Hello again! I am back with another episode, and this week we are going to be focusing on an introduction to healthcare architecture.
This episode is going to be more like a stepping stone, or laying down the foundation for future episodes, so it is going to be rather short and sweet. With that, I hope you enjoy the show! The title image is one I generated with AI.
TRANSCRIPT:
It’s time for Architecture, Coffee, & Ink.
20 second Intro song
Hello, this is Hollywood C. and you’re listening to Architecture, Coffee, &, Ink. A podcast dedicated to introducing concepts, detailing out designs, and tackling the architecture you might not realize the meaning behind. I’m your hostess and I am here today to start introducing you to the designs that make you wonder why.
tag line: So, I ask you to brew your coffee, grab your sketch book and pen, and let’s begin.
Hello and welcome to Healthcare Design 101! I will be your professor today… and no, I am only slightly kidding. Today, we are going to be discussing and laying out some of the building blocks for healthcare design. The intention behind this episode is to lay down some groundwork for future episodes coming out, but more importantly, introduce everyone to the topic, history, the key concepts, and where the design world currently is. This is so future episodes on the show, and hopefully you as designers, can go beyond the buzzwords and start actively practicing it in your designs. Before we begin, just remember to always check your sources, check your facts, and most importantly check me. I should never be your only source of information.
The Introduction and History
Now most of my episodes are slightly more nuanced than this one is going to be, given how incredibly broad the whole topic of healthcare, medical architecture, and places of healing are, especially on a global scale. Now before I dive into the fine details, I want to discuss some of the broad strokes of the changes in how we approach healthcare design. Because, quite frankly, I wouldn’t be here, discussing this episode or researching it, if it wasn’t for this radical shift in thinking. At one point in history, healthcare, hospitals, etc. were originally considered places to die or for end-of-life care only. Prior to that, we had a few examples of healing springs, healing gardens, healing cults, and things like that, which I will discuss later on in the episode. However, we had a dramatic shift in our thinking and scope. This would continue to evolve, especially when technology and our general scientific understanding of germs, diseases, and sanitary practices changed. Currently, the designs we implement today are rooted in how and what impact the design can have on the patients and relatives. And in turn, how that can also impact the care and health of those patients, through how it impacts the staff. For me, it’s extremely important to bring this up before getting into the history, as it’s key to understanding how and why the industry has developed. It also is something you need to hold onto as I describe the changes, so you can fully appreciate the mindsets of the individuals, and magnitude of the amount of change I am describing.
Care has historically occurred in a variety of places, from at home care to being part of places of worship, ritual, or hospitals. I have gone through multiple sources and pulled out a few recurring examples throughout history to put a section of key events in history together.
We are going to start off discussing Imhotep in Ancient Egypt. In addition to being an architect, he was also a physician, supposedly. Now, to be completely transparent, we do know he was the architect of the step pyramid in Saqqara(h) in Memphis, Egypt. We also know he was a vizier, and a bunch of other titles, including a god or demi-god of medicine, with his own cult some years after his death. He eventually was raised up the status of being a god of healing – often compared and linked to a Greek god. His cult would end up building temples associated with healing. Of course, he then came around to star in the Mummy movies, my absolute favorite movies.
One of the oldest healing sites is the Sanctuary of Asclepius, Epidaurus, which was in use from 4 BCE to 6 CE. It is a holy site, for Asclepius, the god that Imhotep was linked to, which is why articles tend to throw the two names together so much. It was added to the World Heritage List in 1998. He was the god of healing, medicine, and physicians, is linked to the Rod or Staff of Asclepius. Which is actually what we based the medical healthcare symbol on, that used today. It’s a serpent wrapped around a physician’s rod, of course, America is different and uses Hermes’ rod instead, which is two snakes and a rod and wings for healthcare. Hermes is of course the god of commerce, thieves, and merchants.
When we approach the topic from a western perspective, the first major organization providing care is the Catholic Church. Now care would occur at a variety of locations, including monastic orders and cloisters, nunneries, or attached to other religious orders. And this is where you get a lot of the associations with charities, but also centers for physical, spiritual, and mental health.
At first, hospitals were being built on the outer edges of the towns and centers. however, over time, population increases would make that a mote point, as the edges of the town would slowly grow and encompass what once was the original boundaries. Once cities start generating enough capital, that’s when we see the introduction of civic-based healthcare. Or healthcare that was no longer dependent on places of worship.
However, one of the most talked about changes in design, is the introduction of the pavilion model, or more accurately, the popularization of it through several published articles and books. I read one article that included a passage on how one book likely helped impact the way that both the North and South addressed hospitals during the American Civil War, and apparently even Abraham Lincoln included a note about incorporating a flower bed into hospital designs. Way back, when I did a Halloween episode, one of my very first episode probably, I discussed Carnton Planation, and how it became a temporary hospital during the American Civil War. My original episode gave a pretty good example of how bad the conditions were at the planation, so I won’t go into detail now, but to sum it all up, the death rate was really high.
