207
Enshrining Humanistic Design in the Project Plan
Ian M. Sinclair
Introduction
Understanding the therapeutic benefits of healing
architecture is an important first step in the
overall project delivery process. However, in an
environment of value engineering and fiscal
pressures to bring a project in on budget, many
of the so-called "soft" aspects of hospital design,
often become targets of the fiscal scalpel. The
holistic benefits of therapeutic design are often
poorly understood by hospital administrators
whose focus, expertise and priority is not on
humanistic design, but on efficiency of operations.
Consequently, humanistic applications of
design may suffer from the same risks as do other
related design movements such as sustainable
design, in that they are still often perceived by
senior hospital administrators and funding agencies
as "nice extras" that fall outside of the core
project objective and may not be affordable.
At risk are features that fall under the umbrella
of Humanistic Design such as: healing gardens,
walking labyrinths, spaces included not only for
art, but the artist, signature design features such
as "breathing walls" and interior decorating
schemes designed to reduced patient anxiety.
Regardless of the design teams' strong belief in
humanistic design, it will end up serving no one
if strategies are not developed to ensure that the
benefits of these design principles are passionately
understood and protected as "sacred cows"
by the most senior decision makers.
It is critical, therefore, to formally enshrine the
principles of humanistic design and therapeutic
architecture into the Capital Development
Project Plan and to then secure formal Board
approval of the plan. Specifically, three ways to
mitigate the risk to Humanistic Design
Principles are:
1. Embed Humanistic Design Principles into the
Project Mission Statement and link it directly
to the overall hospital mission statement.
2. Establish a formal Project Approval Framework
for critical elements such as the design
philosophy,
3. Establish a formal Project Communication
Structure that enables and nurtures team commitment
to Humanistic Design Principles.
Once enshrined in this manner, it is easier to
manage the inherent risks that standard project
implementation processes such as value management
impose on humanistic design elements.
A Personal Epiphany
Early in my facility-planning career, I had an
experience that highlighted for me the need to
take a formal, strategic approach to protect the
Ian Sinclair
Chief Executive Officer
Mr. Sinclair has been working for
20 years as hospital senior management
experience in a variety of positions
including, and Vice President.
He was responsible for overall planning and implementation
of a $225 million capital redevelopment
project for a hospital with a centre of excellence in the
provision of complex continuing care and rehabilitation.
He has extensive knowledge of integrating the
principles of Humanistic Design and Therapeutic
Architecture into hospital capital project. Currently
he is Vice President Planning, responsible for leading
the planning and implementation of redevelopment
Project at Bridge point Hospital redevelopment inclu-
des160 Long Term Care Beds, 388 Complex Beds
and 112 Rehabilitation.
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
International Academy for Design and Health
208
concept of human centred design throughout
the design development process. With a small
private donation, an opportunity surfaced to
help the staff on a paediatric unit to improve
upon the design of an existing but poorly utilized
outdoor paediatric play area. For a variety
of reasons, the space had been non-functional
and rarely used ever since it was created. Among
its many design anomalies was a play structure,
suitable only for healthy, able-bodied children.
Given that the patients were often connected to
IV drips or in traction, the play structure was
neither suitable nor practical. The activity areas
included tables and seating that were fixed into
the concrete patio and did not allow for wheelchair
access. And finally, the courtyard-like
space bordered by exterior nursing unit walls
with reflective glazing, was a veritable oven
during the day when sunlight bore down on the
area. Not exactly child friendly!
In response, we developed a design concept that
allowed for more of an "interactive" environment
as opposed to a "play" area, as this was not
practical given the level of patient acuity.
Instead of retaining architects for this work, we
hired a well known, local team of sculptural
artists who would help design and then deliver
a turnkey solution. Together, in consultation
with a motivated user-group, we created a truly
humanistic design solution. To mitigate exposure
to the sun, we included a connected series
of arching, metal pergolas over which vines
would grow from cedar planters to create an
overhead canopy. This not only reduced the
impact of the sun and heat, but it softened the
concrete environment and reduced the overhead
scale to one that children can feel comfortable
within. It also created fabulous shadow
interplay and became an organic base from
which to add design elements. We introduced
interactive and kinetic sculptures that could be
manipulated by children with the stroke of a
finger from a bed or a wheelchair. The sculptural
elements were made from common objects
that children could relate to, such as old wagon
wheels and metal washers that create sound and
"wobble" down a pole when inverted. We included
a variety of gentle chimes that could be engaged
by the stroke of a hand or simply from the wind.
Given that this space was adjacent to the palliative
care unit, it was intended to be a healing space
for those patients and their families also. At
night, the small white lights that lay within the
vine covered canopy created the image of a
magical labyrinth when viewed from patient
rooms above.
