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CONCEPTUAL DESIGN IN HEALING ENVIRONMENTS

Dissertation Thesis - Interior Architecture and Design (Level 6)

BA(Hons)

Neemaeli A Mkony

QUESTION:


How well can conceptual design in a healing environment effectively make a positive dif-

ference in a patients’ mental health and well being?

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TABLE OF CONTENTS

ABSTRACT ……………………………………………………………………………………… 3

INTRODUCTION…………………………………………………………………………… 3-10

• Where does Architectural form in a healing environment and human psychology meet?

• What does the term stress mean pertaining to a healing environment ?

• What is Evidence Based Design and how can it help patient stress?

CONTEXT AND THEORY……………………………………………………………… 10-26

• How far can the patients attitude and day to day life affect their wellbeing?

• How exactly can conceptual design of a healthcare facility aid in patient recovery?

1. Case Study 1 - Alvar Aalto’s Sanatorium

2. Case Study 2 - Norman Foster’s Maggie’s Centre

• Comparison between case study 1 and 2

CONCLUSION……………………………………………………………………………. 26-27

BIBLIOGRAPHY……………………………………………………………………………. 28- 32

ACKOWLEDGEMENTS ………………………………………………………………… 32-33

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ABSTRACT

The research in this dissertation contributes to the growing research and interest in the

field of interior healthcare design. Departing from the premise that mental wellbeing is just

as important as physical wellbeing, I will focus specifically on patients dealing with emo-

tional distress such as anxiety, depression, grief- widely spread in contemporary urban so-

cieties, who are in need of a more psychological approach in their recovery. The main aim

of this dissertation is to discuss whether there is any correlation between the two spec-

trums :- to use research and supporting case study’s to understand whether a positive

healing environment can actively improve a humans emotional well being. I personally

want to understand if an aesthetically pleasing design in combination with evidence-based

design has any influence in the recovery time of a patient in a healing facility ,as well as

whether the design of a space allows for someone’s mental and emotional health. With

this information ,I will design a healing environment for a wellbeing centre for the emotion-

ally distressed. A framework was developed to understand the effects of healthcare de-

sign, placing contrasts with healing environments in the early 20th century ,versus one in

the 21st century with the help of case studies targeting specific facilities. Using the gath-

ered research and enough evidence gathered from other sources; I will put forward well

researched solutions. In the realm of interior architecture and design that are sustainable,

aesthetic and durable involving the natural environment, colour and ease of circulation.

Displaying how these simple solutions can be applied on a large scale , by discussing

whether these solutions can aid in the long run to effectively improve the psychological

state and patient satisfaction in an optimal healing environment. We conclude by weighing

in on whether a persons personal outlook is ultimately responsible for their attitude to-

wards their recovery.

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INTRODUCTION

Where does Architectural form in a healing environment and human psychology

meet?

I’d like to begin by bringing forth a visual exercise. Take a few minutes and imagine

yourself hospitalised. Immediately you feel uncertain , distressed ,vulnerable and afraid.

Essentially every negative emotion would run through your head. A person can easily feel

depersonalised from the loss of self control over his or her body and his or her surround-

ings. Now take a minute and imagine yourself in a haunted house. You immediately tense

up . Anthony Vidler, a theoretician of architecture explained from his experience that “the

“Atmosphere" that surrounded the house, its smell of the grave that "had reeked up from

the decayed trees, and the grey wall and the silent tarn, was difficult to account for, vague

sentiments, seemingly the products of a dream.”(Vidler,1987) . Vidler painted a scene that

injected fear into us by describing the uncanniness that surrounded the home. You can

sense that it didn't make him feel how one should when visiting a home. The use of his

own memory proves how effective a space can be in evoking feelings of either calm or dis-

tress. He makes us feel like everything about the home is a departure from security and a

freedom from fear. And is ultimately is received as unhomely (Vidler, 1987). What if we flip

this on it’s head and think about if the space he experienced did the exact opposite for

him. If it was warm, inviting , light and peaceful. Is it safe to say that it would leave a differ-

ent lasting impression on him? How a space makes us feel will naturally stick with us

through our memory. Whether we like it to or not. Now imagine being in the waiting room

for your biannual dentist appointment, you might hear some loud and distressing noises

from the treatment area. This would immediately trigger a painful memory linked with a

previous dentist visit. Although the above scenario is fictional the same feelings of help-
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lessness and distress immediately flood . Which is not how our healthcare and wellbeing

facilities should make us feel as a whole. However this is how they have made us feel for

as long as most of us can remember. Forcing us to essentially characterise and affiliate

anything to do with healthcare to fear and trauma.

