The Person-Centered Hospital Room
PATIENT, CAREGIVER, AND VISITOR-RESPONSIVE VARIABLE-ACUITY PATIENT ROOM
Office Tornavida Design Type Concept · Theory Size 27.5 m² Year 2015‑2018
The impetus for this prototype patient room was a lecture I was invited to give in 2014 to the administrators and medical chiefs of staff of GATA, a large military hospital in Istanbul, on contemporary issues in healthcare design. In my preparatory research, I was drawn in by the way in which the "evidence" in evidence-based design conceals the agency of decision-makers, including designers, particularly their prioritization of certain issues over others.
In an article entitled "The Mislaid Architecture of Healthcare" I identify four areas in need of further attention in the design of person-centered patient rooms, and this prototype is an attempt to engage with those issues concretely. Beyond the following summary, the specific design solutions are elaborated upon in a series of annotated videos.
The primary departure from other ideal patient room proposals is a broad, glass-enclosed, secondary "corridor" which has a fivefold function. First, it is a replacement for the traditional waiting room, allowing visitors to "get away" for a time and yet remain near their loved ones. Second, it separates the circulation of visitors from that of caregivers, allowing doctors, nurses, and hospital staff to work with less disturbances, reducing employee fatigue and error rates and increasing employee efficiency and satisfaction. Third, this corridor mitigates the social isolation that single-patient rooms can entail. Fourth, it extends the perceived depth of the patient room. And fifth, at night, sliding partitions divide the space into individual cells that serve as rooms for overnight visitors, offering them a degree of privacy, security, and quiet not ordinarily available in hospitals.
The second innovation is a reconsideration of the architectural essence of each component of the patient room. Many design responses to research into the physical environments of healing have been quick to become canonized – the configuration of distributed nursing stations, for instance. While building on the accumulation of evidence-based design knowledge, the details of each of these design solutions are reassessed in the present prototype.
Indeed, the notion of patient space as autonomous rooms into which required elements are subsequently fit is rejected. The baths, for instance, are encased in solid blocks that, along with the independent headwall-footwall elements, delineate the boundaries among the private spheres of the patients on the ward. The spaces between the bathroom blocks manifest a passage from the hospital-as-workplace to the hospital-as-place-of-respite. The solidity of the blocks themselves evinces a sense of security at the moments of patients' greatest vulnerability, when they are indisposed on the toilet.
Contemporary patient rooms must accommodate the accoutrements of modern medical diagnostics, examination, monitoring, and treatment, be they computers, nursing stations, gases, electrical systems, or mobile equipment. These alien objects are planned for in meticulous detail, but many designers have then been inclined to either hide or decorate them. Conversely, the present prototype makes no effort to disguise the caregiver stations or the various utilities along the headwall. Rather, the design of each points to the architectural whole of which they are part.
The abstract idea of having separate entrances to patient rooms from a perimeter corridor was proposed by Maartje van Roosmalen in her thesis for Eindhoven University of Technology. But the details of its design are essential given the tradeoffs that the scheme entails.
The wall along the corridor is at once transparent – both to compensate for the lack of direct windows to the outside and to accommodate social interaction – but also has depth, maintaining patients' sense of being in their own space. Moreover, patients, caregivers, and visitors have control over the transparency and permeability of that barrier.
The net areas of the rooms are commensurate with current standards: 22.91 m² (246 ft²) for the patient room itself, 4.38 m² (47 ft²) for the bathroom, and 1.92 m² (21 ft²) for the vestibule and nurse's station. The per patient room area of the corridor is contingent on the desired width. At a width of 2.5 meters (as modelled in these videos), the area is 13.17 m² (142 ft²).