Special report: Designing for children and young people

An in-depth look at how one leading architectural practice is changing the way we approach the design of children's hospitals

When designing children's hospitals architects must consider the whole family and create spaces that are non-institutional and which help to relieve anxiety

Increasingly we are recognising that the design of healing environments is massively important, helping to relieve anxiety and promote wellbeing and recovery among patients, staff and visitors alike.

And nowhere is this more important, or more challenging, than in paediatric services.

HOK’s London Studio has become somewhat of a specialist in the design of children’s hospitals, having worked on major projects around the world, including the Royal London, Evelina Children’s, and Great Ormond Street hospitals.

Speaking to BBH, Allison Wagner, regional director of healthcare, said: “It’s great designing spaces for children because the optimism they have is so wonderful.

“It’s about giving back to the community and making a real difference.”

But it is also a fine balancing act.

She explains: “Children and young people visiting these hospitals can be anywhere between 0-20 years of age, so key to design is that it is age appropriate.

“And, as architects, we have to remember that we are not just designing for the children who are the patients, but for their families too.

“Children rarely come to hospital by themselves. They come with their parents and their siblings. As such, we have to design for all.”

Karen Freeman, HOK’s US-based healthcare practice leader, adds: “Designing for these varying groups, creating flexibility, and understanding complexity is a challenge that stimulates innovation and creativity in the design team.

“Ultimately, in architecture and design we provide a service, and what more fulfilling service is there than designing an environment to promote healing and wellness for children?”

The practice works closely with client teams and stakeholders throughout the design process.

Ultimately, in architecture and design we provide a service, and what more fulfilling service is there than designing an environment to promote healing and wellness for children?

And, over the years, this work has led to the creation of best-practice approaches.

For example, when designing inpatient bedrooms, the practice’s philosophy is to locate the en-suites away from the door, positioning them in an area of the room that enables clear line of sight from the doorway to the patient bed space.

Wagner explains: “People in hospitals are much sicker than they would have been 10 years ago, as many more services are now provided in outpatient settings. This means staff need to be able to see them clearly.”

HOK’s design solution also divides patient bedrooms into three distinct ‘zones’. The first is the nursing area which will have a handwash basin and an area for charting or receiving supplies. There is then the ‘patient zone’ with the bed, washroom and maybe a desk area. Finally, there is the family space with seating and a bed.

The design approach is also to provide more facilities for families elsewhere on the wards.

“Designing inpatient facilities is not just about patients,” said Wagner.

“It’s about creating spaces for families when they arrive.”

“With recent schemes we are placing plenty of areas on the ward, like laundries, so parents don’t have to take dirty washing home, as well as showers and kitchens. We are also creating space in the bedrooms where they can carry on with their work to pay their bills.”

“It’s important to design in spaces so they can store personal items, work surfaces, and provide comfortable sleeping arrangements.

“For many parents, these rooms, and the hospital itself, will be home for as long as their child is there.

HOK is helping to improve outpatient environments, with a new approach to waiting areas, introducing virtual queue management, and modernising consultation spaces

“Small design interventions, such as lowering window sills, are also helping to improve views to the outside and provide a very-important link to nature.”

Traditional outpatient waiting areas have also come under scrutiny in recent years, with a shift away from children and their families sitting on rows of seats.

HOK London Studio’s design for improvements at Great Ormond Street Hospital introduced a new solution.

Wagner said: “We moved away from the traditional model of large open spaces with rows of chairs and created a less-complex patient journey.

“We provided a place of comfort to reduce anxiety and stress, giving patients the opportunity for distraction, creating a variety of spaces with a range of table and seating options for different activities to be undertaken.

“We put in family lounge zones where parents can read, work or play with their children. We also created spaces where children can watch TV, play on their computers, colour, or read books.

We try to keep children away from the inner workings of the hospital. It’s about separating entrances and circulation spaces so that the waiting areas and front of house are very calm

“And we implemented a virtual queue management system.

“Patients sign up for text notifications at the self-check-in desk. An app then shows what the waiting time will be. This gives patients the option not just to wait in the designated waiting areas, but to make use of other hospital facilities, including the new café in the hub, the discovery centre adjacent to the main entrance, or the lagoon.”

In addition, the team is using design to relieve the anxiety associated with many hospital visits.

Wagner said: “We try to keep children away from the inner workings of the hospital. It’s about separating entrances and circulation spaces so that the waiting areas and front of house are very calm.”

Zoning waiting rooms is also helping to reduce the clinical appearance of the environment and to cater for the very-wide age range of patients.

“You really don’t want a teenager sitting in a Disney-themed waiting room,” says Wagner.

“So we tend to divide spaces up, so you may have an area with computers for the older children, then somewhere with toys and games for the younger ones.”

Freeman adds: “Most medical journeys require some amount of time in waiting rooms, yet waiting can be particularly difficult for children.

“Research shows that by using positive distractions, such as sound, graphics, art, opportunities for passive and active play, and - perhaps most importantly -views to nature, we can mitigate the stressors and boredom of waiting.