Anthony Vidler’s notion of what is unhomely further cements my research because it al-

lows us to understand the connect between what is psychological and how architectural

form actively plays into that dynamic.The lack of aesthetically pleasing conceptual design

is apparent in looking at most healing environments, in which these encounters (space

and human )are taking place. One might rightfully ask if the psychological needs of pa-

tients are being satisfied. And if the architectural and design values of aesthetics are being

taken into account. Currently the typical hospital room is still painted white, minimal deco-

rations, unaccommodating to family, and minimally furnished. But how can healthcare and

well being facilities be designed so that they create spaces that facilitate high quality med-

ical care and at the same time are pleasant to experience ; in order to assist rather than

hinder healing as well as leave a positive impression?

To answer this question we have to understand what wellbeing means. The term wellbeing

means different things to different people, but generally refers to wellness of mind, body

and soul. Wellbeing is a condition. It can refer to the social , economic, social or psycho-

logical condition of a being. If someone has a high level of well being this is seen as a

positive space spiritually. When a person feels this sense of peace and hope in a space,

the space is playing an active part in the positive response the body is having. The whole

idea is how a positive healing environment can affect a person psychologically and intern

allow them to heal quicker. This kind of research is called Evidence Based Design, and 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 if failure for
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subsequent decision- making” (Malkin,2008). This research goes beyond just the healing

environment ,it also tackles psychoneuroimmunology (emotions on the immune system),

environmental psychology drawn from neurosciences, evolutionary biology(Malkin,2008).

This research can lead to well-designed facilities which may increase positive emotions,

which in turn could positively affect patients’ health and well-being (Malkin, 2008).Use of

the evidence-based design of healthcare environments could impact health-related out-

comes such as length of stay, pain, medication intake, stress, arousal, mood, or environ-

mental appraisals. However most of the research in this field is focuses on patient stress

( Ulrich, 1995). This is because stress has been known to cause slower recovery and more

pain and discomfort due to its impact on our psychoneuroimmunology(Rabin ,1999).

Previous stressful experiences that pertain to past healthcare facility visits can also com-

pletely put someone off psychologically from attempting something that they associate with

a negative outcome. In Anthony Vidler’s ; “Architecture of the Uncanny” he references one

of Freud’s experiences in a provisional town. Freud recounts “That, hastening to leave this

threatening place, un- intentionally and by devious paths he was forced to return twice

more, provoking a feeling he could only call "un- canny”(Vidler,1987). You can tell that

Freud felt a sense of helplessness throughout this experience. Each time he felt threat-

ened, yet he had no choice but to relive the same anxiety he had lived through twice be-

fore. This paragraph draws strong parallels to this discussion at hand. It allows us to un-

derstand that a particular space evoked all this emotion in him from a one time visit and

who’s to say that a healing environment cannot easily do the same. Paradoxically if we

apply evidence based design in coming up with our design solutions we can almost extin-

guish the uncanny thoughts we have about healing environments. Following these guide-

lines we could intern could allow psychology to have a large part to play in architectural

form.
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What does the term stress mean pertaining to a healing environment ?

Having established the reasons for the research, now we need to understand what stress

is. Oxford’s dictionary defines stress as .“ A state of mental or emotional strain or tension

resulting from adverse or demanding circumstances.(Hornby, Ashby, and Wehmeier,

2000).” In a healing environment the demanding circumstances are the persons current

ailments or the looming destiny of their future wellbeing. It may not be obvious at first

glance, but combined with the emotional distress of being in a healing environment, cer-

tain inferential aspects can add an immense amount of stress to the patients. These pos-

sible causes of stress could be :- invasion of privacy , no control over noise , acute or

chronic pain, separation from family and things familiar, feeling helpless, loss of control

over events and the immediate environment, and the anxiety from hospital and wellbeing

bills can also cause anxiety(Malkin, 2008). Leading to behaviours that may not be entirely

characteristic of the patient. He or she may have verbal outbursts, social withdrawals ,

passivity, sleeplessness , drug abuse and non compliance with medication regimes ( Ul-

rich,1991). As a result the stress can In tern manifest itself physically in forms of muscle

tension , more pain and discomfort ( stress decreases the threshold for pain) , high blood

pressure and respiration increase ,cardiac arrhythmias ,depression, insomnia ,delay

wound healing, and the lowering of the immune system (Malkin,2008). All these factors are

reason enough to reduce stress by building stress free environments for healing.
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What is Evidence Based Design and how can it help patient stress?

