“Cure sometimes, treat often, comfort always.” — Hippocrates
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PREFACE 0 1
Introduction
BACKGROUND 0 4
The History of Hospitals
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Experience Modern Hospitals
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The Healing Process
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Conclusion
the healing places for people from ancient Greece to nowadays the unpleasant factors that affect our experiences in modern hospitals what is holistic healing, and what supplements does it require
CASE STUDIES 2 5
The Criteria
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New Venice Hospital
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Prentice Women’s Hospital
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Orbis Medisch Centrum
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RESEARCH SUMMARY PROJECT FRAMEWORK Project Site Karet Tengsin, Jakarta, Indonesia
Cancer patient, Jennifer Merendino, applying makeup before celebrating the wedding anniversary of her husband’s parents.a
[The Ecology of Healing Place] TABLE OF CONTENT
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Project Rational
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Project Objectives
5 1 END NOTES 0
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Intro
What is the image in people’s mind when they think of a hospital? Beeping noise from the machines, funky smells throughout the hallway and rooms, too much artificial lighting but too little sunshine, nurses busy walking around with straight faces, no place to sit or stand…. It is common for people to think that visiting a hospital is stressful and dangerous, not only for families and staff members but also for patients. According to the Institute of Medicine in its landmark Quality Chasm Report (2001), “the frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits.” Hospitals in general have failed to be the healing space for people. A hospital that only fulfill patients’ and physicians’ physical needs is not enough for promoting health. Psychosocial and spiritual supports are also important for the service and wellbeing. However, the reality is when it comes to healthcare design, architecture is rarely focused on psychology and the psychosocial prospect. Somehow the design all too often loses its considerable manipulative power as it becomes 0
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subservient to its parts: structure, models of care, functional programs, efficiencies, infection control. How can design be used to provide a thorough healing experience for the patients? The possibilities shall be explored. A space that can heal is not an absurd concept. The notion of healing space dates back to ancient Greece. Nowadays it is further proven by scientists and psychologists. In 1974, Aaron Antonovsky introduced the “salutogenic model” of health and suggests that, it is more important to focus on people’s resources and capacity to create health than the traditional focus on risks, ill health, and disease. Antonovsky’s theory implies that a healing space should provide people with a sense of coherence. The sense of coherence is complemented by both the material and non-material quality of the place. Meanwhile scientists in different disciplines have carried out studies to identify the factors that help with the rehabilitation process. These studies further recognize the resources that we can take advantage of to create health and promote healing. Architects have the responsibility to identify these resources in spaces. Empathic pioneering architects around the world have already been designing hospitals that are forming new standards for medical designs. From promoting single-bed patient rooms to implementing green open spaces [M.Arch.] Jamie Lu
Patrick F. Tobin recorded his second stay in hospital with photography.b
and social spaces in hospitals, changes have been made to create harmonious communities inside hospitals. Yet hospitals are still isolated from the rest of the city. The vacuum around the hospital building cuts off the flow of social resources from the city. The ignorance of its context also affects the behaviors of the patients in the hospitals as being removed from their familiar environment. The research tries to identify an ecological system for hospitals in urban settings that harvests the resources for health inside and outside the hospital building. Inward, this system identifies the needs of the patients, harmonizing their relationship with the physical environment and the caregivers. Outward, the system recognizes its context and links to the city in a more active manner. Together, the resources flow in and out of the building and transform into a thorough healing experience for the patients. In this research, I will first explore the history of the hospital in order to understand its situation today. The patient experience is at the center of all considerations in the research; however, caregivers’ experience is also included since it directly influence the quality of the healing process. In order to comprehend the definition of healing, the research relies heavily on the method of literature review. A large amount of my resources is from studies on medical design by sociologists and psychologists. Technical issues are regarded with less importance here, which can be a drawback for this research.
[The Ecology of Healing Place] INTRODUCTION
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Background
It’s likely that since the beginning of humankind people have been looking for safe and clean shelter in which to heal. When there were little was known about the human body, not too much could be done to treat the physical causes of illness or injury, so a safe and supportive environment where natural or supernatural forces could aid the recuperative process was vital. Nowadays our understanding of healing processes has deepened enough for us to design and build healing spaces with restorative effects.
