D E S I G N A N A LY S I S
SHANNON ST EINBER G OC TOB E R 2017
DUKE CANCER INSTITUTE DURHAM, NORTH CAROLINA To evaluate environmental design in a healthcare care facility, I selected the the Duke Cancer Institute in Durham, North Carolina as my focus. It is an acute care hospital featuring design based on the patient-centered care model. This ultra-modern facility promotes healing and recovery in a space that nurtures, humanizes, personalizes, and demystifies the health care experience by connecting the patient, family, and healthcare workers to the physical environment in a meaningful way. The Duke Cancer Institute is a compassionate healthcare environment that contains and provides superior specialty and surgical care, advanced imaging technology, and compassionate cancer support services. Design strategies within the Duke Cancer facility are intended to increase quality of care by reducing patientsâ€™ anxiety and stress, accelerating recovery, shortening length of hospitalizations, lessening pain, and promoting a sense of well-being. My design analysis of this healing environment considers privacy and human dignity, homelike vs. institutional design qualities, connection to nature, wayfinding, lighting, cleanliness, color, and interior surface materials in relation to the environmental design of a healthcare setting. Figure 1
D U K E C A N C E R I N S T I T U T E D E S I G N A N A LY S I S PRIVACY AND HUMAN DIGNITY: Design of the Duke Cancer Institute thoughtfully intends to safeguard patient privacy and value human dignity. The overall design of the space including registration, patient rooms, waiting areas, and diagnostic areas felt very personal and accommodating (Fig.2). Design emphasis was placed on providing acoustic and visual privacy (Fig.3) within various treatment and recovery areas. Design elements within the hospital such as location and layout of workstations helped keep conversations between patients and medical staff confidential. The design efforts to maintain patient privacy and dignity helped to decrease stress and minimize negative feelings about the environment.
HOMELIKE vs. INSTITUITIONAL DESIGN: This care environment provided patients a non-institutional healthcare experience. Design elements within the space clearly supported a homelike atmosphere. To help soothe patients and offer comfort, the central atrium featured live piano music that can be heard from the lower level throughout the day (Fig.4) A cozy fireplace evoked a pleasant sense of welcome, familiarity, and warmth (Fig.5). The space aligns with the Plantetree model in which aesthetics, art, design elements, and a connection to nature are emphasized within this healing space. (Kopec, 2012). Guiding design principles include compassion, caring, and respect.
D U K E C A N C E R I N S T I T U T E D E S I G N A N A LY S I S WAYFINDING: Good wayfinding measures were thoughtfully built into the interior environment which made navigating the space easy. At first, it was stressful entering the cancer center for the first time because it seemed overwhelming. However, the visual access, architectural delineation, and building layout helped increase environmental legibility. The elevators were centrally located but some people were not sure which floor they needed to find. It was also difficult to distinguish one floor from another at first and the central set of stairs did not lead to area many women were trying to find. The use of environmental communication such as its interior architecture and graphic information were effective at providing guidance and did not present any unnecessary barriers to wayfinding. (Fig.6) Visually distinctive features and and recognizable furniture did help to provide reference points and minimize wandering throughout the facility. Placement of services was convenient and easy to manage for all people including patients with limited mobility. CONNECTION TO NATURE: Because stress can lower patients’ immune systems, it is critical to incorporate aspects of nature into the design of healing environments. “The use of natural settings within institutions helps to reduce the anxiety many patients experience” (Kopec, 2012). Good access to a choice of inviting outdoor spaces encouraged a connection with nature (Fig7). The outdoor spaces at Duke Cancer Institute afforded patients and healthcare workers comfortable seating, generous garden paths, and secluded sitting areas that allowed for either quiet reflection or socialization (Fig.8). Many references to nature were found throughout the center.
