04 Apr 2021 • Institutions
What does it take to design for truly humanized healthcare?
Laura Lee, CEO of the Maggie’s cancer support centres, explains why architectural briefs should prioritize feeling over function, what interiors can do to ease anxieties, and how flexible, open-plan environments can make patients feel empowered, rather than exposed.
‘Please be patient with us if this seems like a long preamble to the specific spatial requirements of a Maggie’s Centre. More than anything else this brief is about the feelings we need the design of these places to convey to the people who will be visiting them.’ These are some of the first words an architect reads when commissioned by Maggie’s to design one of their cancer support centres. ‘People describe our brief as very surprising and unusual,’ says CEO Laura Lee, ‘but we don’t want it to be prescriptive. We need our buildings to make people walk out more confident, reassured and relaxed than they walked in. There isn’t necessarily one way to achieve that, so we don’t have pre-conceived ideas about how the architects we approach are going to get there.’
Lee previously worked as a Clinical Nurse Specialist at the Western General Hospital, where she treated the late brainchild and founder of Maggie’s: Maggie Keswick Jencks. She worked with Maggie on the blueprint for the human-centric model of cancer care that became Maggie’s. Laura has led Maggie’s since its inception in 1995, first as Centre Director at Maggie’s Edinburgh and since 1998 as CEO.
LAURA LEE: Although we build on hospital grounds, our function differs from that of a hospital. The hospital diagnoses and treats, we support. You want hospitals to communicate that they are efficient factories that are highly technical and clinically capable. Those things can make a patient feel safe when they’re going through the technical aspect of their treatment. But then how do you also make them feel whole as a human being? A hospital can actually help represent more than the tumour that is about to be excised. I think hospital architecture often is driven by responding to the clinical team of health professionals and their technical requirements, as opposed to the patient experience. There must be a way to marry both, but it will require client consistency.
Often in the UK we are in a hurry when we decide on a hospital, but good design takes time and a lot of thinking. We as Maggie’s have the benefit of being independent. We are able to set out our own brief, budget, timeframes and perimeters in which to operate. And most importantly, we are involved from the very beginning of the process down to the selection of the toilet role holders and cutlery. We can be a consistent client, whereas with those massive hospital projects, clients can be transitional. Hospital sites tend to grow incrementally as more and more treatments and equipment become available and this can easily lead to hopelessly confusing buildings characterized by an overload of sign-posting and endless, artificially lit corridors. Such spaces are hard to negotiate for the patients that visit them, who feel small and like they are out of control. I think if a client is involved over the course of the entire process, the vision you set out with has got a better chance of being realized. I believe most hospitals start with a vision that focuses on the patient experience, but that vision often diminishes along the way.
Creating a safe space between home and hospital
Maggie’s Centres are trying to be a number of different building types. Part home, part hospital, but neither at the same time. It’s a place for the spirit that wants to stimulate curiosity and creativity like a museum does. Mostly we want to create a safe, calm, friendly and inviting space where cancer patients and their families and friends can explore their anxieties. In a hospital, patients often perform for their doctor. They put on their best outfit and lipstick and they want their doctor to feel like they are coping, that they are doing okay so their treatment doesn’t get affected. At home, there’s another role to play – of husband, parent, wife, lover, grandparent. It’s why counselling in the home space is difficult. Having a place to let those roles go for a period of time and say ‘actually I’m finding this really harsh’, having that counterpart environment, is really important.
Our interiors should look cosy, but not too cosy. They shouldn’t belittle what people are going through. Comfy chairs and cheerful paint don’t fix the brutal possibility that you could die and how that can make you feel. Yet people who are living with cancer need courage, self-confidence and resourcefulness to get on with their lives and our spaces and gardens are designed to help people draw on strengths they may think they have lost.
Balancing privacy and community
Even though our interiors are much more open compared with those in hospitals, we have never had one complaint about a lack of privacy, whereas hospitals get them all the time. I think privacy is more about the way you treat people than about the way you divide up space. Interactions can be demoralizing and we need to think about that. If you have a doctor pulling up a curtain standing at the end of the bed that you are lying down in, you are immediately intimidated. And when you place a patient in a closed-off private room where they have to push a buzzer to ask for help, you put them in the position of the demanding person. Not everyone is by nature. When as a patient you already feel vulnerable, can’t see how busy everyone is and have no idea where you are in the pecking order of demands, pushing a buzzer can actually be very stressful. Same goes for checking someone into a room. When you close the doors behind someone you immediately create a feeling of ‘this is serious now’, of ‘this consultation has gone up a notch’.
Privacy is more about the way you treat people than about the way you divide up space
We don’t even think about the chairs. Doctors are often on a swingy chair that they can raise up and lean back on, while patients are asked to take place on static, lower chairs on the other side of a desk. All those things impact the way a patient feels. Open-plan spaces where you can see other people don’t have to immediately make someone feel exposed, they can actually make someone feel safer and more empowered. If you create an environment where you can take visitors along with you, make a coffee and then find a place to talk, let them pick their own seat and maybe even reconfigure the furniture a bit, there’s immediately a different atmosphere. We want our spaces and landscapes to allow the people in them to take charge of how they want to use them.
Operating in a new reality
The role environments play in cancer support at Maggie’s was derailed by the arrival of the coronavirus. Initially, people were pleased they could still talk to a psychologist or join a support group through digital platforms, but very quickly it wore off as not being enough. There is something about the physical environment, of being seen physically, that proved essential. Face-to-face interactions are vital for our health and wellbeing. Digital as a way of providing support is not sufficient, especially now that cancer patients are having to deal with a whole new set of challenges. It’s no longer just about how cancer has impacted their lives, but how COVID-19 and the government’s decisions in handling the situation has impacted their potential of a better quality of life and chances of survival. I believe it’s going to be years until we go back to 2019’s survival rate.
Face-to-face interactions are vital for our health and wellbeing
We might all think that we can move to a digital communication life and that buildings like Maggie’s, places for people to come together, are not needed, but in fact I think COVID-19 has proven that they are essential. Hospitals in and outside of the UK are recognizing that too and are keen to see Maggie’s-type facilities rise up on their grounds.
This is a condensed version of the original interview, which featured in Frame 138. To read more of Lee's take on designing to humanize healthcare, get your copy here.
Cover image: Maggie's Centre Barts in the grounds of
St Bartholomew’s Hospital, East London, designed by Steven Holl Architects.