• The History of Healing Place • Experience the Hospitals • The Process of Healing • Conclusion
[The Ecology of Healing Place] BACKGROUND
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THE HISTORY OF HEALING PLACE
• The Healing Temples • Christianity and Hospitals • The Modern Hospitals
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The Healing Temples in Ancient Greece and Rome In ancient cultures, religion and medicine were linked. An asclepeion was a healing temple found in Greece and Rome, sacred to the god Asclepius. The Greek healing cult of Asclepius, of great importance to the metaphysically minded, is worthy of most careful consideration. The healing process was a mixture of religious ceremony and health practices — especially diet, water, herbs and exercise. In an asclepeion, treatments for the sick included mud baths, special diet, exercise, stress relief, and exposure to the sun. As part of the healing process, “sacred water” from a spring and The archaeological a well was regarded with healing site of Epidaurus, power, and it was used for bathing
and drinking. 1 Asclepeions provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing.2 The Asclepeion at Epidaurus was a classical prototype of such – within the place, there were bathing establishments, gymnasium, libraries, sleeping porches for guests, a theater, and the temple proper.3 The composition of the healing place sheltered the Greek’s health – not only their physical condition, but also their psychological and spiritual state.
Argolis, Greece.d
Christianity and the Creation of Hospitals During the medieval time, hospitals were greatly attached to monasteries. They were religious communities, with care provided by monks and nuns. The Hospital of St. John in Jerusalem reflected and elaborated on the values found in the earlier monastic history of Christian hospitals. The establishment was The first hospital equipped with baths, rooms for of the Sovereign bloodletting and shaving, and several Military Order of St. kitchens, and was even provided with John in Jerusalem, 1080.e animal pens.4
The hospital … in which in various houses a great crowd of sick people is collected, some of them men and some women. They are cared for and every day fed at vast expense. When I was present, I learned from the servants that their whole number amounted to two thousand. Between night and day there were sometimes more than fifty corpses carried out, but again and again there were new people admitted, wrote the German pilgrim John of Würzburg in about the year 1660, the house feeds so many individuals outside and within, and it gives so huge an amount of alms to poor people, either those who come to the door, or those who remain outside, that certainly the total expenses can in no way be counted, even by the managers and dispensers of this house. – Description of the Holy Land by John of Würzburg5
[The Ecology of Healing Place] BACKGROUND
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The Eight Stages of Patient Flow
The Eight Stages of Patient Flow
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The Modern Hospitals
The origin of the word hospital shows that hospitals were not primarily places for the sick. Originally, hospital meant to be a place where strangers or visitors were received; in the course of time, its use became restricted to institutions for the care of the sick. Modern hospitals started to appear under the influence of the Enlightenment Movement in the eighteenth century. Trained physicians and surgeons replaced the monks and nuns, and hospitals became places only for medical needs. The goal was to use modern methods to cure patients. The practice of medical treatment changed in the face of rapid advances in science. The analysis of patients’ symptoms in diagnosis became more and more systematic. In turn, within the hospitals, acute cases were increasingly treated alone, and separate departments were set up for different categories of patients. Meanwhile, some hospitals in Europe began to evolve from being basic places of care for the sick to becoming centers of medical innovation and discovery. Hospitals are Aerial view of Royal no longer homes to refuge Melbourne Hospital in but complex institutions for Parkville, Melbourne, Australia.f the provision of medicine and
[The Ecology of Healing Place] BACKGROUND
care for sick in the society. A program of visiting hours for friend and family was thus introduced to better serve the patients. In the mid-nineteenth century, hospitals and the medical profession became more professionalized, with a reorganization of hospital management along more bureaucratic and administrative lines.6 Inside hospitals, vertical or horizontal complexes are linked by a maze of corridors, tunnels, and bridges. A hospital’s internal spatial organization has traditionally been shaped by its function. From simple dormitories adjacent to churches, hospitals redefined and successively fragmented their interiors into wards, private rooms, nursing stations, operating and examining facilities, laboratory and radiology areas, and intensive care and neonatal units. From their inception, hospitals were organized according to official sets of rules first borrowed from monastic models of discipline and later adapted to lay schemes designed to ensure the social control of inmates.7 Jobs by nurses, physicians, and others in modern hospitals often require a complex choreography of direct patient care, critical communication, charting, filling medications, and access to technology and information. For patients, hospitals are no longer a place to wait for death, but a place devoted to recuperation and healing. Under the supervision of the administration department, while a standard workflow for caregivers to follow had been formed, patient flow became simplified and consistent as well.
