Many of these broad, international contemporary critiques of modern medicine came from outside of the profession. In the s and s, they raised concerns about the growing power of medical knowledge, the rise of technology and the consequent shift of patient from subject to object, and the shift towards large impersonal large institutions. Many of these works focused on psychiatric institutions for example, Goffman , but others made broader critiques of medical knowledge about the body and of clinical spaces for example, Foucault .
As a high technology space, the built environment of the hospital came physically to represent many of these wider critiques. Such ideas were undoubtedly problematic in many ways, and some contemporaries recognized them as such. Humanization was also emerging as an agenda in wider medical practice, including education, and in other architectural contexts such as workplace design.
In the UK, such trends were connected to the rise of the welfare state and its more egalitarian model of public services provision, in which the human was collective as well as individual. The NHS had inherited very diverse hospitals, with a wide range of design features and daily practices, and needed to make these serve the purposes of the entire population for the first time.
In moving towards understanding and standardizing these hospitals, the Ministry of Health and the independent King's Fund health charity commissioned several reports to understand how hospitals operated and their impact on patients. These reports, which gathered extensive feedback from staff and patients, indicate that pressure for change was not always driven by external forces.
Many of these proposed measures related to daily routines, but many others related specifically to hospital aesthetics. Humanizing medical practice and care in hospitals was inseparable from the environment in which that care took place. Overall, the concept of humanistic hospital design was inextricably interwoven with ideas about good medical care.
One was a tendency for voices from outsides the medical profession to be those calling for change, even though many medical practitioners were also receptive to these ideas. The second was a shared emphasis on putting the patient back at the centre of hospital design. While undoubtedly a simplistic construction of modern hospital medicine, and not one that was universally accepted, it had power. This context is crucial for understanding the very wide range of design factors labelled as humanistic in the late twentieth century, which at first seem to have very little in common beyond a general goal of aesthetic improvement.
The human aspects of hospital design stood together in opposition to a particular construction of modern medical practice, but they took multiple forms. This section will explore three of the different aspects of humanistic design principles, considering how they operated in opposition to three different types of modern medical practice in the UK. First, it considers the human as not-institutional; this type of humanistic space took form through the idea of human scale and modelling hospital spaces on the village or the home.
Second, it considers the human as not-technology; this humanization operated through hiding technologies and prioritizing natural sensescapes in the hospital. Reducing the scale of buildings was one important goal of humanistic architecture in the UK. It was in line with European intellectual trends, many of which situated the human in opposition to the modern and contemporary rise of large medical and other institutions for example, Foucault . Concerns about scale also reflected the problem of a growing number of hospital beds in existing buildings.
The ideal hospital scale was thus humanistic on two levels: it would give patients space and privacy within specific spaces, such as the ward, and it would be easy to navigate and familiar at an overall level.
The psychology of colour
This humanistic scale operated in opposition to a compelling stereotype of the modernist or functionalist hospital, which was commonly represented as large, intimidating and unwelcoming. Architects drew upon some international design trends in advocating for a turn to smaller scale hospitals. After a mid-century trip to Scandinavia, architect D. There were a large number of interesting points we noticed which are only possible to touch upon. Perhaps one of the most striking was the very pleasant sense of scale achieved inside the hospitals. There was an air of quiet welcoming efficiency without any trace of the institutional feeling.
We concluded that two of the reasons for this effect were the comparatively low ceiling heights … and the widespread use of naturally occurring timbers. Shaw and Petty The rise of patient as consumer was important in the UK, and linked closely with the rise of patient-centred medicine. However, models for humanistic design seemingly aligned more with Scandinavian than US trends, and drew more on the home than consumer culture.
Such models were undoubtedly not new.
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Creating a domestic atmosphere, for example, had long been an explicit goal of hospitals for the aged, dying and chronically ill. However, the reframing of domestic scale as a re humanization tool was a new conceptualization of this design goal.
In an article in Architect's Journal , Professor of Social Medicine Thomas McKeown directly linked hospital scale to new models of egalitarian community health in the UK, indicating also how the application of this concept related to wider social trends. It is noteworthy that McKeown was also well known for publications that questioned the role of medical progress in improved life expectancy, reinforcing points made above about the connection between critiques of hospitals and of general medical care.
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Weeks supported the nucleus hospital as a route to the humanistic village model:. The departments that make up a hospital community are separate parts of the organisation, yet they depend on each other … [A] hospital can have the human scale and easily remembered shape of a village if the designers try, consciously, to learn from the physical characteristics of a village.
His article was therefore an explicit re - humanization agenda, and a case for new uses of scale that went beyond the scale of individual buildings. In line with McKeown's earlier plea, this idea of the human scale operating at a community level echoed changes within health care and society.
The psychology of colour
The increasing emphasis on patient individuality was also evident in subtle shifts in humanistic design goals. By the very end of the twentieth century, human scale was increasingly broken down into different groups with different needs. In this framework, the human was a more individual one and situated in opposition to the perceived anonymity of large institutions. Devlin and Arneill note that medicine turned more towards created specialist building types in the final decades of the twentieth century. Overall, ideas about human scale operated in a range of ways in the late twentieth century, but always in opposition to institutional scale.
It produced complexes of buildings and rooms that allowed for individuality and variety, hid the true size of the hospital's operations, and were not overwhelming for patients. The human aspects of hospital design also operated in terms of aesthetics and interior design. Again, such humanistic design sought to minimize the visibility of modern medicine. It can make the hospital experience more pleasant for a wide range of users from the elderly to the very young. Examples of where colour has been used to enhance the environment include at The Everybody Centre at the Barbara Castle Way Health Centre in Blackburn, which offers health and wellbeing services for young people aged between With such a big age range to cater Designed by Boex Healthcare, colour was a key element in the interior design, helping to break up spaces and enhance mood, with each private consultation and waiting room taking on its own colour identity, giving young people a choice dependant on their mood.
The accompanying reception area and waiting room carry through the colour palette of the pods with bright hues present within wall decoration and seating. It was designed using vibrant pinks, lime greens and orange hues; while in two waiting rooms for older children at Salisbury District Hospital, darker purple and blue hues were mixed with lime green and oranges to be more age appropriate.
Dulux worked with the Dementia Services Development Centre at the University of Stirling to develop to develop paint ranges specifically for use in dementia care environments, where colour can help with wayfinding. Stirling care village creates welcoming environment with intuitive lighting control systems. Dulux Trade launches new healthcare colour palettes. Courtney Thorne contributes to Stirling dementia care centre. The psychology of colour Mar Building and Design How the use of colour in interior design can help to create healing environments Boex used rich colours to create age-appropriate relaxing areas for young people of all ages at The Everybody Centre in Blackburn.
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