Health Promoting Architecture in

St.OlavsHospital

Ragnhild Aslaksen Special Advisor Architecture and Health, Sykehusbygg HF - former Chief Architect Helsebygg Midt-Norge (building organization for St. Olavs Hospital, completed 2013) - former Associate Professor NTNU

health promoting environment

Professor Roger Ulrich at St. Olavs Hospital

EVIDENCE BASED DESIGN (EBD) Specific Design (elements or qualities) proven or indicating to support wellbeing,health, efficiency, security and reduce stress in hospitals and health faciities from commercial/illustration for blood pressure medicine

(Building performance related to specific design desicions)

«HEALING» ARCHITECTURE

normality daylight privacy control contact nature view art

«basic high quality scandinavian architecture»

New Norwegian Hospital Environment with poor experiential quality and stimulation of senses

about 1200 research reports

Professor Roger Ulrich Trondheim 2015 About evidence based design (EBD) as part of total designprocess

EXPERIENCE qualitative, subjective interpretation , description

aesthetics eksperiental sense of meaning and coherence

PERFORMANCE quantitative, objective facts, regitration technical performance building structure logistics buildings humans

ethics culture attitudes habits

systems organization flow

Hospitals and building solutions - how to understand it as a whole?

environmental - psychology antrophology

neuropsychological, neurofysiological perspektives

interaction between humans holistic and and physical phenomenological environment perspectives theory of achitecture and aesthetics

the blind men and the elephant

evidence based knowledge

users different perspectives and perception

ENTRIES OF KNOWLEDGE Designguidelines for Hospitals

70% of hospital space has no special requirements:

Interior «Upkeep»

Masterplan Landskape Building

KEEP IT NORMAL! We experience the physical environment as a whole - but we plan it in parts Strong requirements to some hospital arias - difficult to understand concequences of all design decisions

Designguidelines

St. Olavs Hospital

Emergency Wing Heart and Lung center Supply center Mobility center

Woman and Child center

Gastro center

Knowledge center

Neuro center

Laboratory center Patient Hotel Medical Research center Nursing home

• Regional hospital for Mid-Norway: 660 000 inhabitants • Local hospital for Trondheim: 270 000 inhabitants • 8000 employees (inkcl. univ) • 1000 students • About 2500 outpatient visits a day • About 750 patientrooms • Integrated University Hospital • Patientperspective • Sustainability • 7 «Organ based» clinical centers • 3 non clinical, «support» centers • Patienthotel • Urban Block Structure • Public streets, parks, gardens • 220 000 sqm • 10200 rooms • Construction time 2000 – 2014 • Construction 9 cost 12.7 mrd Nkr

sustainable localization St. Olavs Hospital 2010

• Close to citycenter and university • Optimum accessability and access to public transportation and service • About 80% of staff transport is public or by feet or bicycle

SUSTAINABLE CITY DEVELOPMENT - concept of development “BUILD - DEMOLISH – OPERATE” The new university clinic is built in stages around the old hospital which remains in full operation. When the building process was over, the last hospital buildings torn down liberated over 60 000 m2 spare area centrally located in the hospital plan.

>98% recycled or recovered

of

«medical part town» new public space Olav Kyrres plass

«medical neighborhood» Central Square

”medical neighborhood” – new public areas Women-Children Centre cafeteria

«medical neighborhood»

Laboratorycenter - bloodbank

28. sep. 2016

“medical part of town” 19 St. Olav 2012

“medical part of town” St. Olav 2012

GREEN HOSPITAL - therapeutic gardens

21

principle medical centre/urban block

4th, 5th, and 6th floor: Wards, offices. 3rd floor: technical services over medical functions requiring technology, connecting bridge, research 2nd floor: treatment connecting bridge, theatre, radiology, recovery. Ground floor: Polyclinics, day areas, cafeteria, kitchen for the centre, auditoria, rental areas.

20% of footprint as green space

plan - principles

Basement: technical underground passages between centres, technical functions, bed equipment stores, locker rooms and sanitation.

