The importance of architecture in the healing process was recognised as far back as 350BC; the asclepieion at Epidaurus in Ancient Greece, one of the most renowned "hospitals" of the era, contained carefully controlled spaces thought of as conducive to curing both the body and the soul. But fast-forward to the 21st century and this philosophy has been all but lost, replaced with sterile corridors, artificial light and impersonal design; the patient doesn't really figure in the equation at all.
There are, however, a growing number of committed individuals seeking to change this. And one philosophy unites two particularly innovative medical projects in the UK, CircleBath hospital and Maggie's Cancer Caring Centres – the belief that architecture can contribute to the effectiveness of healthcare.
Maggie's Cancer Caring Centres
Maggie's Cancer Caring Centres were co-founded by and named after Maggie Keswick Jencks, who died of cancer in 1995. An ever-expanding network of drop-in centres, located in cities including Dundee, Fife and London and designed by luminaries such as Frank Gehry, Zaha Hadid and Rem Koolhaas, they offer support and advice to anybody that has been affected by cancer, based on Maggie's view that medical treatment for the disease is not enough.
"The design of Maggie's Centres, from the very beginning, was always a collaboration between the architects and the healthcare professionals," says Professor Robert Leonard, clinical director at Imperial College NHS Healthcare Trust and patron of the charity.
"The first centre in Edinburgh was thought out by a group of us that included Maggie, her husband Charles Jencks (an architectural consultant himself), Laura Lee (who at the time was her nurse and who is now CEO of Maggie's) and me, her doctor. We gave our vision to the potential architects."
For Leonard, it is simply common sense that a pleasant environment is going to make people feel happier. "Otherwise, why do we have architecture?" he asks. "It's a simplistic statement, but I can't give a scientific one."
This also rings true for Spencer de Grey of Foster + Partners, the lead architect for CircleBath, which opened in south-west England in March 2010. "Architecture can lift people's spirits and if their experience of a building is a positive one, that must be good for well-being," he notes. "Research has shown that people's surroundings do affect their mental state and that in turn affects their physical wellbeing, and even if these are only small increments of "betterness", everything you can do to help is really worth doing."
At CircleBath, the first hospital in the world built on a partnership model, which is co-formed, co-owned and co-run by clinicians, patients can open their windows, each with their own personal herb box, and take in spectacular views of the countryside. "All of these things are quite straightforward and obvious but they add up to making a better environment, and if the environment's better, I think people get better quicker," de Grey says.
Rory Coonan, head of architecture and design at Health Properties Management, the development arm of Circle, agrees, but stresses that the empirical evidence does not entirely convince him. "It's something I believe, but the evidence is not the most important thing about it," he explains. "Medical outcomes are influenced by many things, of which the environment of the patient is only one; yet it is good in itself to have it."
For de Grey, the importance of the patient as the "prime mover" in the design was always foremost in his mind. "'How do you make a more humane experience for the patient?' was one issue we addressed with Circle from the outset," he emphasises.
Collaboration between architects and healthcare providers was key for both projects and Coonan, the former director of architecture at the Arts Council of Great Britain, is keen to illustrate the importance of this 'iterative' process throughout CircleBath's design.
"Our architects Foster + Partners, members of staff and doctors all contributed," he says. "A design always evolves in a sideways sort of way and it's constantly iterated, changed, modified and improved. The medical professionals contributed to ensuring that doctors' and nurses' time was used efficiently. They've short circuited processes that take a long time in many hospitals and in CircleBath, for example, there's very little distance to travel between waiting for a consultation and receiving it."
Coming to healthcare afresh was a distinct advantage for Foster + Partner's head of design, who had some ideas of his own on how to bring the patient to the centre of the design.
"The use of natural light is very, very important – capturing views over the countryside and getting top light into the main central space," he explains. "That's emphasised by the way we detailed the roof lights, enhancing and exaggerating the natural light."
The clarity of the diagram also contributes to the patient's hospital experience. "You can read the building very easily, you know where you are and you don't get lost in a labyrinthine maze of corridors," de Grey continues.
This also means that the harsh labelling so often seen in medical facilities has been avoided. "Modern hospitals should not announce themselves as 'factories for the body'," Coonan explains. "CircleBath is not defined by the tools it uses. We don't have signs for 'X-ray' or 'mammography'; the tools are not the end, they are merely the means to the end."
Maggie's Centres are similarly founded on a model that is "appropriate for the needs of the patients, carers and families". "Although very different in their appearance, they have all been based on the same concept, which centres on the use of open space with the kitchen at its centre," Leonard explains.
"It's important that Maggie's Centres are seen to be separate from the healthcare environment and to an extent, of course, the emphasis on architecture is a very important component separating them from that sterile, clinical environment."
Both Zaha Hadid and Frank Gehry's Maggie's Centres were their first buildings in the UK and Leonard accepts that some may perceive the charity initiative as an exercise in architecture, rather than patient care. This is particularly pertinent now given the prestige that has been associated with the development since the centre at London's Charing Cross hospital won the 2009 Stirling Prize.
"But the board is very well aware of its responsibilities in terms of providing centres at a reasonable cost and at a reasonable rate of development commensurate with the over-riding desire to provide as many Maggie's Centres as possible across the UK over the next several years," he counters.
Healthy bank balance
A strict budget, comparable to those allotted to UK National Health Service (NHS) hospitals, was also observed throughout the CircleBath project, suggesting that as well as being applied to the several Circle projects on the horizon across the UK, de Grey's ideas could realistically be extended to a growing number of NHS hospitals in the future.
"Wherever possible we tried to use natural materials," he says. "Moreover, we saved money by having a very efficient plan formed, which meant we were then able to spend more on the finishes of the building. These fundamental points could very easily be applied to larger hospitals."
The impact of Maggie's Centres will not be quite so direct, but Leonard is convinced that the principles of the project could be implemented on a larger scale. "It is simply not possible to provide efficient clinical care within a setting based on a domestic concept," he says of Maggie's. "But we'd all like to think that the experience of medical professionals will in some way begin to affect the design of clinical facilities."
Hospitals don't have to be sterile, impersonal "factories for the body". By bringing the patient to the centre of the design, two of the most innovative healthcare projects have demonstrated that it is possible, within tight financial restraints, to create a pleasant, efficient and above all humane clinical environment based on the assumption that architecture is good for the soul.