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Yet as the situation changes, many hospitals’ settings have not been rethought, and, as a result, the design of hospitals often increase people’s stress and reduces their effectiveness in receiving care.8
• The General Experience • The Staff Experience • The Patient Experience
Experience the Modern Hospital
umpleasant factors that can slow down the healing process
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THE GENERAL EXPERIENCE NOISE Medical equipment and staff voices often produce 70 dB to 75 dB levels measured at the patient’s head, which approach the noise level in a busy restaurant. Noises from alarms and certain equipment exceed 90 dB (for example, portable X-ray machine), which is comparable to walking next to a busy highway when a motorcycle or large truck passes. The research review suggests that hospitals are excessively noisy for two general reasons. First, noise sources are numerous, often unnecessarily so, and many are loud. Welldocumented examples include paging systems, alarms, bed-rails moved up/down, telephones, staff voices, ice machines, pneumatic tubes, trolleys, and noises generated by roommates. Second, environmental surfaces – floors, walls, ceilings – usually are hard and sound-reflecting, not sound-absorbing, creating poor acoustic conditions. Sound-reflecting surfaces cause noise to propagate considerable distances, traveling down corridors and into patient rooms, and adversely affecting patients and staff over larger areas. 9
AIR QUALITY Unclean air is probably the biggest enemy of healing, since air can flow around freely. Insufficient ventilation and lack of opening create dead air, which traps the smell of sanitation, human odor and the smell of food in the patient’s living area, as well as bacteria that can be passed around in the air. It decreases the quality of the environment and can affect the amount of social support the patients receive. LIGHTING QUALITY The lack of openings also reduces the amount of natural light people receive in hospitals. The overuse of artificial light is also a problem when patient don’t have control the amount of light in their room. Moreover, when the light is too dim, mistakes increase for the caregivers. ISOLATION Modern hospitals are usually buffered with green belts, in better cases, or huge amount of parking lots. Inside the buffers, buildings that are out of scale both in vertical and horizontal direction, together with its puzzled system of network, disconnect the medical service from the rest of the city, but create its own world.
THE STAFF EXPERIENCE INEFFICIENCY Nurses spend a lot of time walking, which includes the time to locate and gather supplies and equipment and to find other staff members. One study found that 28.9% of nursing staff time was spent walking. This came second only to patient-care activities, which accounted for 56.9% of staff time.10 Unnecessary walking leads to a waste of precious staff time and adds to fatigue and stress among staff. STRESS Hospital environments are filled with stressful scenes: blaring alarms, beeping machines, busy monitors, and endless tubes and wires all vie for doctors’ and nurses’ attention and overload their senses. When worse enough the staff would start to ignore the constant Photographer Rick Davis’s photo showing cacophony of alarm sirens and miss the 11 a busy in a medical signals sent by patients.
[The Ecology of Healing Place] BACKGROUND
center.g
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THE PATIENT EXPERIENCE LONELINESS & ABSENCE OF FAMILY Hospitals were created for the sick ones. Their exclusive function and the danger of infection often isolate them from the city, therefore isolating the inpatients from society and their families. The absence of family and social support makes a more severe impact for the patient’s psychological condition than normal people because of the fear of illness that they are already facing. PRIVACY & CONFIDENTIALITY Patient privacy in hospitals can be elusive. Doctors knock on the doors of exam rooms and wards to signal that they are about to enter – not to ask permission. Yet we expect some degree of privacy in hospitals. Patients trust the doctors with their secrets since it is reinforced by laws for the doctors to respect the patients’ privacy, but a lot of times the spatial configuration in hospitals can make it very hard for both sides to sustain their trust in each other. In multi-bed wards especially, the presence of other patients and their families can become a disturbance for the intimate moments between the doctor and his patient. When the doctors’ working area are too close to the public areas, there’s a danger for the conversations among doctors to be overheard by other people and create rumors.12 A more current threat on patients’ privacy is the installation of secret cameras in a few hospitals. The action of installing cameras in private spaces, as the doctors explain, is for the prevention or in-time reaction to bad circumstances that may happen to patients.13 Although the intent is good, it denies the patient’s other Kristin waiting for identities in society other than her first birth at Southview Maternity being a weak man who must rely Center, Dayton, OH.h on the hospital to survive.
[The Ecology of Healing Place] BACKGROUND
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• Defination of Healing • Self & Healing • Environment & Healing • Human Relationship & Healing
Understanding The Healing Process
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DEFINATION OF HEALING To heal means to make whole, to make healthy again. There are two ways to define health: the biomedical and the holistic. From the biomedical viewpoint, health is considered to be a condition without disease, which has been the leading perspective in the field of modern health care.14 The doctor has to abstract the patient to basic symptoms in order to identify the diseases. The doctor is required to study anatomy to understand the internal structure of our human bodies; “but only in order to subtract them.” Healing Sanctuary at Envision Festival Healing has become a process of killing 2013, Costa Rica. i microscopic invaders with synthesized drugs. The holistic viewpoint emphasizes on multidimensions of health, including the physical, psychological, emotional, spiritual and social. Holistic healing focuses on reaching a higher level of wellness than eliminating symptoms. Since a holistic healing process takes commitment from the patients themselves as well as passive treatments from caregivers, to promote the patient’s self-motivation toward wellness is rather important in this perspective.