With today’s competitive market to attract and retain clinical staff, it is imperative that the design of the hospital provides spaces for staff to take breaks away from patients and families

“Another example is how we address patient flow and wayfinding.

“Children are looking to their parents to guide them through unfamiliar processes and places. If a parent is stressed trying to locate their intended destination, it erodes trust in the bond between parent and child.

“A simple, easy-to-understand patient flow system allows the parent to focus on their child’s wellbeing.”

Even inside the consultation and treatment rooms, design is changing.

“We are trying to move away from that situation where you have the doctor one side of a desk and the patient the other,” said Wagner.

“It’s more of a round-table approach now and we design rooms with that in mind.”

Freeman adds: “Our ability to process information is not fully formed until our teenage years, so breaking down the medical experience into moments that can be easily understood allows children to interact with their surroundings in a more-meaningful way.

“Children are inherently more social, even when they are not feeling their best. Therefore, creating environments that promote positive social interactions, through touch, talk, and meaningful communication, can engage both patients and their families.”

HOK's London Studio (pictured) has become a specialist in the design of children’s hospitals, having worked on major projects including the Royal London, Evelina Children’s, and Great Ormond Street hospitals. Image by Chris Ansell

With patients and their families catered for; staff are also key when approaching the design of any paediatric hospital.

Freeman said: “As paediatric patients present with more-acute diagnoses and require more-complex care, there is often a multi-disciplinary team with a co-ordinated care plan treating these children. This impacts the kind of spaces we design.

“We’re seeing an increasing number of acuity-adaptable spaces to accommodate these diverse teams.”

And staff rest areas are being located off wards and in spaces with views to the outside or access to landscaped gardens.

“We try not to have nursing stations as they are traditionally known,” said Wagner.

“Instead we have areas around the ward where they can take notes, for example.

“Then we create rest areas away from the hustle and bustle where they can relax and unwind.”

Our healthcare planning and building designs support change and evolution over time by incorporating soft spaces, a regular structural and planning grid, standard room sizes, and a lift strategy that supports changes in use and work flows

She added: “With today’s competitive market to attract and retain clinical staff, it is imperative that the design of the hospital provides spaces for staff to take breaks away from patients and families.

“Treating the staff as valued members of an organisation and expending capital and resources to support them will attract workers and help prevent burnout and high turnover rates.

“At Great Ormond Street we created a staff and research hub in a self-contained element of the hospital that is dedicated to staff.

“Two interconnected floors of staff lounge and research spaces are designed to provide a discrete breakout area.

“Rather than providing these spaces in an isolated manner within each department, centralising these facilities has enabled us to develop a dynamic place that provides an opportunity for staff to retreat from the busy, high-pressure environment of clinical departments.

“A centralised space of this kind also creates wonderful opportunities for accidental collaboration and communication between teams.”

Flexibility and safety are critical, too.

“Technological progress has created new protocols for the treatment of most disease in adults and children,” said Wagner.

“This progress often substitutes minimally-invasive procedures for more-invasive ones, non-invasive ones for minimally-invasive ones, and preventative care for intervention.

“To facilitate the advances in technology, and their impact on the built environment, flexible design is our top priority.

“Our healthcare planning and building designs support change and evolution over time by incorporating soft spaces, a regular structural and planning grid, standard room sizes, and a lift strategy that supports changes in use and work flows.

“For example, at the new Royal Papworth Hospital, we strategically designed offices adjacent to the theatres.

Building design must support change and evolution over time by incorporating flexible rooms, such as those at the HOK-designed Royal Papworth Hospital. Image by Andrew Meredith

“When the trust is ready to add additional theatres and catheterisation labs, they know they have room to add capacity.

“And we placed the offices next to the façade so the building works would be less invasive to the working hospital and no departments would have to shut down during any construction period.”

And, on security, she added: “Security is an important concern in a children’s hospital.

“In our projects we have increased security by limiting the number of entrances into the wards and by having staff control access.

“We have also designed inpatient wards with lifts that only access patient floors, so children who are allowed off their wards can take a lift to go to the school room, teen lounge, or similar area without exiting the secure zone.

“Visibility into the patient room, as discussed earlier, is also critical so a clear line of sight to the patient bed is essential.”

It’s about how can we make the process as simple as possible, how can we assist the medical team and the quality of their care, how can we reduce anxiety, and ultimately how can we uplift and inspire

Freeman concludes: “Going to the doctor or being in the hospital can be a very-stressful time for children and their parents.

“I love that, through design, we can make that experience better.

“We can create whimsical, uplifting environments for the social and psychological needs of children, while also building trust and conveying clearly to parents that their children are receiving high-quality medical care.

“The importance of the patient and family experience is not to be overlooked and is at the core of our designs.

“It’s about how can we make the process as simple as possible, how can we assist the medical team and the quality of their care, how can we reduce anxiety, and ultimately how can we uplift and inspire.”

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