward and not to the entire hospital. A subsequent section will consider the entire hospital and demonstrate how some of these findings might be extrapolated to be relevant to the entire hospital. Theories The findings were compared against a set of verified theories in order to create the foundations of an evidence‐based method. The different theories that have been reviewed in past literature include:
Kaplan’s attention restoration theory
Privacy and Proxemics
Environmental Psychology
Healing Environments
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project The first step in evaluating the different environmental assets of the different spaces is to identify what elements in each of the spaces was positive for each party, and which ones were negative. Doctors and nurses The features that were identified as positive for the doctors and nurses were:
Proximity of the station with patients’ rooms. The spatial arrangement of the patients’ rooms enables the doctors and nurses to perform their task quickly and efficiently. The fact that they can constantly (to a certain extent) see and monitor what is happening in the patients’ room means that they can quick reach their patients should an emergency happen. Besides the physical proximity and the ability to perform task efficiently in terms of time, the ability of the doctors and nurses to see the patients give them a sense of control. Studies have demonstrated individuals who perceive that they have some form of control over their environment are less likely to be subjected to stress, negative emotional responses and will show less strain.8
Zouki Café The Zouki Café is perceived by most of the interviewed people as a stress reliever. However, there was no general consensus as to what they felt afterwards – some felt less stressed, some felt no different than before coming down the café, and some even felt worse in the sense that they were really depressed about going back. In this sense, Zouki cannot (in the context of this particular research and studying this particular demographics) exactly be seen as a restorative environment because, while effective at relieving stress this effect was not carried forward after the interviewees left the café.
Features that were identified as negative for the doctors and nurses:
Small spaces and absence of specialised spaces Besides the obvious fact that space restrictions prevent the medical staff to work properly and efficiently (someone having to wait for someone else to complete a task before doing his/her own, being interrupted when asked to move aside to let someone pass, or the
8
Septor, P. E., ‘Employee Control and Occupational Stress’. p.136.
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project inability to move quickly and safely through the space) there is an inherent quality to crowded spaces that makes them an uncomfortable environment. This stems from the theory of proxemics, whereby respecting an individual’s interpersonal spaces and boundaries is vital for that person’s proper social functioning. In the case of the doctors’/nurses’ station at the surgical ward, doctors and nurses are almost always at arm’s length distance from one another. Sundstrom and Altman argue that this kind of violation of personal space often results in discomfort, both in the invader and invaded.9 Bryan Lawson use of idea of the fight and flight mechanism to explain this – the narrow spaces in which doctors and nurses operate are such that most of the interactions that are happening are mostly taking place within the flight and fight boundaries – this unwanted proximity is a generator of stress and may turn into aggression, anger or embarrassment.10 11
Absence of natural light An environment that is almost fully artificially lighted is not beneficial to the occupants of this environment – natural light creates lighting patterns and variations according to the external weather conditions and the time of the day. The absence of visual connection to these natural cycles means that the metabolisms of the occupants do not have any sensory clue as how to adapt to the environmental changes.12 A particular doctor working in that ward stated that sometimes (especially during the winter), she could spend an entire week without seeing the sun (came to hospital before sunrise, left after sunset.) Such a configuration is detrimental to the condition of the occupants since there is no natural regulation of time, and the body unnaturally remains unresponsive to the unchanging environment13. A condition known as Seasonal Affected Disorder is associated with these lacks of visual connections to changing lighting patterns. The absence of views, similar to the absence of natural light, prevents the body to regulate to variations in daylight. These variations produce stimuli that satisfy the physiological need of the human eye to constantly adapt and readapt to different distances. In this respect, even a poor outside view (i.e. one having no particular beauty) is better than no views at all.14 While none of the reviewed
9
Sundstrom, E. and Altman, I., ‘Interpersonal Relationships and Personal Space: Research Review and Theoretical Model’ p.57 10 Lawson, B., 2001. The Language of Space. P. 103 11 Sundstrom, E. and Altman, I., ‘Interpersonal Relationships and Personal Space: Research Review and Theoretical Model’ p.56 12 Phillips, D., 2000. Lighting Modern Buildings. p.25 13 Phillips, D., 2004. Daylighting: Natural Light in Architecture. p.18 14 Phillips, D., 2000. Lighting Modern Buildings. p.31
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project literature makes a clear connection between natural light and medical performance in a hospital specifically, a wealth of existing research has demonstrated that the absence or the poor quality of natural light in a working environment can lead to stress, eye discomfort, itching eyes or migraines. These symptoms in relation the interior environment of a building are often referred to as the Sick Building Syndrome.15
Absence of a place where doctors and nurses can disconnect from the hospital. In the surgical ward, doctors and nurses do not exactly have a space where they can go even for just a couple of minutes to disconnect from the work. The only space that is available to them is the multipurpose room, but this doubles as an office and a meeting room, so there is no real disconnection. The distance of the cafeteria from the ward and the absence of windows makes it highly impractical for quick restoration sessions (as per Kaplan’s attention restoration principle), which means that doctors and nurses go for long hours without mentally breaking away from their tasks. Although the nature of their work demands that they be constantly on alert, any prolonged mental effort will ultimately result in directed attention fatigue.16 At this point it becomes more difficult to concentrate and fend off distractions. This could result from higher risks of making mistakes to the total inability to focus on the task at hand.