A positive response to this evidence based design research is that it has lead to the inter-

est from a niche group of designers who have noticed the lack of aesthetic mindfulness in

healing environments. These designers work closely with hospitals , including staff and re-

searchers to come up with some solutions that would cater both to the patients physiologi-

cal needs ,well being as well as creating a pleasant healing environment for them.

Research in the field of environmental psychology by Babin, Hardesty & Suter, demon-

strates that environmental stimuli can actively affect cognition.( Babin, Hardesty & Suter,

2003).,mood (Knez, 2001; Leather, Beale, Santos, Watts & Lee, 2003) and behavior (Gif-

ford, 1988; Mattila & Wirtz, 2001) .These studies show that our physical environment in a

variety of settings can be an important determining factor on how people act and think. In

saying this creating ambiance is only one factor in the balancing act involved in reducing

stress , having a connection to nature tends to have a calming effect:- the human body re-

sponds positively to nature and has an inclination to connect emotionally with nature

(Malkin, 2008) .So a view of a garden and interaction with a water feature could aid in their

healing process (Ulrich,1995) . So even introducing these visually through videos can aid

with anxiety. The same idea applies to control :- It is documented that if a patient feels in

control of their env especially in a hospital where they have stressors that they have no

control over e.g.. surgery. So the recovery environment should be a space free of envi-

ronmental stressors such as noise (snoring roommate) and have the provision of stress

free services to help them recuperate.

Social support follows closely :- having immediate access to friends and family is a great

help psychologically and is directly linked with autonomic , endocrine, and immune(Ulrich
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1995). Putting it simply being around our loved ones is scientifically proven to makes us

feel happy and hopeful.

The fact remains that elimination of environmental stressors is nothing but positive for pa-

tients :- Stressors have been proven to slow down the healing process. Factors such as

poor air quality and glare from direct (as opposed to indirect) light sources are also an ex-

ample of aspects that design-wise can be avoided. If the design team is educated it can

work collaboratively to create a better environment.

Another aspect is positive distraction. Making sure that the patients have multiple sensory

experiences can be extremely therapeutic. This can ultimately boost the immune system.

Introducing complimentary therapies such as music , aromatherapy, massage , acu-

puncture, meditation , art therapy, guided imagery , biofeedback , yoga , herbal medicine

to any health care facility can ease anxiety and ultimately reduce stress.
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CONTEXT AND THEORY

How far can the patients attitude and day to day life affect their wellbeing?

The psyche (mind and spirit) of the patient coming into the healing environment is

also imperative. Forcing us to think about what a patient contributes to their own healing

experience. Does he or she have an acceptance of self , a willingness to take responsibili-

ty , if they have a negative or positive view of disease, trust in treatment and ultimately an

overall willingness to live . These factors can drastically affect the patients outlook and at-

titude on their own wellness. Which can effectively increase or decrease /their chances of

improvement.

This is why mental wellbeing is just as important as physical wellbeing. Patients who suffer

from emotional distresses such as anxiety, depression, grief are widely spread in contem-

porary urban societies leading stressful, demanding lives under difficult economic climates.

They spend their days in banal office spaces, crowded transport hubs, badly designed

houses with little natural light availability. Its safe to say that these environments encour-

age ‘badbeing’ (due to their opposition to wellbeing). A mental illness such as depression

can stem from a persons personal thoughts of dejection and despondency. Whereas anxi-

ety disorders which take many forms can be described as a feeling of worry , nervousness

or unease about something with an uncertain outcome. Now imagine having these feelings

throughout your day and your immediate environment (listed above) does nothing to sup-

port your emotional needs. The end result shows that the person will likely end up sinking

deeper into their illness. We don't realise that the spaces we inhabit could intern have a

negative affect on us mentally and be a source of anxiety, depression, grief. The reason

behind my confidence is our reaction to what is naturally unpleasant to us, take the
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staged haunted house scenario ; even though we know its fictional and was created for

the purpose of scaring us and we know that we are going to be frightened when we enter

through those creaky doors.

