Good hospital design should not be an afterthought, a lovely and surprising bonus, or something only for new spaces that, over time through poor future planning and lack of finances, degrade to meet the poor standards of the NHS estate; it should be a basic requirement.
Every day I see staff and patients frustrated by the physical space in which health care is carried out. They are frustrated by a lack of appropriate space, bad artificial lighting and confusing signage. Clinical conversations happen in corridors because there is no space anywhere else. Patients with mobility and sensory difficulties struggle to use department entrances or find themselves lost and disoriented in a maze of similar-looking corridors.
Rather than dreaming about building beautiful new hospitals, we could manage the small everyday frustrations that add an unnecessary level of complexity to an already complex system.
The importance of well-designed healthcare environments has been recognised. Ulrich (1984) demonstrated that poorly considered environmental spaces have demonstrable negative effects on patient outcomes. Work since has made clear the harmful impact on patients and on staff (Ulrich et al, 2008; Benitez et al, 2019; Halawa et al, 2020).
Despite evidence that the design of hospital environments is important, it remains a low priority. I work in a well-resourced teaching hospital with a reputation for excellence in patient care and in research but the outpatient space where I work could not be described as a therapeutic healing environment. Out of the 31 rooms that make up this department, almost two-thirds have no windows and therefore no natural light, ventilation or connection with the external environment. Although the space is immaculately clean, it is inflexible; wayfinding is poor, and staff struggle to find appropriate spaces to work and to rest.
This is not a unique experience. Staff and patients have come to expect that NHS environments will be unpleasant. We are surprised if thought has been given to the design of a space when this surely should be what we expect as standard. Staff and patients are accustomed to spending time in an environment that few in the private sector would tolerate.
There are beautiful examples of where design has been considered in health care – just look at what has been achieved in Maggie's centres – but this should not be an exceptional luxury.
The patients I care for, in common with many patient groups, present with a variety of health needs, which include poor mobility, cognitive impairment, mental health problems and visual and auditory impairments. Poor healthcare environments impact disproportionately on people with communication difficulties. Healthcare environments need to be accessible to enormous ranges of people who will access, use and understand the space differently.
Poorly designed spaces delay, impede and frustrate visitors and staff. Although healthcare environments should be designed with users in mind, the reality is that they often develop over time as demands on space and resources, and healthcare models, change. As a result, they are often difficult to use for people with visual and auditory impairments, restrictions in mobility and for able-bodied people alike.
We need to improve the experiences of healthcare environments by evaluating patient, staff and visitor experiences; asking: ‘What does a therapeutic environment look like and how can we adapt our existing spaces and services to best fit our patients' needs?’. The COVID-19 pandemic led us to revaluate how we deliver care and use space and highlighted the inherent risks of poor hospital environmental design. We need to look at our existing spaces as well as indulging in a few jewel-like new buildings. We need to mitigate the everyday frustrations, the terrible signage, the shiny floors that look wet and slippery, the doors that are too heavy to open, that add up to make it harder for everyone to use our NHS.