Paradigm Change? The Perspective of the Patient
We would like to thank the organizers of the ‘Building the Future of Health’ conference, www.btfoh.eu, for their kind support of this COR WAGENAAR, NOOR MENS publication.
Taking care of patients has always been the core business of hospitals, but as the ‘Short History of Hospital Architecture’ in this book demonstrates, this does not mean that they Layout and cover design Jenna Gesse, Berlin were built with the intention to cure people. That only became their primary mission with the advent of the scientific revolution of the 17th and 18th centuries, when the medical proGraphic design concept of ‘Design Manual’ series fession began to look more toward empirical science for inspiration. This change marks Oliver Kleinschmidt, Berlin the beginning of an unending struggle against irrational views about illness and healing. There has never been a shortage of rituals, rites and the use of herbs and drugs, the alleged Cover Akershus University Hospital, Oslo, C. F. Møller Architects; photo: Torben Ekserod healing qualities of which often depended entirely on religious beliefs, superstition or salesmanship. The medical profession has made the fight against these dubious therapies Frontispiece Surgical Clinic La Croix-Rousse, Lyon, one of its primary objectives and hospitals as we know them today are the physical manifesAtelier Christian de Portzamparc; photo: Erick Saillet tation of this fight. Since the late 18th century, they could be called ‘healing machines’ (machine à guérir), that is to say, buildings designed to cure those suffering from medical disConcept Cor Wagenaar, Noor Mens orders. A machine is a technological device designed according to rational principles and Project texts Noor Mens, Cor Wagenaar because hospitals have defined themselves as machines run by medical professionals and technicians, they have always been seen as offering the best possible chance of recovery. Copy-editor Harvey L. Mendelsohn, Cambridge, The negative aspect of this outlook is that people were treated as objects of the same Massachusetts order as any other objects studied by the natural sciences. For centuries, medical professionals adhered to the Cartesian distinction between mind and body, seeing the latter as Editorial supervision Ria Stein, Berlin René Descartes (1596–1650). Portrait by Jan an object which functioned solely according to physical laws (and which was thus divorced Baptist Weenix. is associated the Production KatjaDescartes Jaeger, Amelie Solbrig,with Berlin from the workings of the mind). Diseases, therefore, had to be dealt with in much the same conviction that mind and body represent sepaway as defective machines: by interventions based on the findings of the natural sciences. rate worlds, implying that people’s state GmbH, of mindBerlin Lithography bildpunkt Druckvorstufen Medicine considered itself as one of them and thus treated mental illness, too, in the same cannot impact on150 their medical condition in Paper BVS matt, g/m² way, i.e. as a mechanical failure. any way. Medialis Offsetdruck GmbH, Berlin Printing As long as the Cartesian separation between mind and body prevailed, the idea of taking into account the patients’ personal experiences was believed to be on a par with the Library of Congress Cataloging-in-Publication data superstitious concepts medicine had tried so hard to overcome. Ultimately, the emergence A CIP catalog record for this book has been applied for of at psychology at the end of the 19th century began to undermine the Cartesian dichotomy, the Library of Congress. and since then it has become widely accepted that people’s mental states can have an impact on their physical well-being. Psychology, however, did not at first reject the view that Bibliographic information published by the German National mental disorders should be seen as mechanical failures. Moreover, the idea that patients Library. The German National Library lists this publication should have a say in what is done to their bodies and minds — something which is now in the Deutsche Nationalbibliografie; detailed bibliographic data are available on the Internet at http://dnb.ddb.de.believed to reduce the stress on them — had not yet developed. In the 1930s, people’s personal experiences were increasingly seen as linked to their This work is subject to copyright. All rights are reserved, social and physical environment. Consequently, health-oriented interventions in the enviwhether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuseronment, previously focused on hygiene, now incorporated attempts to offer relief from of illustrations, recitation, broadcasting, reproductionstress. In the 1950s and 1960s, the modern housing estates that were then being built in large numbers came under fire, with experts blaming the living environment they providon microfilms or in other ways, and storage in databases. For any kind of use, permission of the copyright owner ed for a great increase in psychological diseases associated with stress. Similarly, hospitals must be obtained. themselves began to be seen as stressful environments that hampered their patients’ healing processes. Friendlier, less machine-like architecture was promoted as a way to