When we get the perspective change of healthcare being a place of healing, we also see a dramatic change in the way patients are treated. According to one article I read, while we were originally seeing an overall improvement after the wholehearted embracing of the pavilion style of architecture, we were also seeing in an improvement in moral, health, and hygiene. A key aspect of this design is basically pushing all the ‘dirty’ areas to one end, and the clean to the other. Additionally, there is an increase in ventilation, bright colors, and as a result, overall well-being. Another key feature is the incorporation of garden features, and garden views when possible.
However, this really only lasted until World War II, when necessity leads the switch back to an efficiency-based model. Our casualty rate was higher, and the focus changed to getting through the numbers, not the well-being or care of those involved. This is when the introduction of the podium model of design pops up. So, a pavilion design is long buildings that are grouped together, each one looks like a pavilion, and everything you need is right there. A podium is where everything is designed per efficiency, and the nurses spend the majority of the time in transit. Basically, you have a platform, and then a bunch of towers on top. And the departments will be in the most efficient location, meaning you could theoretically enter the ER on one side, have to go to radiology on the complete opposite end of the building. This model meant that hierarchy wasn’t really there in a way that it needed to be, and the care was pretty impersonal. Of course, a criticism of the Pavilion style, according to an article in the Journal of Ethics, Architectural History of US Community Hospitals, was that the pavilion-ward only varied by site location.
Healthcare Now
Now, this section, I am basically going to briefly describe a few areas of contemporary healthcare design. You would have undoubtedly heard of these topics I am going to discuss, but when I was researching them there was a significant amount of overlap between them. Especially between the principles the ideas are founded on. Today, healthcare design is considered to be a specialty within the design field, that really focuses on all of the aspects of healthcare spaces. However, many of the principles associated with it, and the lessons we will discuss, can be applied in other sectors. Healthcare Design as a whole, can further be divided into specialties like senior living, hospitals, specialty care centers, etc. And you can absolutely find firms or individuals who specialize in one area.
Now, when you are designing for healthcare, there are a couple of different concepts to understand. Among these are healing architecture, evidence-based design, green architecture and healing gardens. I do want to clarify, I have seen each of these ideas used together in various combinations, and sometimes interchangeably, but for the purpose of this episode, I want to define and explain each aspect.
Evidence-based design and healing designs will often overlap, or you can find articles that claim it’s the same thing, or that healing designs have evolved together into interchangeable terms. I am separating them, because they have separate definitions, and healing architecture is defined as using evidence-based design principles. You can have a design founded on evidence-based design, but not on healing architecture. Evidence based design, according to the Center of Health Design is:
“the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”
Healing Architecture or a healing environment, the Center for Health Design is quoted as defining it as the following:
“the creation of environments that are designed to promote the improvement of health outcomes through the integration of evidence-based design principles”.
Essentially, according to this idea, you are healing through design, or at least, creating an environment that promotes healing. While evidence-based design is all about the facts and evidence.
In healing architecture, the goal is designing a space or creating a design that meets not only the physical needs, but also the psychological and emotional needs of the patients and their families, as well as the staff. It is an all-encompassing approach, that is focused on more than just the basic principles of design. I would argue that it’s a form of compassionate design. As designer, you have to think beyond what is the most innovative, what is the big statement, and think what is going to promote the most comfort and healing.
According to that same article, there are five key areas to consider when creating a healing environment. They are as follows, in no particular order: art, acoustics, climate (including ventilation), colors and materials, and light/nature. Now, let’s take a moment to expand on each of these in the order I read them out. Art is actually an extremely pivotal aspect in healing architecture. Beyond just ensuring that the images displayed looks good, additional considerations should include the tone and colors, any connections, or connotations the images might have, and the overall feelings of the piece and how they work in the environment you are creating. Acoustically, you need to consider things such as echoes, sounds transmitting between places, patient confidentially, tones, and how those things affect the people in the spaces. Climate and ventilation go back in no small way to the historically important considerations, such as the miasma theory, or bad air, where they believed that diseases could be caused by the air, or from decomposition in the earth and is also sometimes called night air. This is different than airborne pathogens. This was a huge consideration in designs for years, including in the pavilion model, though at that time it was more of general call for good ventilation and less of an almost-entity or mythical creature that miasma is depicted as in drawings. Additionally, this should also include how comfortable the staff and patients will be in the space. Colors and materials could absolutely be their own episode, on the color theory alone. Studies have proven that colors are insanely important for our moods, stress levels, and wellbeing. One of the very first things I was cautioned about design was don’t paint a bedroom red. Or more accurately, don’t paint it a few certain shades. Materials will have the same impact. And finally, light and nature. Natural light helps tremendously with our rhythm and has a strong impact on our psyche. Nature will have the same impact, and even bringing in images of nature will assist with creating a positive change.