Traditional norwegian

”tun” (town); - protected space enclosed by a cluster of buildings

Visual contact between street entrance and private garden, Mobility center 28. sep. 2016

26

SPACE for HEALTH private gardens, Mobility center

Semi private gardens, Women and Children Centre

Semi private gardens, Women and Children Centre

semi private gardens, Laboratory Centre

Daylight and view for rehabilitation, Spinal unit

«room with a wiev» isolation room, Neurocenter

the patient perspective to read, understand and design the hospital environment from the patient`s point of view

Including the Patient Perspective in the hospital design:  Patient participation  Knowledge based design Multidiciplinary knowledge of interaction between humans and physical environments (including “evidence based design”)

MAKE THE HOSPITAL MORE HUMAN

Norwegian organization democracy User participation

whose space is it?

patient/family

patient participation

technical operation

clinical operation teaching/university

– more than 140 patient organizations meet in one common unit – participate at most levels of planning and design

staff participation

– more than 1000 participants principal groups of users represented in the hospital

at all levels of planning and design

Patient participation - main issues: Stronger protection of privacy during hospital stay - Singe patient rooms (first public hospital in Norway) Easy access to staff - Open receptions etc.

Involving patient organizations - Training is needed to act professional and represent the patient perspective

Accessibility for all users/patient groups - Universal design

’evidence based design’ – Roger Ulrich Evidence based design (Roger Ulrich) - patients need:  a feeling of control  easily available personell contact  contact to nature and other factors which yield a positive experience to engage patients attention in a positive way, art  daylight ans sunlight  positive sound(water, naturesounds,music), absence of noice Single rooms to ensure patient control, privacy and contact with next or kin. NATURE, SENSES EVIDENCE BASED DESIGN Specific Design (elements or qualities) proven to support wellbeing, health, efficiency and security in hospitals

EQUALITY, CONTACT

PRIVACY, VIEWS, ART, NATURE

Weak protection of private space in traditional hospitals

Patient perspective – protecting privacy, single rooms for all patients

LAYERS OF BOUNDARIES:

TERRITORY

body - senses Biological, multisensory visual, sound, smell, temperature, touch

PERSONAL body SENSES

personal /intimate emotional - ”bubble” surrounding the body

territory geografical - defined with walls, objects, signs, cluttering, etc.

PRIVACY = control of boundaries - prequisite for feeling of safety

Traditional closed reception - contact and confidentiality is challenged

Space for contact - ward pods with open work stations

THE PATIENT PERSPECTIVE – open receptions and counters Openness and equality

Nevroscience -

unconcious reactions «intelligence of senses and emotion»

support positive stimulation – fight negative stimulation

DO NOT SCARE THE PATIENTS! - establish stress-free zones in the hospital!

Lars Heslet og Kim DirknickHolmfeld, Arkitektens Forlag 2007

«Hospital of the Senses» - Wide collection of knowledge about how hospital architecture influences our health and wellbeeing though stimulation of the senses

delivery room - old hospital

neonatal unit - old hospital

NEED OF «soft» surfaces and materials, textiles, art soft acuostics, • • • • •

SPACE FOR CONTACT

RELAXED ATHMOSPHERE ”SLOW SPACE”

CONFLICT infection control cleaning efficiency maintanance hospital culture architecture trends

NORMALITY

WOOD & ART miracle cure for hospital interior

”slow space” Nevrosenteret 06.08.06

Natural materials and art - Neurocenter

Traditional ICU - multi-occupancy, technology focus

St. Olavs Hospital CentraI ICU – single occupancy, natural materials, daylight and view

way finding and identity of place

Form, colour, will free your patient from his painful ideas better than any argument” Florence Nightingale, Notes on Nursing, 1859

Art at St. Olavs Hospital

VISUAL VITAMINS  Budget ca 60 mill Nkr (0,5% total budget).  More than 2200 pieces of art  More that 60 % of the Art is integrated in the building or landskape All patient rooms, wards, entrances, public space, parks, waiting areas, restaurants, conference rooms, auditoriums and meeting rooms is decorated.

INTEGRATED ART «visual vitamin» at ward, Gastro center

INTEGRATED ART «visual vitamin» at Maternity ward

The Knowledgecenter – exterior from the plaza and interior from the library

Integrated «wood art» in isolation room, infection unit, Knowledgecenter

OUTCOME New St. Olavs Hospital

«anecdotal»

«hard facts» experience

performance

more than 30%

rise in hospital production (activity) since 2010 with roughly same amount of staff ”The difference between the new and the old hospital is like heaven and hell” Father of fatally ill child to Dagbladet 04 jun 06

(numbers from 2014)

Norsk Forms hederspris, Trondheim Kommunes Byggeskikkspris, Årets bygg, Health Building World Architecture festival, Murprisen, Norsk bolig og byplan pris, Hovedpris Norsk Designråd Universell Utforming 2015, Attraktiv by 2015,…………………………………….

Design @ Health World Conference Toronto 2014 St. Olavs Hospital achieves 7 of 10 prices for Health Promoting Design

THANK YOU!