By Ahmad Soueid, AIA, LEED AP, Principal and Senior Vice President, HDR, Washington, DC, USA.

Designing spaces for young patients is a task full of many challenges. These environments often must meet multiple demands simultaneously. They need to inspire confidence while being flexible. They offer hope while being high performing. They must encourage playfulness while enabling excellent serious medical care. They must instill a sense of comfort for all ages while also integrating state-of-the-art technology.

For more than 20 years, we have studied best practices in caring for this special patient population. Below are key strategies to help create intentionally designed experiences throughout the continuum of paediatric care.

Design to Engage at All Levels

Engage patients and families at all levels with positive distractions. Provide space for patients and visitors including age appropriate diversion activities. Craft a design language that children and adults intuitively understand. Use form, materials, colour, and texture to develop places in which patients and their families feel a sense of belonging and a home-like atmosphere.

Keep Families in Mind

Support family members’ roles as caregivers. Emphasise space for families including family sleep rooms, family kitchens, extra storage and other spaces that allow families to continue familiar and comforting routines. Provide technology so families can connect with work, home and school and classroom spaces that give children the opportunity to continue their education throughout the treatment process.

Create Neighbourhoods

The social and privacy needs of paediatric patients are different from that of adults; so the organisation of patient units needs to respond accordingly. Paediatric inpatient units that are organised around neighbourhoods with their own identity and emotionally accessible parameters break down the scale of patient units to reduce stress in patients, families and caregivers as they focus their energies on ‘living’ in a more appropriately sized space.

Integrate Flexible Spaces

Provide added convenience for families by incorporating interactive play areas for siblings and flexible exam rooms that accommodate families. Acuity-adaptable patient rooms minimise the need for moving patients and causing disruption to families.

Consider Efficiency, Safety and Security

Enhance process through design. Minimise risk and streamline processes to improve the experience, efficiency and productivity. Use Lean Six Sigma and other process tools as well as technology to enhance the model of care.

Promote Healing Environments

Understand the human impact of design. Consider daylighting, noise control and acoustics, air quality, privacy, and social support. If possible, separate treatment areas from patient spaces to keep the patient room a safe haven. For patients with special needs, including autistic children, provide low stimulation healing environments.

In addition, take healing outside. Children need access to outdoor therapy spaces that are playful and healing, calming and rejuvenating. Outdoor healing environments such as healing gardens and activity spaces create opportunities for improved indoor/outdoor connections that minimise stress for children and families, and let kids be kids, even if they need a wheelchair to move around outdoors and indoors in a healthcare setting.

Support Caregivers

Recognise the demands we place on caregivers, acknowledge the emotional investment they make every day and provide areas for respite and recharge with natural light and consideration of circadian rhythms. Design the unit to allow nurses more time at the bedside, greater visibility throughout the unit, and quick and easy access to medication and supplies. Create highly collaborative environments to provide opportunities to enhance the knowledge transfer process among clinicians and patients, and, if appropriate, scientists.

Connect to Social Networks

Our children approach and interact with their social networks in ways never before thought possible, which means we need to create a world where being in the hospital does not mean children are separated from their circle of friends. Incorporate technology so that schools and social networks are brought into the room in full living colour, allowing participation and fostering social identity. Here, a child’s life is not “interrupted” by a clinical episode.

Footwalls play an important role in this new environment. Consider one with a screen that can switch from developing an app one minute to a dashboard of the patient’s health the next. But connectivity will be more than virtual. These networks will demand a physical presence as the hospital becomes a social space, transforming a once clinical area into a community centre. Areas on the unit should be able to host birthday parties, play dates, study sessions and the myriad of group activities that are part of everyday life.

Consider Population Health Impacts

Multidisciplinary space is also needed to support programmes that draw in social organisations, religious leaders, and educators. Activities for these groups can include personal or group religious services, or classes for adolescents and teens. Health organisations that create space and opportunities for these types of activities will find greater success in their population health initiatives and reinforce the integration of health into “normal” life for their patients and families.

Design Strategies Come to Life

These strategies can be found in the evidence-based elements that have informed the design of two paediatric facilities in the Middle East.

For the Al Maha Centre for Children & Young Adults in Al Wakrah, Qatar, we designed an environment that strives for a non-institutional, non-clinical, non-intimidating domestic ambience with a focus on developing community integration. Design features include:

• A “pin wheel” concept for inpatient units connected by a central shared hub to reinforce the neighbourhood concept
• Flexible rooms provide each child equal access to outdoor views including removable walls between adjoining rooms creating shared play area for the child residents.
• Strong reference to the traditional social and urban patterns and architectural references of the Qatar vernacular
• Internal public spaces include a centrally located mosque and are shared by both the inpatient “residences” and the outpatient day programme facilities
• Natural light filtered through decorative external shading devices to provide magical internal patterning in the facility constantly
• Splashes of colour to key areas of the building and within the bedrooms for identity and visual stimulation
• Water in the external gardens with strong visual connection from all clinical spaces for a serene, relaxing, therapeutic environment
• Soft landscaping to provide a variety of fragrances to stimulate the senses

This project was awarded a Future Healthcare Design Prize in the 2016 European Global Healthcare Design Awards.

We also provided research and design for a Child Development Centre facility in Riyadh, Saudi Arabia. The vision of the Centre is to improve the development and healing experience of children by engaging the community in a calming and collaborative environment while the mission is centred on providing the highest level of care in a fully integrated treatment and educational facility. Services include treatment of inpatients, outpatient and daycare for early intervention, autism, speech, audiology and other growth disorders.

The facility takes shape from the combination of the natural environment and vernacular architecture and materials in the region. Just like patterns are observed through Behavioral Science with the intent to redirect and change problematic patterns in paediatric development, a simple change in the formation of dunes in the desert can fundamentally change the landscape. This is a wonderful metaphor for the CDC’s work and care. Key features include:

• A Great Hall that serves as a central way-finding feature; a curved stone wall receives patients and families in an inviting and non-threatening manner
• Each specialty centre is well identified with a separate coloured entrance along the curved interior wall
• The Main Hall, in the form of a Wadi in a natural environment, also emulates a streetscape in an urban environment—providing for multiple opportunities for therapeutic exercises with children to broaden their skills
• Both indoor climate-controlled areas as well as exterior environments that are conducive to therapy, play, gathering and repose in a series of courtyards
• Access to natural light is fostered in all clinics by minimising the width and depth of the floor plates
• A hierarchy of waiting options offers a realistic simulation of daily life for the children as well as multiple safe zones for retreat should this be required