Unfortunately, my enthusiasm and passion for
this small but meaningful expression of humanistic
design was not universally embraced by the
key decision-makers. In fact, it was clear that this
project was not perceived as valuable to the organization
as I had assumed, relative to other organizational
priorities. As a result the project was
postponed.
It was from this defining moment, that I began to
understand the need for a more rigorous approach
to protect humanistic design principles and
highlighted the importance of creating a tangible
link between humanistic design and the achievement
of the fundamental mission of the organization.
Without that link, it would be difficult
for senior hospital decision-makers to fully
understand the benefits of humanistic design for
the organization and the community it serves.*
Interactive Hanging Chimes in the Paediatric Garden
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
209
The arching metal pergolas, creating needed shade, a child friendly scale and playful shadows
A wagon wheel with metal washers that "wobble" down when inverted
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
International Academy for Design and Health
210
Primary risks to Humanistic Design
Risk # 1: TheUltimate Decision-Makers
Who are the ultimate decision-makers for most
hospital capital development projects? Is it the
CEO or the Chair of the Planing and Building
Committee? Is it the Board of the hospital? Is
it the funding agency or a combination of these
players? How likely is it that any one of these
players fully understands the critical nature of
the design principles, philosophies and beliefs
that are regularly discussed at international
healthcare design conferences? Who primarily
attends conferences on healing architecture?
We know, and not surprisingly, that the ultimate
decision-makers rarely attend conferences on
Health and Design. For the most part, these
sessions are attended by architects, other design
professionals, senior hospital management personnel
responsible for managing large capital
projects and academics. Therefore, when we
meet to discuss and share our vision for hospital
and health care design, we are often, "speaking
to the converted." We often carry the assumption
that the value of these notions is self-evident
to all. Unfortunately, this is not always the
case and as a result, the principles of humanistic
design and therapeutic architecture are often
left exposed to great risk.
Typically, a hospital CEO is held accountable to
his/her board to deliver a "state-of-the-art"
facility that allows for future flexibility, evolving
technology, and smooth and efficient operations.
He/She is expected to ensure it is delivered
on time and on or under-budget. Rarely, I
would argue, are the principles of therapeutic
architecture on his or her list of first priorities.
Often, the CEO is under great pressure to deliver
new or expanded health care facilities for
various reasons. For example, he/she may be
anxious to add inpatient capacity to alleviate
Emergency Department gridlock. Under such
circumstances, it is never surprising that the
CEO has little sympathy for your request to
hold a two-day off-site retreat with the entire
design team to develop the fundamental guiding
principles for humanistic or therapeutic
architecture for your project!
Therefore, if the key decision-makers do not
fully comprehend the importance of these
design principles, they are at risk of becoming
victims of latter project stages and processes.
Given such common circumstances, how can
we ensure that these essential design elements
are in fact agreed upon by the design team,
senior management, the CEO and the Board
and are ultimately protected throughout the
design and implementation process?
Risk # 2: Budget and Cost Alignment
The second area of risk to humanistic design
relates to the need to manage project costs
within a specified budget. If design proceeds
without cost checks at the 30, 60, and 90%
drawing phases (as is far too often the case), and
only does so toward the end of the working
drawing stage, then the risk to humanistic
design features is greatest. The need to find
easy targets to reduce project cost is most pressing
and typically, the decision makers target
the things that they can see such as landscape
architecture, healing gardens and softer interior
design elements. Although mechanical and
electrical systems make up roughly 45 % of the
costs of any project, it is often impossible to
redesign these complex systems in an effort to
reduce costs, so late in the process.
Similarly, for projects that employ a more
enlightened approach to managing design costs
on an on-going basis through structured and
rigorous interventions such as "Value-Management"
workshops, the risks to the "softer" humanistic
design elements will be equally great.
*Footnote:
With ongoing education and perseverance, the pediatric
garden project was eventually constructed!
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
211
Risk Mitigation Strategies
Use the Project Plan to your advantage.
1. Create a Project Mission Statement
Project Mission Statements are sometimes
established in order set the overall guiding direction
for a large capital project. They must, of
course, relate directly to the overall Hospital
organizational Mission Statement. Like the hospital
Mission Statement, the Project Mission
Statement becomes the pillar upon which all project
related activity rests. If, however, the project
cannot be linked to the Hospital Mission, then, of
course, you shouldn't be doing the project!
How does the Project Mission Statement reduce the
risk to Humanistic Design Principles?
The project mission statement can be used as a
strategy to help enshrine humanistic design
principles. The key is to develop a Project
Mission Statement that is clearly linked to or is
in unambiguous alignment with the overall
Hospital Mission Statement and at the same
time reflects the value you see of humanistic
design. By doing so, you add another layer of
indisputable legitimacy to the design principles
you establish for your project. The humanistic
design principles embedded in the Project
Mission Statement will become, therefore, just
as sacrosanct as the organizations' overall
Mission Statement.
