What does a designer do when he/she has to build a paediatric hospital?
Generally, approaching the design aspect of the “Healthcare Space” – particularly in paediatrics – leads to the interaction with various regulatory contexts, even those relating to the most intimate structures of constitutional law and human dignity. It also encounters multiple requirements and regulations that inform contemporary construction work, which is increasingly oriented towards environmental and social sustainability. Being mindful and having a responsible awareness of this complexity implies a methodological approach that cannot be limited to the mere search and application of the best design, managerial, medical and functional solutions, or the celebration of a reassuring healthcare or community architecture; instead it must necessarily rely on a new project culture. The project – thus conceived, through the careful design of the spaces, the quality and the guarantee of the permanent relationship parent/child-adolescent, the application of the most advanced clinical technologies and the best conditions of room comfort and sensory stimulation – becomes the active interpreter of a great innovation process, able to impact positively the child and adolescent patient’s healthcare journey.
Therefore, this is not about facing only the technical nature of the problems – that could be resolved with the relevant technical-scientific competencies applicable to the healthcare construction field – but rather focusing the effort on listening to the needs expressed by the multiple subjects that are active in the paediatric healthcare setting every day. These are the professionals, the health workers, the patients and their families, the academic experts and the voluntary organisations. I believe that listening methodically, through the relevant instruments that can translate needs into design guidelines, is one of the most important prerequisites to create the correct functional, healthcare and architectural solutions for a hospital facility intended specifically for paediatrics.
What should you always keep in mind?
I would like to answer quoting a great paediatrician and haematologist-oncologist, who is also a friend, the Professor Giancarlo Izzi, the person in charge of the healthcare model of the children’s Hospital in Parma. He tirelessly reminded those of us who were involved in the making of this important project that, “health and sickness represent two dimensions of life; each one is reminiscent of the connotations of the other one. Therefore, the choices of design have to allow patients to experience the condition of crisis induced by the sickness and by the hospitalisation as an evolutionary challenge and a personal development. The cultural recovery of the disease, as an experience with cognitive value that forces us to confront the limits and finitude of the human condition, also includes the reappropriation of the sense of wonder towards life and the restitution of the value and the meaning of existence in its entirety”. I believe it is precisely this awareness – that one should internalise with particular conviction – that must direct our work and the professional effort of anyone approaching the responsibility of designing a new paediatric hospital facility.
How can we ensure that a hospital is, not only beautiful, but also functional for physicians and patients?
I believe it is necessary to work so that architecture can really contribute, with its quality, to the transformation of the healthcare space into a socially active structure, where you can take care of, promote, guarantee and achieve the following: the patient’s recovery, the protection of the intimate, interpersonal relationships and needs, as well as the best working conditions for all health workers and professionals. Furthermore, a strong and continuous integration and alliance with the relevant communities can be achieved, both in the scientific sector (university: academia and research) and in the territorial sector (urban, regional and national context), and in the social and associative context (functional integration and subsidiarity). In short, it is a matter of reaching an innovative design that promotes the concept of assistance, which prioritises the respect to the individual person.
What are the indicators to evaluate the quality of the work done in the design phase, in terms of the satisfaction of the families, children and clinicians?
The design phase must anticipate the achievement of both general and specific performance objectives, many of which can only be verified during the operational phase. Only after a prior definition of the main performance indicators will it be possible, in the subsequent operating phase of the paediatric hospital facility, to investigate and measure their actual efficiency, in order to mitigate and/or resolve any possible operational issue that has been identified. Performance indicators can be sought in the following different groups, although these are just examples and some factors are not limited to either one of the categories.
1. Environmental quality indicators – meaning those indicators linked to quantitative parameters. Most of them are of physical nature, thus, measurable. For example they include: the thermic and hygrometric comfort, the lighting conditions based on the individual field of vision, the acoustic comfort, measured through factors like the reverberation time or also the “speech privacy” test, and other parameters of a very similar nature.
2. Indicators to evaluate the functional and managerial efficiency – these are designed to detect, in qualitative and quantitative terms, the degree of efficiency achieved by the operations of the entire hospital complex, or parts of it. For example, in the case of the children’s Hospital in Parma it was decided to evaluate the efficiency of the proximity to the assistance functions in the emergency routes, based on the clinical protocols, as well as the patient transfer times. Another important parameter, functional and managerial but of a completely different nature, is the adequacy of the material surfaces applied to the floors and wallcoverings in relation to the time of the related sanitation and cleaning. In this specific case it was decided to limit the application of resilient floorings and wallcoverings and to apply large-format ceramic materials (stoneware) instead. This allowed to increase the durability of the materials utilised and to lower the sanitation cost, due to the reduced use of chemical cleaning products and the increased use of automated cleaning equipment.
3. Indicators to evaluate the quality of the hospitality services received by the users: the design of a new hospital, especially if meant for paediatrics, must offer high hospitality standards. There are several relevant indicators for this type of service and these can include mainly qualitative parameters, such as the user satisfaction rate with respect to the restaurant service or the entertainment offered through free access to TV channels or Wi-Fi network, or the amenities available in the inpatient room etc. This information can be obtained with the distribution of questionnaires or by facilitating the complaints procedure and making them clearer and safer.