[The Ecology of Healing Place] BACKGROUND
terminology: holism The notion of holistic health can be dated back to ancient India, China and Greek culture, but the term “holism” was not introduced until 1926 by Jan Christiaan Smuts as a way of viewing living things as “entities greater than and different from the sum of their parts.”
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“It is more important to know what sort of person has a disease than to know what sort of disease a person has.” — Hippocrates
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SELF & HEALING AUTONOMY Patients should have the right to self-rule or self-determination during the process. CULTURE Culture values and beliefs can influence patients’ illness perception, care seeking, and acceptance of caregivers.15 LIFESTYLE The various lifestyle of each individual impacts his/her health statues and re-covery process. We all have inherent abilities to recover ourselves with our own immune system. If a patient can have a sufficient amount of activity every day, a balanced diet and enough sunshine during their stay in the hospital, he is more likely to recover in a shorter term and with more prominent results. Jennifer Merendino gazes out the window of her hospital room.a
Conceptual Framework of Nightingale’s Environmental Theory
ENVIRONMENT & HEALING “What nursing has to do… is to put the patient in the best condition for nature to act upon him.” – Florence Nightingale
FLORENCE NIGHTINGALE, THE ENVIRONMENTAL THEORY The positive effects of space and the environment have been well known in the era before science. In the nineteenth century, by observing differences in survival rate, Florence Nightingale recognized that many factors in the hospital environment could pose a negative impact on patient health. The physical environment is stressed by Nightingale in her writing. Nightingale’s writings reflect a community health model in which all that surrounds human beings is considered in relation to their state of health.16
[The Ecology of Healing Place]
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Why Physical Environment can Affect the Process of Healing? “During the healing process, communication between the brain and the immune system is vital. Besides bringing in new cells to help fight germs, molecules released by immune cells during infections also travel to the brain and change the way it functions. One of the things immune molecules do when we are sick is wipe out memory of our surroundings. The part of the brain that focuses on sensations from our inner organs becomes more active, and the part that focuses on the outer world shuts down. So we become exquisitely sensitive to internal signals from our throat or stomach or lungs, and acutely aware of every breath or twinge, and we lose interest in any thing beyond the self. The brain, in turn, sends its own signals to immune cells— hormones and nerve chemicals that can tune up or tune down the ability of immune cells to fight disease. There are many things that can influence the release of these chemical signals from the brain, and our surroundings play a very important part.” – Dr. Esther Sternberg, Healing spaces: The Science of Place and Well-being
Factors in the Physical Environment that can Affect the Healing Process When exhausted and frustrated, people appear to have the following needs for restoration and recreation: 1) The need of being away from everyday life and its surrounding sounds, routines, crowding, etc. 2) The need for designating stimuli that effortlessly stimulate the individual and diminish the risk of becoming bored.17 Positive distractions refer to a small set of environmental features or conditions that have been found by research to effectively reduce stress help healing. Distractions can include certain types of music, companion animals such as dogs or cats, laughter or comedy, certain art, and especially nature.18 Several studies have confirmed that human beings perceive natural environments as more
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restorative than urban environments.19 Being in nature or having a view to nature can reduce people’s stress as well as pain. Regarding art, results suggest a consistent pattern wherein the great majority of patients respond positively to representational nature art and other emotionally appropriate art, but many react negatively to chaotic abstract art.20 Studies also showed that daylight has positive effects on humans’ psychological wellbeing. A lack of daylight can lead to both physiological and psychological difficulties. For instance, one research group studied the impact of the amount of natural light on the length of hospitalization of patients with unipolar and bipolar disorder. The researchers found that bipolar patients randomly assigned to the brighter, eastern rooms (exposed to direct sunlight in the morning) had a mean 3.67-day shorter hospital stay than patients in
[M.Arch.] Jamie Lu
west-facing rooms.21 Some other studies showed that an individual’s general satisfaction was higher when they had the ability to control the lighting levels themselves, which also can decrease their energy consumption.22 Adequate ventilation is extremely important to ensure both staff and patient safety in hospitals. It is considered one of the most effective environmental measures to reduce the risk of spread of infections in healthcare settings. Colors can possibly affect the brain’s activity and create a sense of wellbeing and originality within architecture. Warm colors are considered to have an activating affect, while the cold colors are considered to have a calm affect.23 There are also geographical, cultural and historical factors that can influence a person’s color choice.24 The
[The Ecology of Healing Place] BACKGROUND
color in a space should suit the contextual environment, and it is important that color activation be well balanced to fit the environment.