Even with this knowledge we still react to these spaces the same way. A person’s reaction

will most likely be the same; fear , anxiety and stress. So why purposely design to hinder

and not heal? We can easily defend early architects and researchers who simply did not

know enough about designing sustainably to heal patients , however in the past two

decades healing sustainable design has come to light but is often ignored or implemented

on the most basic level due to limited funds. The reason behind this is that the architects

responsible for these Health care facilities do not use healing design concepts in their de-

signing process. However “Sustainable design and healing environment must compliment

each other.” (Mkony, 2009) . Attention must be paid throughout this process to achieve

physical comfort levels for patients , staff and surrounding communities addressing all

facets of a patients well being ; mind body and spirit (Renzi , 2001). But is this enough?

Ultimately there is a difference between being cured and being healed. According to Lin-

ton(1922) the term healing can be used to describe a deeper outcome than just curing.You

do not have to be cured to be healed. Healing is a combination of factors. “It is a system-

atic interaction between interventions and healing healthcare environments”(Mkony,2009)

The intervention is directed at the patient or the environment or both which could lead to

physical comfort reducing stress and improving their levels of anxiety which could in tern

heal them. Ultimately healing design is meant to tackle mind, body , and spirit. Thus giving

us a positive outlook and making us feel better in the environment.

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How exactly can conceptual design of a healthcare facility aid in patient recovery?

At the core, we are "unconsciously" enlisting the ecological factors' impacts on our sensory

system such as :- warmth, light, noise, smells, sensations, and our impression of move-

ment and spatial introduction emerging from the stimuli within us. “ At the level of extended

consciousness, we are simultaneously experiencing space as assembled by our sensory

system and combining this experience with memories of places similar to the one we are

in”(Eberhard, 2016). In essence our bodies’ need certain factors in order to allow it to heal

and still promote the wellbeing of the person. Conceptual design in healing environment

almost answers the needs we have as patients. The spaces we produce to patients can

essentially promote or hinder their efforts to heal quicker. A question worth asking is; how

exactly can conceptual design of a healthcare facility aid in patient recovery? To answer

this question we have to refer to the quote above from Eberhard. To put it simply, when

we walk into a space we have already conditioned ourselves into having a specific re-

sponse to it, almost like a preconceived notion. So as a designer especially in a health

care environment we have to focus our energy to almost reverse the negative connota-

tions tied to these facilities from memories and previous experiences.

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figure 1: Linton’ “hypothetical model’ showing the four variables that primarily contribute to a positive healing

environment’

Conceptual design has been proven by various architects such as Norman Foster

with the Maggie’s Centres or TAF’s work on the Carema Healthcare Centre to work hand

in hand with function.This speaks volumes about it’s importance . The term conceptual de-

sign is used to describe the non aesthetic forms of design, usually established in the initial

stages of the design process but ultimately carves out the function of form of the design

brief to come. The concept becomes the designers primary focus as every decision made

to do with the design process should comply with the concept set. The architect can es-

sentially cultivate the patients entire experience by running the whole matrix of the health-

care facility through the design process. In order to design this building one must compre-

hend the future dialect and different parts of the entire framework inside the site, climatic

setting and cultural context(Mkony 2009). So with the understanding of the above they can

create an atmosphere in which the patient isn't being greeted with an atmosphere that

adds to their stress and anxiety whilst in the facility. The design has power to counteract

these feelings by incorporating calming and relaxing elements. The design of a healing

environment is dependant on interconnectedness and quality of its performance. It’s suc-

cess relies on the patients and staff feeling supported by the architecture . The architect as

a systematic designer must understand the complexity of the design process. And that a

change in the design of one piece of the healing facility will intern influence other parts of

the system, usually in unpredictable ways.(Bertalanffy ,1969).

Case Study 1 : Alvar Aalto’s Sanatorium

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Alvar Aalto’s Tuberculosis Sanatorium of Southwest Finland in Paimio is a building in

which the architect who is very important in the History of Architecture took extreme care in

it’s conceptual design. His use of intuition in this little known field at the time produced

something truly remarkable. He believed that the building could be a “medical

instrument” ,specifically patient rooms. The arial view of the plan was described as a bro-

ken wheel, with pieces wandering off. He laid out his hospital in a branch plan , with two

main wings reaching out the North- south axis (cite sustainability website).He believed that

architecture can be a source for healing. He had addressed the importance of acknowl-

edging patients’ psychological and physiological needs as the basis for design in a talk he

gave in Oslo in 1931(cite). He had meticulously studied individual needs for each patients

room with simple design solutions in toe ,he created furnishings and specialised fixtures to

fit the patients needs. He wanted to ensure that the building itself was part of the healing

process, in these early times they believed the only known “cure” for tuberculosis was rest

in an environment that had clean air and sunshine.HIs direct response to this was creating

skylights in the lobby entrance and in operating theatres which filtered light into the Paimio