Figure 7 Figure 8
D U K E C A N C E R I N S T I T U T E D E S I G N A N A LY S I S ARTIFICIAL & NATURAL LIGHT: Design of the Instituteâ€™s elevation and orientation to other buildings within Dukeâ€™s Medical campus seemed to maximize natural daylight as mush as possible. The space did include a mix of abundant natural light and high-quality artificial lighting that provided clear visibility, optimal comfort and safety(Fig.9) Design of the interior lighting appears to effectively reduce glare and shadowing and is proportionate to the overall space. Lighting levels and lighting transitions increased comfort and created a pleasant atmosphere. The Institute features a quiet room for patients and families that engages the senses through subtle light manipulation for deep reflection and meditation (Fig. 10).
SANITATION + SMELL: It was clear that sanitation at the facility was a high priority, yet the environment did not feel institutional. Design supported and encouraged proper sanitary procedures. The surface materials used appeared to be antimicrobial yet they did not make the space feel impersonal or austere (Fig.11) The overall ambiance of the space was therapeutic and nurturing. There were no disagreeable aromas within the space that would increase negative feelings or associations about the quality of medical treatment or experience.
D U K E C A N C E R I N S T I T U T E D E S I G N A N A LY S I S COLOR: A soothing color palette consisting of soft green and blue tones mixed with earthy neutrals (example Fig. 13) had a calming effect on patients and supported a healing atmosphere. Colors, patterns, and textures of surface materials and furnishings were soft and comforting and appeared to effectively lower patient stress and anxiety within the space. The use of color promoted interest across the interior environment and the applied color palette did not reduce environmental comprehension.
SURFACE MATERIALS: All surface materials were appropriate for the space. Floor finishes, wall coverings, cabinet sheathing were highly durable and functional for each area within the Institute( Fig.14 &15). Materials present were hygienic but also appeared inviting and comfortable. There were no glossy surface materials that produced glare. Recognizable cues found in flooring, furnishings, and color patterns were thoughtfully integrated into the space which enhanced wayfinding between floors and throughout the building.
DESIGN SUCCESS + RECOMMENDATIONS: This healing environment succeeded at providing a soothing space that felt reassuring, compassionate, and caring. Interior design elements, materials, layout, and the Center’s connection to nature support the healing process and made the space feel familiar. My design recommendations for the Duke Cancer Institute would be to improve directional signage near the main entrance. There are a variety of floors, doctors, and specialty treatment areas that patients and their families need to find. Because patients are experiencing a high level of stress in the facility, clearer communication would help to reduce patient anxiety and confusion. Overall, the environmental design of this healthcare setting effectively ”conveys the associative meaning that the facility provides high-quality care” (Kopec, 2012).
FIGURES Cover Photo: http://www.tka-architects.com/hc_duke_cc.html Figure 1: http://www.wral.com/news/local/story/5871862/ Figure 2: http://www.tka-architects.com/hc_duke_cc.html Figure 3: https://www.youtube.com/watch?v=HVDj4_fi1FU Figure 4: http://designawards.architects.org/projects/healthcare-design/duke-cancer-center/ Figure 5: Figure 5:http://thebigcnotmiddlec.blogspot.com/2012/03/first-round-of-march-chemo.html Figure 6: http://www.tka-architects.com/hc_duke_cc.html Figure 7: http://www.tka-architects.com/hc_duke_cc.html Figure 8: http://perkinswill.com/work/duke-medicine-pavilion-plaza Figure 9; http://designawards.architects.org/projects/healthcare-design/duke-cancer-center/ Figure 10: http://designawards.architects.org/projects/healthcare-design/duke-cancer-center/ Figure 11: http://www.tka-architects.com/hc_duke_cc.html Figure 12: http://www.tka-architects.com/hc_duke_cc.html Figure 13: https://www.remodelaholic.com/popular-best-selling-paint-colors/ Figure 14: https://www.youtube.com/watch?v=HVDj4_fi1FU Figure 15: https://www.youtube.com/watch?v=HVDj4_fi1FU *My request to personally photograph the Duke Cancer Institute was not approved because of HIPPA privacy regulations. The staff was kind enough to direct me to web sources for images.
REFERENCES Kopec, Dak. Environmental Psychology for Design. 2nd Edition, New York: Fairchild Publications, 2012.
The Duke Cancer Center