The Crown Sky Garden in Chicago Children’s Hospital, designed by Ann & Robert H. Lurie .j
Navigation problems in hospitals are costly and stressful and have particular impacts on outpatients and visitors, who are often unfamiliar with the hospital and are otherwise stressed and disoriented. Creating landmarks inside the buildings can help with the situation. Landmarks can serve as reference points for the patients in the buildings for easy orientation and creating cognitive maps of environment, therefore reduce their stress caused by unfamiliarity to the place.25 The overall structure of the system of rooms and corridors can also impact the paths people take since people tend to move toward spaces and through corridors that are more accessible from a greater number of spaces.
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How ventilation works.k
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Environmental interventions that have proven especially effective for reducing noise and improving acoustics in hospital settings include: installing high-performance soundabsorbing ceiling tiles, eliminating or reducing noise sources (for example, adopting a noiseless paging system), and providing single-bed rather than multi-bed rooms. In general, studies of the effectiveness of noise-reduction measures suggest that environmental or Natural Ventilation for Infection Control in Health-care Settings, design interventions are more by World Health Orgnization successful than organizational Publication/Guidline. interventions such as staff
[The Ecology of Healing Place] BACKGROUND
education or establishing quiet hours.26 Studies showed that the design of the physical environment sternly impacts hospital-acquired infection rates by affecting both airborne and contact transmission routes. Infection rates are lower when there is very good air quality and patients are in single-bed rather than multi-bed rooms. Also, some evidence shows that providing numerous, easily accessible alcohol-based hand-rub dispensers or hand washing sinks can increase hand washing compliance and thereby reduce contact contamination.
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Family leaving the hospital.h
HUMAN RELATIONSHIP & HEALING SOCIAL SUPPORT Many studies of several different categories of patients have indicated that social support reduces stress and improves, for example, recovery outcomes in myocardial infarction patients. For example, Edvardsson’s research showed that healthcare environments that are welcoming and that create space for social meeting affect patients by making them receptive to rehabilitation. The research also showed that it was easier for patients, visitors, relatives and personnel to relax, follow their own rhythm and feel secure and safe in these kinds of settings.27 Crowding is closely linked to social support. It is a condition where a person’s private sphere is trespassed.28A balance between social interaction and desired loneliness can be regulated and achieved if one can control his/her own Spatial sequence & self-autonomy.l levels of social interaction. PATIENTS WITH PHYSICIANS/NURSES Modern hospitals rely on technologies to treat patients. A downside of the method is
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that patients become categorized based on their diagnosed symptoms. Through the pathological trainings provided in medical schools, doctors can abstract their patients to simplified facts. This notion changes the way that the doctor unconsciously interacts with his patient. If the physical setting of a hospital is so organized and uniformed that it visually mimics a producing line in a factory, patients can feel like they are placed in the environment as objects. The absence of dignity can eliminate their hope and make them feel pessimistic about their future. Good staff communication helps reduce patient and family anxiety, promotes better care at home after discharge, and in other ways improves outcomes. Data obtained from more than two million patients in the U.S. in 2003 show that inpatients consistently report remarkably higher satisfaction with communication from nurses and doctors when they are in single-bed wards compared to when they have roommates. RELATIONSHIP AMONG PATIENTS Patients does not always provide each other with stress-reducing social support. While some patients find that roommates provide comforting social support, results from several studies indicate that the presence of a roommate usually is a source of stress rather than social support. In most cases, roommates are linked to stress such as loss of privacy or having a roommate who is unfriendly, has too many visitors, or is seriously ill.30