Sanatorium, he also incorporated sunning balconies on each floor of the building. To pre-

vent cross contamination, Aalto created a seamless flow that allowed weaker patients to

be able to be wheeled to these sunning balconies in their beds, and a sun deck in the roof

for healthy patients to relax and engage in a community environment amongst the staff

and patients. Aalto provided them with positive distractions in incorporating communal fa-

cilities , a chapel, staff housing, and routes through the forest landscape which both patient

and staff could enjoy allowing social interactions which proved spiritually uplifting to pa-

tients. In his design special care was given to the patients rooms. A presentation sheet

summarised the architects plans regarding patients rooms , it read “In a collective

dwelling-house (sanatorium) the private room demonstrates the individual part of the resi-

dence, sleeping, private hygiene etc. Maximum of morning-sun / minimum of afternoon-

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sun / (sun- curtain) / permanent ventilation through windows / heating by rays by ceiling

radiator (also cooler air and minimum inner air circulation in the room) / no shadow angle

under the window/lamps out of sight (sleeping) / 1⁄3 of wall area of soft wood to diminish

sounds in the room / dark ceiling colours / light wall colours / threshold and foot boards of

rubber profile.”(Heikinheimo,2016) .

The room was a standard 25 cubic meters double room. Each bedroom had spe-

cially designed furnishings that were created to cater to the patients needs. For instance

the wardrobe designs consisted of a plywood batten frame with softly rounded corners with

straight plywood panels supported by tubular profiles drawn by Lards Wiklund( Heikin-

heimo), Making for a frameless wardrobe. The general structure of the wardrobe had

been simplified. The doors panels on the side of the metal wardrobe were reinforced with

metal sheets. The sides of the wardrobe were slanted to depart from the traditional rec-

tangular design of the wooden wardrobe(Heikinheimo,2016).

Fig.2 . The wardrobes of the museum room of the former sanatorium in 2015.

Photograph Ark-byro

He also designed a night stand that was multifunctional, it acted as a cabinet and a night

stand. The unit consisted of two parts, the bottom was a closed volume with a cabinet and
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two drawers. It was framed by a tubular structure that supported a table top. It was space

conscious in the medium sized rooms and could be used separately.It’s height was also

meticulously designed to match the bed and be used as an over bed table. As well as

wheels for flexible movement for the staff.

fig3 . Bedside table for the patient room manufactured by Huonekalu- ja Rakennus- työtehdas. Photograph

Ark-byroo. 2015.

The desk that was designed for the bedroom was the only piece of furniture that could be

classified as a fixture. It was placed in front of a window. to allow the patients to be able to

read or write while enjoying the surrounding forest landscape.

The bed was finished with a tubular steel frame with curving end panels, with the

panel at the foot of the bed lower than the headboard. The beds were placed by one wall

with the end facing the wall. The bed was originally designed to provide the patients with

much needed privacy with the bent plywood. The footboard was also meant to be made
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out of plywood but was placed lower on the bed. However the design was amended and

the head board made straight to promote interaction , creating a sense of community

among the patients.

fig.4, Original bed design

Another aspect that Aalto paid great attention to in the design of the patient bed-

rooms was hygiene. He chose wash basins that were noiseless so as not to disturb the

other patient while one was washing. The wash basin was splash-less due to its 45 degree

angle between the tap and basin incorporated into the design. The spittoon was a conical

glass piece with an inward curling rim, with a 30 millimetre pipe which water ran through

designed with a right angled rotational piece. Just slightly above the wash basin were

glass shelves and above that was an overhead lamp. The rooms also had small conical

shaped wall lamp fixtures also which were specially designed by Aalto to be hygienic by

including protective glass to prevent collection of dust (Heikinheimo,2016).

Aaltos need for his building to heal meant that he understood the need for abundant nat-

ural light. Along with the sky lights and sunning balconies, Aalto also paid great attention to

the design of the windows throughout the building, especially in the patients rooms. He

designed a rectangular window that was a hybrid of steel and wood. He ultimately incorpo-
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rated the requirements necessary to fulfil the “health window” which had been the stan-

dard since the 19th century(Heikinheimo,2016).The compromise was for the large window

to not reach the floor for hygiene purposes so Aalto designed them so that the bottom

edge of each window section were level, he also changed the flooring by altering its shape

to curve upwards near the window so visually the window would look connected to the

floor.

fig.5. Photograph of newly completed patient room with light fittings, spittoon , glass shelf, noiseless

basin ,beds and convertible night stands.

