Challenging Healthcare Design

21 March 2021

The new Dyson Centre, or Neonatal Intensive Care Unit (NICU) at the RUH in Bath was FCBSudios’ first venture into the Healthcare Sector. We had no pre-conceived ideas of what healthcare architecture should be and so we came with a completely fresh set of ideas about how we might help to improve the facility for both parents and care staff. Along the way, we were able to challenge assumptions about what would be possible to create a space that promotes health in every sense of the word.

The unit cares for premature babies for up to four months so it was imperative to put the babies and the families at the centre of the design. The existing unit was cramped, inefficient, dark and stressful for users and provided no privacy for parents. Our design ethos was ‘attention to emotions alongside hard edged medicine.’

We organised the spaces in a horseshoe arrangement around a central staff base where the parents could clearly see their babies progressing from critical care through to going home. This reorganisation of the space has had a very positive psychological impact on parents and staff.

The different users of the building had diverse and often conflicting needs which had to be balanced. For example, there is a range of requirements for controlling light and sound: premature babies need to be nurtured in quiet and relatively subdued lighting, but the staff and parents benefit from knowing what time of day it is and whether it is sunny or cloudy outside. None of the cot spaces are in direct sunlight and the care rooms have highly controlled lighting but the circulation spaces enjoy direct or reflected sunlight, allowing the staff and parents to stay in touch with the outside world.

We proposed a palette of natural materials, particularly the use of exposed Cross Laminated Timber, even to the critical care rooms and managed to overcome the concerns of the Infection Control Team by demonstrating the positive impact to health and well-being of exposed timber.

Careful planning of the spaces and services allowed us to create uncluttered care rooms and the exposed timber contributed to the calm and warm feeling to what are actually highly technical spaces.

Design for all the family had to be taken in to account. For example, careful consideration was given to the needs of older siblings who may feel neglected or confused. A play area is located centrally within the building where it can be passively monitored by parents and staff. Parents’ suites provide discreet bed-sits, with rooms leading on to a small external courtyard for reflection and time away from the inevitable stresses of NICU.

A research team, comprising clinicians and consultants, was established to measure the effects of the new facility on staff, parents, babies and the environment. The research staff were gathering information and collecting data even before the old unit was demolished and briefing began on the new NICU, primarily to make a case for funding the new unit. This meant they were also well-placed to provide a very clear brief and were aware of all the issues the new NICU would need to address.

The team focussed on four areas of research:

* Building Data: sound and light and energy efficiency
* Parent wellbeing and behaviour
* Infant wellbeing
* Staff wellbeing and behaviour

The tools used for the evaluation were questionnaires, interviews, cot side diaries, baby movement detection, staff tracking and light meters.

The baby movement detectors were small, self -contained wireless devices mounted on the babies’ nappies to measure breathing, restlessness and sleep patterns.

Nurses were located by wi-fi triangulation and tags. Their location information was recorded continuously throughout a 24-hour cycle and used to calculate time spent in clinical rooms, caring for babies, and in non- clinical rooms such as the nurses' station and in the coffee and milk rooms. Nurses were recorded anonymously and their locations could be viewed remotely online.

The outcome of the research shows that putting babies and their families at the heart of the design has had a significant impact on the health and wellbeing of the users.

The new unit is 8 decibels quieter than the old. It is far brighter, allowing natural daylight to penetrate the building while giving control to the care rooms and ability to dim lights during the evening. The building is more energy efficient, £50 per 100 cubic meters, compared with £80 per 100 cubic meters in the old unit.

The nurses spend on average nearly twice as much time in the clinical room looking after babies in the new unit as in the old one.

Parents reported that compared to the old unit:

* The new one feels much more spacious
* There is less interference from noise and light
* They feel more at home and less in the way
* They feel more comfortable breastfeeding

Testament to this is that 90% of babies in the new unit compared to only 64% of babies in the old unit go home breastfeeding.

The data shows that parents' anxiety levels decreased significantly with time spent in the new NICU, whereas anxiety levels increased for the parents during time spent in the old NICU. Parents now visit the new centre for an average of 30 minutes longer a day and have more positive and direct physical contact time with their babies, crucial for development and parent/baby bond.

Critically the new unit allows babies to get 20% more sleep, so desperately required for growth and development, giving them a greater chance of survival.

Design for healthcare is often driven by the technical needs of medicine. If a healthcare facility works well for clinicians the general assumption is that it will therefore meet the needs of the patients too. The emotional wellbeing of the staff, patients and families is less well-considered. Our research at the RUH serves to support the theory that accounting for the needs of the patients when planning a new healthcare building can have a positive effect on the quality of care and the mental and physical wellbeing of the building users.

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Hester Brough