For example the Mission Statement for one
Ontario hospital is:
To be the finest hospital in Canada in the hearts and
minds of the people we serve.
The appropriately linked Project Mission
Statement created in consultation with the
design team and the hospital senior management
may be:
To design and construct a state-of -the-art
healthcare facility that embodies an agreed
upon set of humanistic design principles that is
sensitive to and respectful of the spiritual, physical
and emotional needs of all it touches.
The implementation of a humanistic design
philosophy for any capital redevelopment project
is a very tangible way for an organization to
express its Mission to its community. How better
to express to your community your commitment
to compassion and healing than creating
tangible design manifestations of your beliefs
such as:
• Walking Labyrinths for patients, staff and
visitors and that allow personal reflection and
meditation in a non-denominational, non-threatening,
and accessible environment.
• Spaces that are designed as " off -stage" safe
places, such as healing gardens solely for staff to
enable them to temporarily escape the high stress
environments they work in ("heal-the -healers").
• Design solutions that respect the dignity of
the patient, such as the relationship of the patient
bed to the hallway door.
• Enabling technologies that empower patients
to control their physical environment somewhat
while in a hospital where fear, confusion
and loss of control are paramount. (i.e. consider
patient-activated lighting controls, temperature
controls, automatic window blinds, etc).
• Introduction of operable windows to allow
patients to feel a breeze, or hear the sound of
children playing in a nearby school yard
• Views to nature and gardens.
• Introduction of soothing sounds from nature.
• Application of earth tones.
• Sustainable design solutions, such as green roofs.
Each of these examples of humanistic design
and therapeutic architecture, illustrate in a
comprehensive sense, that the organization
believes in more than just the physical needs of
patients staff and visitors, but that it passionately
cares about the holistic needs of all users
from a body, mind and spirit perspective. For
CEO's who long to "walk-the-talk", this is a
compelling application that they will support.
2. Project Approval Framework
Central to the Project Plan, is a clearly articulated
Project Approval Framework that clearly
articulates the terms of reference of various
approval bodies (See figure I).
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
International Academy for Design and Health
212
It is here that the approval relationships between
the design processes and the Board and its
committees are established. This is critical
because any elements of the Project Plan that
relate to the development of the design philosophy
will then be tied into the various ascending
levels of approval required to endorse your
overall plan. As such, therefore, you will achieve
formal approval for the design philosophy.
3. Project Communication Structure
The next logical step is then to create a Project
Communication Structure that allows for an
organized arena to discuss and integrate humanistic
design ideas. (See figure II)
Such a structure:
• Is a formally endorsed arena for developing
and discussing project activities including
Humanistic Design Principles and other design
documentation.
• Allows for on-going emphasis on Humanistic
Design issues.
• Ensures appropriately allocated budgets for
the disciplines including vulnerable design areas
such as landscape architecture and Art,
• Creates a legitimate venue for team education
and endorsement of overall Humanistic Design
Principles , thus protecting them from risks associated
with traditional Value Management Sessions
Conclusions
Humanistic Design Principles are exposed to
the risk of being eliminated or greatly minimized
in a capital project as a result of two primary
realities. Firstly, the ultimate project decision-makers
often do not always fully understand
the benefits of humanistic design given
their traditional priority is to deliver an efficient
and effective facility, delivered on time and on
budget. Secondly, humanistic design will face
The waiting areas themselves, looking up at the glazed lanterns that bring natural light
into the below grade space, highlighted by electric fireplaces.
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
213
The Peel Regional Cancer Centre in Mississauga Ontario, which highlights
glazed lanterns punching up from the radiation therapy waiting areas below.
The Credit Valley Hospital in Mississauga Ontario. The lobby's signature element is
the curved, wooden structural supports emulating a tree, obviously inspired by nature.
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
International Academy for Design and Health
214
Figure 1
on-going risk due to the need to align project
costs to the project budget. On-going emphasis
on cost-saving measures tends to threaten
easy targets such as humanistic design features.
Three strategies are suggested that will serve
to mitigate the risk to Humanistic Design
Principles:
1. Embed Humanistic Design Principles
into the Project Mission Statement and link
it directly to the overall hospital mission statement
and get it approved by the Board.
2. Establish a formal Project Approval
Framework in order to achieve formal approval
for the Design Philosophy.
3. Establish a formal Project Communication
Structure that enables and nurtures team commitment
to Humanistic Design Principles.
Together, these three strategies will serve to help
enshrine humanistic design principles and thus help
protect them from the many risks inherent in any
major capital project. We all have a responsibility
to employ these and other strategies in order to
ensure that humanistic design becomes a standard
requirement for any healthcare capital project.
ENSHRINING HUMANISTIC DESIGN IN THE PROJECT PLAN
215
Figure 2
pdf