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Fig.6. Photograph of large windows in patient rooms

Aalto’s final touches on the buildings interior were seen

through his choices for finishings. The colours he chose for the ceilings changed from one

room to another or one floor to the next as well as the corridor wall colour on different

floors (Heikinheimo,2016).The lobby had a fresh yellow colour on the floor, the iron win-

dows were red with pipes pipes painted in different colours according to their function

adding a decorative but still conceptually functional aspect to the design. He made sure

that the patients rooms had minimal pipes in view in exception to heating pipes.He had

also designed specialised doors for patient rooms which allowed them to communicate

whether they were in their rooms or not helping the nurses work load. Besides these Aalto

had also studied reflection of sound and attempted to create a calm acoustic environment

for the patients. The combination of the splash-free noiseless basins and the use of spe-

cialised noise cancelling wallpaper shows the architects compromise between function and

beauty.
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Ultimately if you were to ask if Aalto was successful in designing a cohesive healing envi-

ronment the answer unquestionably would be yes. Even for the 21st century's first world

standards. After reviewing his design you can certainly tell that the essential values that

dictate the patient rooms were targeted towards 1932’s standards of how they could ‘cure’

tuberculosis. His design especially in patient rooms ensured that they would have a quiet

environment, fresh air, good heating, eye friendly views and most importantly prevented

the spread of disease. The patients rooms in their entirety have a harmonious feel, he cre-

ated a space that was modern for their times. The furnishings were a result of holistic

thinking, the design solutions were accomplished through maximising space and optimis-

ing functionality through the multipurpose fittings. Aalto's standards especially for the pa-

tients rooms were aimed at the patient ,he seemed to tackle each moving piece of the

puzzle between concept and function separately, coming up with an aesthetic solution in-

dependently before incorporating it into the final product. My only criticism is that Aalto did

not do a very good job at looking at the future. Once the cure for Tuberculosis was found

in administering antibiotics use for the specialised building slowly deteriorated in the 1960s

it was converted into a general hospital, the open sunning decks were enclosed and a new

operating wing added. However recently the design was reworked with technological up-

grades to function as a rehabilitation centre for youths and children. One never assumed

that the design was tailored to make staffs lives easier, I personally believe that Aalto’s has

managed to design a sustainable healthcare facility that is viable 80 years later by collab-

orating with health care specialists and coming up with aesthetic conceptual solutions to

help heal the patients.

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Case Study 2 : Norman Foster’s Maggie Centres.

Another conceptual healing environment worth exploring is the Manchester Maggie’s Can-

cer Centre by Norman Foster. Completed in 2016 this facility focuses on not only the phys-

ical wellbeing of patients but massively prioritises the mental and emotional wellbeing of

the patient. Arranged over one storey ,the building is located at the Christie hospital in

South Manchester and much like the 17 other Maggie’s Centres around the UK and covers

1,922m²(Maggie’s at the Robert Parfett building | foster + partners, 2016).Norman Fosters

design was intended to allow the patient to “engage with the outdoors” through interaction

with the surrounding gardens and tranquil water features. (Frearson, 2014b).Norman who

is Manchester native had a first hand experience with bowel cancer and believes that ar-

chitecture has the power to lift spirits and help in the process of therapy. This outlook is

absolutely necessary for cancer treatment , the disease strips the sufferer of hope , cer-

tainty and a sense of control over their own body. Cancer patients may find the physical ,

emotional and social effects of the disease to be stressful. Due to this stress people usual-

ly attempt to manage their emotional distress with behaviours that do not encourage their

healing process such as drinking alcohol or abuse of drugs (Segerstrom SC,2004). These

are not positive coping mechanisms, and may lead to a poorer quality of life proceeding

the treatment. Paradoxically facilities designed with care such as the Maggie’s centres of-

fer relaxation and stress relieving activities that will intern work to lower their levels of de-

pression , anxiety and the symptoms resulting from their cancer treatments. Although

there is no direct evidence of a connection between stress and cancer outcomes, it is still

helpful for patients to be exposed to these stress free environments. Mainly because

patients usually have a sense of helplessness and hopelessness when the stress from

their deteriorating health due to the cancer becomes overwhelming. So exposing them to
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this sense of community with likeminded people going through similar feats in combination

with Norman’s healing design programme creates a mechanism that although not full proof

could rear them away from an unhealthy lifestyle that could ultimately lead to premature

death.

fig.7. Photograph of finished model of the Manchester Maggie Centre designed by Norman Foster.
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fig.8. Photograph of finished model of the light and airy homelike Manchester Maggie Centre designed by

Norman Foster.