The presence of family members can reduce patients’ anxiety and stress. In two of his books on humans, Charles Darwin argued for “the greater strength of the social or maternal instincts than that of any other instinct or motive.”31 In this part of his theory, he believed that communities of more sympathetic individuals were more successful in raising healthier offspring to the age of viability and reproduction. Scientists found that sympathetic touches could be processed by receptors under the surface of human skin, and set in motion a cascade of beneficial physiological responses. Inspired by Darwin’s theory of sympathy, Dacher Keltner, a psychology professor at UC Berkeley, and Matthew Hertenstein conducted a series of studies on emotion and touch. They discovered that our emotions can be conveyed through direct touches just like through facial expressions. In one of their studies, anxiety of participants waiting for an electric shock were measured by detecting activation in threat-related regions of the brain, but the response quickly turned off when their hands were held by loved ones nearby. Friendly touch activates the vagus nerve, a bundle of nerves in the chest that calms the fight-or-flight cardiovascular response and triggers the release of oxytocin, which enables feelings of trust. Comfortable seatings in private rooms together with abundant natural light and ventilated air encourages the families to stay. A study by Harris in 2000 found that family and friends stayed substantially longer during visits to rehabilitation patients when patient rooms were carpeted rather than covered with vinyl flooring.31 Much evidence indicates that single rooms are markedly better than multi-bed rooms for supporting or accommodating the presence of family and friends. Some research suggests that open-plan multi-bed rooms discourage families’ presence.32
PATIENTS AND THEIR FAMILIES
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The normal with in the abnormal. m
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Conclusion
The practice of holistic healing arises from ancient culture when religion dominated people’s beliefs, but it died out as science and technologies took over the role of healing. In modern hospitals, the treatments require patients to be abstracted to symptoms. Patients’ self-autonomy and self-reliance are neglected. The healing process depends heavily on the caregivers and the technology, which make the process a one-direction flow and unsustainable. Both the caregivers and the patients can feel very stressed and exhausted being in this relationship. Meanwhile, the environment often cannot help release this kind of stress among the caregivers and patients. Noise, bad air quality, lack of natural light and view to greenery, and the absence of privacy are all problems that common to find in modern hospitals. Fixing all these problems are necessary on one hand, but on the other hand, promoting better relationships between the public and the hospital, and between the patients and the doctors is even more critical. In short, a holistic healing experience firstly requires respect to the patients; secondly, a nice environment shall be set up to accommodate the dwellings in the hospital; and finally, hospitals’ social function should be recognized by introducing social spaces around – from as small as a couch in a patient room to meeting areas across the building.
[The Ecology of Healing Place] BACKGROUND
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Case Studies
To be chosen as a candidate for the case study, the precedent must be inside or close to a city, and serve medical services to a large population. The chosen precedent must have public inpatient-care service, which means a large number of inpatient rooms should be seen in the building. Most importantly, the design intention of each precedent that are chosen should be driven by humanistic ideas that recognize the patients’ needs and helps with the patients’ healing process.
• New Venice Hospital, Venice, Italy • Prentice Women’s Hospitals, Chicago, United States • Orbis Medisch Centrum, Sittard, Netherland 02
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NEW VENICE HOSPITAL (UNBUILT) Venice, Italy 1965, Le Corbusier with 1148 inpatient beds
Model of
The first phase of the design took New Venice place between 1964 and 1965 in the Hospital.c1 site of a former slaughterhouse in San Giobbe neighborhood in Cannaregio. After Le Corbusier’s death, Guillermo Jullian de la Fuente led the team through the completion of the building. Anyway, a shift in the city government occurred and the hospital ended never seeing the light. The plan of Venice Hospital interprets the growth logic of the ancient city of Venice and its spatial configuration, its system of semiautonomous islands and campi (the Venetian squares) separated by channels and connected by bridges. The Building consists of many cells, the individual rooms. The room is a mean to provide
[The Ecology of Healing Place] CASE STUDIES
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Site plan & site model of New venice Hospital.c2
Circulation & layout c2
Floor plan & unit c2
Pure geometery & public voids c2
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KEY POINTS • Being coherent with the city’s spatial configuration by using spatial elements and spatial logic abstracted from the city. • Understanding the system of a hospital following a sequence of scales. • Using horizontal and vertical spatial connections to interweave solid and voids together. • Inpatient areas are always away from the other activities. • Fragmenting inpatient area allows better ventilation and more natural light. • Public functions of the hospital, including entrances, administration, services and ambulances access, should be located on the ground level.