Patients The features that were identified as positive for the patients were:
Ability of the patients to leave their room
The ability of the patients to leave their room (under certain conditions) means that they have the ability to disconnect from the clinical, highly managed environment that is their room. Similar to the necessity of light variations, it is important for the patients to be able to experience a change of environment throughout their day. However, although just wandering in the corridors might help break the routine, the only places they can really go is around the ward or down to the café (which is very far and might not be practical in certain cases). As a result, the restorative potential of leaving their room is currently not as high as it 15 16
Phillips, D., 2004. Daylighting: Natural Light in Architecture. p.18 Kaplan S., ‘The Restorative Benefits of Nature: Towards An Integrative Framework’. p.170
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project could be.
Windows in the rooms The classification of windows is the ‘positive’ section is open to debate since, while the windows in the patients’ room do provide a certain degree of natural light penetration and light variation, the current amount of windows in the rooms is just not enough – not all beds have access to a window and the windows themselves are not large enough to provide a view from elsewhere inside the room. However, in response to the lack of restorative spaces around the ward, a patient has stated that just lying on his bed and looking out the window had a positive effect on his experience of the space. The windows (if operable) could also allow fresh air inside the room to flush out the smell of medication – this would, however, have to be done in compliance with how much outside contamination is allowed into the room.
The features that were identified as negative for the patients were:
Close proximity of beds from one another
This touches on the notion of privacy and proxemics. The use of the curtains to isolate beds from one another provides a certain degree of visual privacy, not auditive and olfactory privacy. If the patients do not feel that they are in a certain way shielded from the outside, this will definitely affect their recovery. In terms of Lawson’s approach to proxemics, the placement of beds too close to one another puts the patients in the position of both the invader and the invaded. The patient becomes the invader of another one’s personal space when he/she can record (via any of the senses) some of what is happening there – this can include overhearing the doctor discussing the medical condition (which is stressful)17 , or hearing snoring at night. The patient becomes the invaded one when he/she no longer feels he has control over his/her privacy because of what the other can hear/see/smell. Both cases can lead the patients to become uncomfortable and stressed, and these are definitely detrimental for their recovery. The close proximity also means that there is not a lot space left should every patient receive visitors at the same time.
17
Kaplan S., ‘The Restorative Benefits of Nature: Towards An Integrative Framework’. p. 178
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project Comparison Comparing the results of the analyses of the positive and negative elements of the doctors and nurses against those of the patients will enable the establishment of a matrix which will constitute the basis of this research’s results. Similar results
More spaces and larger spaces Patients o
Increased privacy.
o
Not disturbed by neighbouring patients.
o
More room for visitors.
o
More room to stretch.
Doctors and nurses o
More room to move around equipment and beds.
o
More room so that one activity does not oversteps the boundary of another.
o
Dedicated spaces for dedicated tasks to reduce the risks of mistakes.
o
Respect for interpersonal distances and boundaries to make work environments more comfortable.
Dedicated relaxation space
Patients o
Ability to leave the room and completely disconnect from the hospital environment.
o
Could boucle up as visiting room to dissociate relatives and friends from the hospital room.
Doctors and nurses o
A space that doctors and nurses can easily and quickly access to temporarily mentally from the stress of the ward.
o
Remove absolute need to walk five minutes down to the cafeteria at every break.
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project Natural connectivity and positive distraction
Patients o
Views of nature, stemming from the principles of biophilia, have been proven to enhance recovery.
o
Distractions can again disconnect the patient from the hospital environment.
Doctors and nurses o
As discussed previously, connection to the natural systems can considerably enhance body functions and increase performance.
o
Soft distractions can subconsciously restore attention, or decrease the rate of attention drop.
Conflicting results No apparent environmental or architectural attribute of the spaces that have been under study have suggested a conflict between the needs of patients and staff. At most a feature that was regarded as positive or negative by one party was seen neutrally as the other (e.g. nurses and doctors are annoyed by the small size of the station, while this had no direct effect for the patients) so a conflict is not actually existing.