The relatively simple ,symmetrical rectilinear structure is punctuated by landscaped court-

yards ,sheltered from the elements by an overhang roof. The entire structure almost looks

like an outdoor gazebo or a futuristic wooden greenhouse surrounded by garden instantly

giving us the feeling of community whilst blending into the greenery. The Interior spaces

feature malleable fabrics and wooden surfaces, the colours and sensory experience of na-

ture will over time marry itself with the aesthetic of the centre through gardens and internal

courtyards, relating the spaces within the space(ArchDaily, 2016).

The sophisticated roof is supported by slender timber beams and a timber lattice which

helps to partition the spaces. Institutional remnants such as corridors and hospital signs

were excluded in favour of home like spaces. The heart of the building is the kitchen with a

large communal table.The design also incorporates a mezzanine floor where staff offices

are located , which is beautifully lit naturally from the overheard glass roof and a beautiful

greenhouse on the South end of the building that allows for a warm inviting gathering

space for the visitors(ArchDaily, 2016). The building design within itself does not cure the

patients but plays a substantial role in healing them. For instance every treatment and

counselling room on the Eastern facade faces its own private gardens celebrating light and

nature which has proven therapeutic for patients. Within itself the building offers pro-

grammes that support sufferers and survivors . He designed bespoke furniture for each

programme that would allow comfort to be an extension of the patients experience . The

greenhouse provides a space to gather and provide positive distraction when they feel

most vulnerable(ArchDaily, 2016) . The qualified professionals on the other hand carry out

programmes to support the patients and through these they have managed to improve
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both physical and emotional wellbeing . They are accessible to the patients yet un-obstruc-

tive . Foster aimed to create an environment whereby anyone with cancer can come to the

non clinical environment for advice and a sense of community. These programmes allow

individuals to either reflect peacefully or work with their hands. Working hand in hand with

the design, the Maggie centre offers support varying from practical support in managing

stress, bereavement support, facilities that train the person to return to work after cancer,

to name a few(Frearson, 2016) .The facility also encourages emotional support through

providing spaces that provide opportunities to practice expressive art , creative writing , as

well as supporting families by talking to children about cancer and what it could mean to

their loved ones. (The architecture and design of Maggie’s Manchester, 2017). Social sup-

port comes in through activities made possible through the outdoor and indoor pro-

grammes created , these groups include gardening groups, kitchen table which provide

positive distraction and community support.

All in all the most relevant aspect of the Maggie’s Centre is the fact that the design in itself

is simple and serves its community above all else. It’s design and low carbon footprint puts

it at the forefront of sustainable design. Ultimately what drew me to this building is the fact

that it was established to provide programmes that fit in the design and are geared to-

wards positive distraction of the patients. As well as council and provides them with a

sense of community. The design has a home-based feel and allowed the patients to feel

less like they are in a healthcare facility and more like they are at home within their own

community.
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Comparisons between Case study 1 and 2

Both the buildings above encompass what a positive healing environment should be . Aal-

to focused his approach on creating a centre that was the furthest from a typical healing

environment. After an evaluation of Norman Foster’s design process and the decisions

made you can tell that the patients mental well being is of ultimate importance. The same

applying to Aalto’s work on the Sanatorium . Almost 80 years later Aalto’s intuitions are be-

ing verified, you can tell that they followed similar guidelines in the execution of their heal-

ing environments. They both focused on ease of circulation, social interaction , maximising

natural light and instilling a design programme that provided positive distraction. Their

main aim was the patients mental wellbeing first. They wanted to not only aid the in the

process of curing but also healing the patient spiritually making sure the spaces they

spend their time in will nurture them. The main difference however would be that Fosters

building aimed to mimic a home like environment which plays with the patients pschycolo-

gy and allows them to relinquish their anxiety and feel at peace. His aim was making sure

that every square inch served a purpose and or function in he grand scheme of the design.