complete isolation with no windows looking outside. Light enters the room only through skylights that the patients can use to modulate intensity. The section with two rooms facing a middle corridor and the lateral skylights on top is replicated throughout the whole building. In section, the patient areas are always above the other activities. The ground floor, built on piers, contains the entrances, administration, services, arrivals by boat, ambulances access, and a chapel situated directly on the water; the first floor houses emergency rooms, diagnostics, doctors’ offices, surgeries and operating rooms, morgue, a free clinic and the laboratories. The concept of the entire hospital articulates upon the splinter of unites to the human scale. Le Corbusier stresses that the hospital was “above all man, rather than the patient, who is being considered.” The plan of the hospital consists of a series of squares. Each group of 28 rooms and fore corridors identify a square “care unit”. Each care unit provides different treatment, form the gynecology and pediatrics at the front of the neurological unit at the rest left of the complex. Four care units are arranged around a central square and are served by four paths. The basic
[The Ecology of Healing Place] CASE STUDIES
concept behind this arrangement is to create an ideal link between the man (the patient, whose size directly relates to the size of the cell) and the city, whose “growth logic” is echoed by the composition of the building. The system that Le Corbusier adopted was claimed to have the flexibility to accommodate growth, future medical innovations as well as an effective and economical cure built around the preventative and rehabilitation capabilities of the hospital. “By opening up the ground floor directly onto the city, one allows for a city-hospital encounter and facilities the visual transmission of medicine towards outside.” A large number of vertical and horizontal links established large scale spatial connections on each floor of the hospital and from the third floor to the ground level. The building is well-integrated in terms of both internal organizations and its relationship to the exterior. This kind distribution of integration in the hospital helps to promote good levels of collaboration among members of staff, and also realized the encounter in between the city and the institution.33 34 35
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Treatement unit
Detail sections c2
Computer motherboard & Intervention of New Venice Hospital. c2
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Building Section c5 Building location beofre demolition c5
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PRENTICE WOMEN’S HOSPITAL (DEMOLISHED) Chicago, United States 1975, Bertrand Goldberg with 894 inpatient beds 310,750 square feet
Photo of Prentice Women’s Hospital Prentice Women’s Hospital before it was is regarded the best example of demolished in 2013.c6
a series of Goldberg designed medical facilities, which all adhere to a similar form: a tower containing rooms for patient care, placed atop a rectilinear plinth containing the hospital’s other functions. Consistent with his inside-out process of form-making, Goldberg give the lower floors of the hospital a rectangular shape to accommodate the surgical suites, research laboratories, dining facilities and maintenance areas, which provide the greatest possible flexibility. On the other hand the patient tower is unlikely to change the way it accommodate the patients, therefore less flexibility is required. 36 Goldberg was inspired by anthropologists such as Edward T. Hall, who were developing
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Massing model study.c6
Physical model of patient rooms.c6
Photo of the patient rooms.c7
KEY POINTS • Continuous floor plan for outpatient services can provide more flexibility. • Creating communities inside hospitals by decentralize patient area into groups, and implementing meeting places at cross points. • Respect human differences by giving each patient room a different orientation. • Increase efficiency by using a radial floor plan. theories of human interaction in different spatial orientations.37 Goldberg found that sample choice of orientation could either result in linear, “sociofugal” spaces that tend to keep people apart, ot radial, “sociopetal” spaces whose overlapping sight lines routes could promote spontaneous interactions.38 Trying the decentralize the community groups in the hospital, the ‘four-leaf clover’ plan of this tower splits each floor into four tiny communities, fostering greater social ties between the neighboring occupants. The radial arrangement creates a large number of crisscrossing routes around each floor, meaning there is more chance for incidental social encounters than in a typical hospital with rooms arranged along a corridor. It also places all patients roughly equidistant from the centrally located nurses’ station, allowing for efficient care.
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“What I believe I have tried to translate into its many forms is the tendency of people to relate to each other,” said Goldberg in an interview in 1992. “I don’t think the box or the rectilinear form of architecture, which has been so prevalent in the last portion of the 19th century and the early half of the 20th century, was invented by the architects,” he explained. “It was a denial of human difference. You might say it was also a denial of humanism, because to say humanism is to say that we’re made up of lots and lots of different components and different objectives and different reactions.”36 [M.Arch.] Jamie Lu
In the city of Chicago.c7
Form follows function.c7
The brutalist structure.c7
Comparing the radial floor plan of Prentice Women’s Hospital with the plan of Ebenezer Howard’s Garden City.c5 c7
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Comparing the floor plan of Orbis Medisch Centrum with the Tokyo Bay Project, both have the public space in the middle and living area on two sides with infrastructures intergrated in between.c8 c9
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ORBIS MEDISCH CENTRUM SITTARD, NETHERLANDS 2009, Bonnema Architecten & De Zwarte Hond with 425 inpatient beds ~1,400,ooo square feet ~2,000 employees
Ariel view of Orbis
Opened in the 2009, Orbis Medisch Centrum.c10 Medisch Centrum spread over 130,000 square meters, with 425 single bed patient rooms and 2,000 employees. In Orbis Medisch Centrum, patients are always the focus of attention – both on and off stage. The recovery process of individuals are especially of central importance. The linear arrangement of all programs echoes to a standard process that the management of Orbis and the caregivers in the hospital designed for the in- and out-patients. In order to gain more flexibility, the layout of the hospital is inspired the design of airports, which includes a large amount of flexible and multi-use spaces. Overall, all spaces has been thematically divided into four functional areas: public, meeting, staying and working. The building has a clear-cut, linear structure with an atrium as its central axis, accommodating all public and patient-oriented functions, which include the entrances, the reception areas, the
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THE DESIGN IS ORCHESTRATED AROUND CONVERGENCE POINTS OR MEETING SPACES.