Interpretation From the above results, we can observe that most of the positive attributes (existing or extrapolated) of the ward are similar for both the patients and the doctors and nurses. However, the inherent reasons as to why the spaces need to be in such a way is different – patients want a larger room to increase the level of privacy they have vis‐à‐vis the neighbouring patients; doctors and nurses want a larger to facilitate the movement of beds and equipment. It is important to understand these differences because, while there appears to be no conflict currently, an intervention based on a misinterpreted analysis might lead to the introduction of a spatial conflict (a room that is fully enclosed to ensure patient privacy will prevent doctors from properly monitoring the patient). The features which are expected to be the most successful in reconciling the needs of the patients and staff are the sizes and the quantities of available spaces, and the introduction of natural attributes and distractions into the space. Besides the obvious physical advantages of having larger
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project spaces in the ward, the underlying, not‐so‐apparent elements that would need to be considered were the ideas of privacy and proxemics. However, in terms of nature and distractions, (and relaxation spaces which can also fit under this banner) the relationships that exist between the space and the occupants are more complex. The research has not produced a sufficiently large amount of data from the patients to be relevant. But there already exists a wealth of literature that explores the impact of the quality of the space on the recovery of patients, and it is already an established fact that features such as a view on a natural landscape or natural light contribute to a quicker recovery.18 The performance of the medical staff is what is most interesting here. The concept that is most relevant to explore this is Kaplan’s attention restoration theory. If we consider the fact that doctors and nurses at that ward cannot allow themselves to have their attention levels drop (although this is inevitable), don’t actually have place that they can define as a restorative environment, and that the closest thing to a restorative space is quite far away, it might be necessary to consider all these elements together instead of studying them individually and overlooking some of their relationships. This purpose of this research is not to make any design proposal, but for the sake or argument, let us hypothetically create a scenario and use this as the basis of the discussion. The idea arrangement would be a ward large enough to accommodate all the required functions, open and flooded by natural light and containing positive distractors (artwork, sculptural elements, plants). Following Kaplan’s model, it could be argued that this fully integrated workspace would itself acts as a restorative environment19, meaning that the attention levels of the staff would continually be restored through brief disconnections (enabled by the soft distractions.) This does not mean that the doctors and nurses will be able to work forever – mental fatigue will be reached eventually, but distractions will only delay the moment of directed attention fatigue. Refering back to Zouki’s café and the comment that coming back up from a break was sometimes depressive, it can be posited that a workspace that is integrally restorative might dampen this type of experience by reducing the gap between the preconception of work and relaxation. The abovedescribed space was created with the needs of doctors and nurses in mind. If patients are now introduced in the space, we can safely assume that none of the described features will be detrimental for their recovery – quite the contrary actually – natural light will enhance their recovery and distractions will help them temporarily be away from the hospital.
18 19
Sternberg, E. M., 2009. Healing Spaces. p.10 Kaplan S., ‘The Restorative Benefits of Nature: Towards An Integrative Framework’. p.172
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CHU SIN CHUNG Adrian 332874 Human Environments Relations ABPL 90322 Research Project The above description is meant to be illustrative only and the real life implementations of such proposals might yield different outcomes. However, the facts remain that even though patients and staff have different needs, they can potentially be addressed by the same spaces.
The Larger Scale The discussion about the size of the spaces and the absence of dedicated spaces is relevant only to the surgical ward. However, some of the research and findings conducted at that ward could be implemented at the scale of the entire hospital – notions that are space independent such as the effect of natural light, presence of positive distractions or the level of performance associated to attention fatigue. Regardless of the size of the wards, the number of beds per room or how much or little activity is crammed into a certain space, these elements remain relevant to the performance of the hospital as a health institution.
Conclusion The purpose of this paper has been to determine what spatial qualities are necessary for the recovery of patients and for the performance of the medical staff at the surgical ward of the Royal Melbourne Hospital, and if these two could be reconciled into a single space. The research conducted has shown that, while there is no actual conflict between the spatial needs of the patients and those of the staff, the current spaces do not perform very well in enhancing recovery and performance. However, the analysis of interviews and traces of behaviour obtained through detailed observations have led to the conclusion that even though the distal needs (e.g. need for privacy, need for interpersonal space not to be violated) of patients and staff might be in many aspects different, these can be addressed by the same spatial intervention by first addressing their proximal needs (need for a larger space). In other words, the needs of patients and medical staff in a hospital can potentially be fulfilled by the same space so that the performance of a hospital in terms of healing rates can be improved by both the ‘passive’ work of the environment on the patient, and the more active improved performance of doctors and nurses which is again attributed to the quality of that very same environment.
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