diminish This book is also available as an e-book stress, and patient-centered care became a popular slogan. Moreover, new organizational (ISBN PDF 978-3-0356-1125-0; ISBN EPUB 978-3-0356-1126-7). concepts were developed to alleviate the inevitable tension people experience when they are hospitalized. In the same vein, the evidence-based design movement that emerged in © 2018 Birkhäuser Verlag GmbH, Basel the United States in the 1980s began to explore the ways people react to their physical and P.O. Box 44, 4009 Basel, Switzerland social environment with the aim of learning how spatial design can influence medical outPart of Walter de Gruyter GmbH, Berlin/Boston comes. In sum, psychology was perceived as a way of exploring the link between personal experiences and objectively verifiable medical data. Printed on acid-free paper produced from For quite some time, a paradigm shift has been underway that takes this evolution chlorine-free pulp. TCF ∞ one step further, inviting patients to take an active role in treatment, something that in the Printed in Germany United States is already considered a matter of ‘conventional wisdom’.11 ‘The elevation of ISBN 978-3-03821-473-1 the patient to partner’, the American Joint Commission concluded, ‘is not a ceremonial ti987654321 tle bestowed for a “feel good” moment, but has significant implications for the quality and www.birkhauser.com safety of patient care’.12 From the traditional, medical point of view, this turns the world 12
DEFINING THE HOSPITAL OF TOMORROW
Principles of the Hospital Building 8 Preface Cor Wagenaar, Noor Mens 9 Introduction Cor Wagenaar, Noor Mens
DEFINING THE HOSPITAL OF TOMORROW
DESIGNING HOSPITALS
PUBLIC SPACES
TREATMENT AREAS
12 Paradigm Change? The Perspective of the Patient Cor Wagenaar, Noor Mens
23 Distribution of Healthcare Facilities: Centralization, Decentralization and the Network Hospital Guru Manja, Colette Niemeijer, Cor Wagenaar
52 Zoning and Traffic System Tom Guthknecht, Peter Luscuere, Guru Manja, Colette Niemeijer, Cor Wagenaar
67 Planning: an Integral Approach Tom Guthknecht
15 Healthcare as a Public Service Cor Wagenaar, Noor Mens 19 The Business Case for Hospitals Guru Manja, Colette Niemeijer 22 Changing Healthcare Needs Cor Wagenaar, Noor Mens
27 The Design of Hospitals: Care Pathways Guru Manja, Colette Niemeijer, Cor Wagenaar 32 Processes and Spaces: the Example of the Maternity Department Guru Manja, Colette Niemeijer, Cor Wagenaar
58 Arrival and Entrance Noor Mens
69 Outpatient Department Tom Guthknecht, Guru Manja, Colette Niemeijer, Cor Wagenaar
61 Public Spaces in and Around the Hospital: Streets, Squares, Patios, Waiting Areas, Healing Gardens Giuseppe Lacanna, Cor Wagenaar
75 Inpatient Wards Tom Guthknecht, Guru Manja, Colette Niemeijer, Cor Wagenaar
65 Wayfinding: Signage and Orientation Systems Noor Mens
83 Diagnostic Imaging Tom Guthknecht, Guru Manja, Cor Wagenaar
37 85 Evidence-Based Design for Operating Theater and Healing Environments Recovery Area and expertise — Cor Wagenaar The Bijlmermeer, Amsterdam, the Netherlands, upside down, offering people who obviously lack professional knowledge 1968–1975. The ‘Cartesian Dichotomy’ was inTom Guthknecht, Guru and are likely to be burdened with numerous unsubstantiated notions — the opportunity creasingly challenged in the 20th century. Manja, Colette Niemeijer, 42In the to interfere with medical procedures they know nothing about. Giving patients a say in the 1950s, the phenomenon of stress was discussed Wagenaar The Building Type way theyand are treated clearly touches upon the very essence Cor of medical practice and remains at numerous medical conferences and linked its Emergence quite difficult to achieve. ‘In ideal circumstances, hospitals would be highly responsive to to mental and physical health problems. New 100 are in a weak position. They Noor housing estates like the Bijlmermeer were seenMens the needs of their patients. In reality, this is rarely so. Patients as particularly unhealthy. Intensive are in an unfamiliar setting, vulnerable because of their illness and Care their Unit lack of informaGuthknecht, tion and dependent on others’, Martin McKee and JudithTom Healy conclude Guru in a report of Manja, Colette the Joint Commission, a not-for-profit organization that assesses health Niemeijer, programs and orCor Wagenaar ganizations in the United States.13 ‘Although it is self-evident that care should be focused on the needs of the patient, in reality many hospitals are run more for the convenience of 108 as an impersonal ‘healing the staff.’14 Obviously, it is very difficult to reconcile the hospital machine’ with the hospital as a caring institution that notEmergency only offersDepartment treatment, comfort and support, but also invites patients to take responsibility.Tom Guthknecht, Guru Manja, Colette Niemeijer, This paradigm shift coincides with a new definition on health, one that is widely proCor Wagenaar moted by the World Health Organization: people can consider themselves healthy if they can do anything they want without being hampered by their physical or mental conditions. 111 and breaks away from the Clearly, this approach puts personal experiences at the center Laboratory Department Tom Guthknecht 13