Our final of the three topics I wanted to highlight, is green architecture and healing gardens. And I am discussing them together because they were the most commonly grouped when I was researching. Healing gardens actually originate extremely far back, especially if you are lumping healing springs, or herbal gardens all underneath the same term. I can’t remember which episode, it may have been several, where we discussed healing springs. This is not a new concept and it’s been done for centuries. I also noticed it’s one of the most abused terms, as it seems like the most fluid of the definitions applied the most liberally. The term green architecture actually first occurred in the 1960s and 70s, occurring in parallel with other green movements. It was driven from great concern over pollution, sprawl, and the energy crisis. Since that time, we have continued to pass green literature, laws, and established organizations to promote green spaces, green uses, and regenerative design. This will absolutely be another episode; I can go ahead and confirm that now. As a quick definition, regenerative design is taking green architecture a step forward, into something that improves the environment through intervention, and regenerates it, as the name implies. Nevertheless, research currently exists and is ongoing showing that in addition to the environmental implications, patients are generally healthier under this idea.
Conclusion
Nowadays, I am pretty excited to see that current trends tend to be towards a holistic well-rounded approach, that considers not only the hygiene and the cleanliness, but the social, psychological, interior and materials, and the urban context. I am pretty excited to see what comes next.
And with that we end our episode. It’s a bit short and sweet, but I am actually actively in the process of moving right now. I recorded this whole episode surrounded by half-filled boxes, so the complete opposite of a healing environment. Our next episode will be our official 50th episode! And am I excited for that one, it’s perfect for October. We also have a guest episode lined up for before the end of the month. On a side note, I have posted a link on the Facebook page for Hurricane Relief Efforts through the American Red Cross. If possible, please see how you can help.
As always- please rate, review, and subscribe everywhere you get your podcasts from. You can find me on Instagram at architecturecoffeeandink. Email the show at architecturecoffeeandink@gmail.com or the blog at architecturecoffeeandink.com. Architecture, Coffee, & Ink is a Hollywood C. Studios, LLC production. I am excited to meet with all my designers, dreamers, and DIY enthusiasts next time, but in the meantime,
May your coffee mugs be full, and your inkwells never run dry.
60 secs end song re-looped.
SOURCES:
(PDF) Healthcare Architecture: History, Evolution and New Visions, http://www.researchgate.net/publication/282852376_Healthcare_Architecture_History_Evolution_and_New_Visions. Accessed 5 Oct. 2024.
(PDF) Regenerative Development and Design, http://www.researchgate.net/publication/273379786_Regenerative_Development_and_Design. Accessed 5 Oct. 2024.
Australian Healthcare Week 2023, http://www.ahwdigital.com.au/events-austhealthweek. Accessed 5 Oct. 2024.
Brandt, Sarah. “What Is Healing Architecture?” DAMPA, 20 June 2024, dampa.com/what-is-healing-architecture/.
Cherney, Montana, et al. “The Value of Design in Global Public Health.” McKinsey & Company, McKinsey & Company, 17 Dec. 2019, http://www.mckinsey.com/industries/social-sector/our-insights/the-value-of-design-in-global-public-health.
“Design for Health.” Advancing the Appropriate Use of Design in Global Health Contexts, http://www.designforhealth.org/. Accessed 5 Oct. 2024.
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“Explore Scientific, Technical, and Medical Research on ScienceDirect.” ScienceDirect.Com | Science, Health and Medical Journals, Full Text Articles and Books., http://www.sciencedirect.com/. Accessed 5 Oct. 2024.
“Healing Architecture: IMM Cologne Magazin.” Imm Cologne Magazin | Imm Cologne, Koelnmesse GmbH, http://www.imm-cologne.com/magazine-archive/future-living/healing-architecture/. Accessed 5 Oct. 2024.
Interiordesign-Ed, interiordesign-ed.com/classes/materials/CEU-Evolution.pdf. Accessed 5 Oct. 2024.
Jayachandran, Krittika. “10 Examples of Healing Architecture around the World – RTF: Rethinking the Future.” RTF | Rethinking The Future, 19 Jan. 2022, http://www.re-thinkingthefuture.com/designing-for-typologies/a2179-10-examples-of-healing-architecture-around-the-world/.
Kisacky, Jeanne. “An Architectural History of US Community Hospitals.” Journal of Ethics | American Medical Association, American Medical Association, 1 Mar. 2019, journalofethics.ama-assn.org/article/architectural-history-us-community-hospitals/2019-03.
Mahlum, http://www.mahlum.com/pdf/HistoryofHealthcareArchBurpee.pdf. Accessed 5 Oct. 2024.
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Mondo Insights Recent employment news & industry insights from the Mondo digital content & research teams., et al. “The Rise of Design in Healthcare and Its Benefits.” Mondo Staffing Agency, 27 July 2023, mondo.com/insights/rise-of-design-in-healthcare-and-benefits/.
Moneah. “Past, Present & Future of Healthcare Design.” National Solutions, 22 Mar. 2023, http://www.nationalsolutions.com/frontline-surfaces/healthcare-design.
“Pavilion-Style Hospitals of the American Civil War and Florence Nightingale.” National Museum of Civil War Medicine, 28 Oct. 2021, http://www.civilwarmed.org/surgeons-call/pavilionhospitals/.
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