Life Model  Increasingly artificial environment in healthcare  HD Journal of Healthcare Design & Development June 2004

Life model

Graham Cooper says that despite some modern artists" appreciation of hospital environments" perceived minimal appeal, the reality is spaces sorely in need of humanising.

In the Art & Architecture spring lecture William Pye, renowned for his fountains described sculpture as "transfusing with life inanimate materials like clay, stone or metal." However what chance has the orthodox designer to bring to life typically specified materials like plasterboard, ceiling tiles, vinyl floors, plastic conduit or fluorescent tubes? We are only too aware of the results in healthcare a service encapsulated by insensitive and oppressive surroundings. In retaining the legacy of workhouse-style facilities, healthcare by default has adopted an instantly recognisable design ethos. Based on the principle of patient-as-object, the institutional model is evidently harmful to the patient and damages staff morale. Even in new-build or refurbishment, there is a preponderance of low grade spaces and cubicles for rooms, an inanimate clinical backdrop masquerading as health provision. The mainstream maybe an easy target but why does such a glut of indifferent bog-standard, harshly-lit austerity meet with little criticism?

The continuous build up of medical paraphernalia installed into industrial conditions intrinsically lead to an increasingly artificial environment. The scene is open to all forms of interpretation; nevertheless the authoritarian attracts a certain perverse sentimentality, an aesthetic irony not missed on contemporary artists. The most powerful creative statement on this theme the Treatment Room by Richard Hamilton, is an installation based on the subject of ³power and control². The viewer is invited to witness a familiar patial scenario. A lone bench within an imposing diagnostic chamber dominated by a massive overhead monitor and subjected to a loop videotape of dubious political broadcasting. The empathy towards the patient¹s vulnerability is intensified by the sense of containment and disempowerment. Here the sinister scene is only an artistic creation but oddly even this setting appears idealistically minimal compared with the cluttered reality.

Association with fearful experiences is deeply rooted in us as viewers. The artist offered a mirror to everyday occurrences, opening our eyes to the daily drama. Hamilton¹s contrivance is based on the denial of the nourishment of our senses The art of architecture is also about transforming occupants¹ experience by entwining man-made assets with the phenomena of the living world. The more withdrawn and severe the subject¹s circumstances are, the greater the intolerance and desire to transform. The ornamentation and adornment of spaces or surfaces are codes and visual registrations to distract and heighten experience through appealing to the occupant¹s expectations and inner self. Deeply enclosed places require a high level of decorative attention but are frequently disenchanted, redundant places. The health service is dominated by excessive amounts of un-cherished utility spaces, and despite designers¹ attempts to change scenery, the resilient institutional profile stubbornly prevails. The image problem persists. When based on material and physical functionality, the well-meaning planning principles and guidance fail to recognise the user¹s perception and feelings. Hostility is further fuelled by sub-contractors who churn out hardware that¹s antipathetic, often ecologically unsustainable and potentially hazardous. Speeded by obsession with delivery, authorities, constructors and manufacturers alike are hell bent on widespread urbanisation. A proliferation of the means determining the ends show clearly there are countervailing forces against delivering effective and high quality mass care.

But how can the institutional fabric be unpicked? Liberation from institutional branding will be achieved by reducing the degree of artificiality. This will require dramatic dissolution from the footprint of a close cellular built structure in favour of openness and flexibility. Discouraging massing accommodation along interior and dual loaded circulation at the core will allow opportunities for geometrical form and delight at the edges. To redress the balance between the artificial and nature the barriers between the artifice and the verdant must be reduced. Consider layers of artificiality ensuring the social and the patient¹s personal space are open to the joys of daylight, with separate clinical services banished from view backstage. Part of this goal of engagement with the living world requires manufacturers to infuse life into their products and raw materials by using natural options. Flourishing at the perimeter, innovation  in the form of pavilions, conservatories, winter-gardens, gazebos, verandhas allow a controllable engagement with nature.

Encourage a symbiotic relationship through the creation of an in-between phase at the threshold between the artificial and nature. Reducing the impact of the artificial is both a two and three dimensional issue. The facades may be shiny and sleek but to improve wards and other user spaces it is better to introduce ways to modulate the experience between the enclosed and open. We also need to explore penetrating or puncturing the elevations and roof, providing a seamless passage between the exterior and inside. To provide a permeable and variable filter introduce a layering or veiling of the exterior skin. Introducing natural surfaces and exterior features within will provide a more tactile relationship with the surroundings. A fog has descended, blurring cultural and local distinctions, but speeding the oblivious spiral towards universality. The unprecedented global development of industrial materials is accelerating and current procurement programmes require built forms ³as is². Artistic expression is pre-ordained by manufacturing at large even before the designers propose it. The health service appears destined towards still further artificiality unless awareness is raised now.

Graham Cooper is chair of Art & Architecture and curator of the Nature of Healing Art Exhibition currently on tour in the UK.

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