In the double rooms although limited in space catered to the tuberculosis patients specific

needs. Ultimately they both created spaces that did not add on to patient anxiety ,Trudy

McLeay a patient of Norman Foster’s Maggies centre said "I just felt the building en-

veloped me in love. It’s bright, it’s light and the first thing you do is smile”(The architecture

and design of Maggie’s Manchester, 2016).Ultimately countering what ones response

would be when asked about how a hospital would make them feel. When most could com-

pare their health care experience as one resembling visiting a haunted house, you can see

here first hand that the building has managed to feel welcome and relaxed. This relaxation

could intern be the reason they are comfortable in the environment. Allowing them to let
26 of 35
their guards down and be stress free while receiving treatment, leading to a therapeutic

healing experience.

These two healing environments were incredible learning tools. They almost vali-

date the need for conceptual design in healthcare and wellbeing facilities. Designed up-

wards of almost upwards of 80 years apart, visually they do not have much in common.

However they have everything in common when it comes to the spirit of the design. Aalto’s

building focused more on providing function whereas Norman Foster paid more attention

to how the spaces he designed would make people feel. Ultimately they were both suc-

cessful in creating spaces that behave as a a therapeutic environment that encouraged

their patients to heal peacefully. The aim of this paper was to research a less than glam-

orous side of the design world in healing environments and learn if conceptual design can

play a role in creating a well balanced environment for a patient to heal.

27 of 35
CONCLUSION

I have come to appreciate conceptual design in healthcare because it almost takes

away the negative stigmatism attached to hospitals that evoke fear within people. Which I

believe is half the battle when trying to make people feel comfortable, cared for and im-

portant. Ultimately the goal for designers is that the negative memories tied to the haunting

experiences they had in hospitals to be replaced by positive ones. The fortunate or unfor-

tunate part of this seemingly simple equation is the patients role in their own healing. We

mustn't forget Lindon’s hypothetical models fourth quadrant which states, their will to live ,

love of life, attitude towards recovery can play the most important part in the patients re-

covery. Architects and designers can go above and beyond to ensure a positive healing

environment but if the patient is not receptive and accepting of their situation and willing to

take the necessary steps to heal, the healing environment has a possibility of not making a

positive difference.

Whether it’s through the use of specialised materials that absorb sound, addition of sky-

lights to increase natural light, or the incorporation of design programmes that encourage

social interaction and positive distraction. Going above and beyond for the patient rather

than designing around the needs of the staff without completely disregarding their needs.

At the end of the day as designers we must be aware of what effect interior design has on

people. Ultimately how we feel about the space will stay with us , whether positive or nega-

tive. So in this case understanding how neutral environments can have a desired or un-

desired effect on people is extremely essential when designing a health care facility. This

dissertation adds to a growing body of evidence that proves that the physical environment

can actively make a difference in how quickly a patient recovers from an illness. The fact is

our physical environmental factors can easily be manipulated during the design process ,

research shows that something as simple as even the colour on a wall can affect a pa-
28 of 35
tients behaviour and how comfortable they are in that environment. For instance if a room

is painted white as opposed to green research found that the person would be more willing

to disclose more information about themselves. The counselling room plays a role in the

counselling process, in tern affecting how effective the therapeutic treatment is for the pa-

tient. I feel that the only solution that can bridge the gap between understanding the needs

of health care environments and carrying out these needs in an aesthetically pleasing

manner is to do what Aalto did during the design of his health care facility in Paimio and a

marriage of Norman Fosters approach of a homelike design to have the patients feel at

ease and working closely with the health care professionals to come up with modern ,

beautiful yet sustainable design solutions that will allow the healthcare facility to have a

longevity and maintain its relevance in the design world. Another possible solution would

be to make readily available publication that has updates on the healthcare design and

basic information on how these facilities can be manipulated. Almost like a designers hand

book to Health care design this together with the implementation of simple , cost effective

and durable solutions may have a considerable impact on the health ,mental state and

wellbeing of the patient to an extent. What the most important factor here is the patient

and how they view the quality and importance of their own life, thus, showing a willingness

to live and a positive outlook on their recovery. These factors in conjunction with a positive

specialised healing environment with the staff support and care they require can effective-

ly have a considerable positive response to the health of the patient.

29 of 35

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ACKNOWLEGEMENTS

First and foremost I’d like to thank my father Dr.Moses E Mkony for inspiring me to venture

down the path of healing design and helping me understand the importance of positive

healing. I would also like to thank my tutors especially Alvaro for his support and guidance
35 of 35
throughout the construction of this dissertation. Hopefully it is an educational piece of writ-

ing that enlightens the reader as it did the writer.

Thank you