The central atrium. c13
HOSPITALS : 113
‘This hospital is a meeting place, where the doctor visits the patient instead of the patient the doctor’ Erik Veldhoen
CARE DURING TREATMENT AND CARE, THE PATIENT IS ‘THE OWNER’ OF THE SPACE.
MEDICAL STAFF DIAGNOSIS
TREATMENT
PATIENT
TREATMENT
CONSULTATION MEDICAL STAFF
CARE
Patient-centered arrangement.
DIAGRAM SHOWING PATIENT-CENTRED APPROACH.
ORBIS MEDICAL PARK
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The new Orbis Medical Park in Sittard is based on the ideas of Erik Veldhoen, a strategic consultant in workplace innovation. He brought a fresh approach to bear on the hospital, rethinking its organization, IT and other processes. There A common space outside patient rooms. c14 A patient room with sliding doors with shutters instal are two design focus points: the patient and [M.Arch.] Jamie Lu technology. During consultation, treatment and care, the patient is the ‘owner’ of the space. The
HOSPITALS : 113
The meeting area. c13
lled. c15
catering facilities, parking accesses, waiting rooms and hospital the consultation ‘This is a center.
meeting place, where
thecaring doctor visits is theorganized entirely The process patient instead of around the patients. Theirthe experience of the patient the doctor’ hospital is considered to begin from their very Erik Veldhoen first visit. The hospital is designed in a way that the professionals visit the patient, not vice versa. Doctors come out of their offices to consult patients in open meeting areas. The CARE meeting area consists of standard consultation, research and treatment rooms.39 40 41 In these MEDICAL STAFF DIAGNOSIS areas, comfortable chairs and round tables are provided. The doctors can approach their TREATMENT PATIENT TREATMENT patients in a friendly manner, which helps them CONSULTATION to build better relationships with their patients. MEDICAL STAFF Doctors and staff work also together in activitybased knowledge CARE centers (no private desk or rooms anymore).
from the central atrium, and are transition areas for patients before entering the public space. With this arrangement, some visitors claimed that they felt a sense of community during their stay. Proper organization of this theme will ensure that patient and professional only meet in the consultation, treatment or nursing rooms. The design encourages a distinct separation of traffic flows; between the nursing and treatment units and general hospital traffic. Doctors and nurses have their own lifts, which are also used by the robotic carts used for internal transportation.39 40
DIAGRAM SHOWING PATIENT-CENTRED APPROACH.
All inpatients stay in private rooms, which all include a private bathroom and a sofa bed for theirORBIS guests. A self-reliant patient with access to MEDICAL PARK The new Orbis Medical Park in Sittard is based on state-of-the-art technology helps curb staffing the ideas of Erik Veldhoen, a strategic consultant in workplace innovation. He brought a fresh costs, therefore an integrated bed controller is approach to bear on the hospital, rethinking installed for every patient. With the controller, its organization, IT and other processes. There are two design focus points: the patient and the technology. During consultation, treatment and patient can place meal orders, and even closecare, the patient is the ‘owner’ of the space. The or open the curtains or the door to their professionals visit the patient, not vice versa. Doctors and staff work together in activity-based roomknowledge centres (no private desk or rooms without help.41 At the same time, the anymore) and the patient has a private room. designer also tries to bring the patients out of Technology is optimized and information is digital theirand accessible via mobile devices and wireless room. Right outside the patient rooms networks. In the building there are three separate therestreams: patients, professionals and logistics. are common spaces with open kitchens These converge at meeting points. social areas can be and seating areas.39 These TYPE OF FACILITY General hospital (65,000 m ), considered as semi-public spaces that are away rehabilitation clinic (20,000 m ), prevention and
KEY POINTS • Spatial
configuration
follows
the
optimized patient flow. • An open central atrium that accommodates most social and circulation spaces in the building increases interactions and helps with orientation.
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medical education centre (20,000 m2) LOCATION Sittard, Netherlands DESIGNER Concept: Erik Veldhoen For Change (erikveldhoen.nl); building: Jan van der Leij van Bonnema architecten (bonnema.com) DATE OPENED January 2009
• Separating
the
patients
with
the
professionals in term of circulation, and overlapping the two only at consultation, treatment and nursing rooms. • Technology helps patients to be selfreliant. • Organizing circulation paths around a
Caregiver bringing in food ordered by the patient through her controller.c16 [The Ecology of Healing Place] CASE STUDIES
central space can help with navigation. 30
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ABSTRACT 1.Environment is fundamental for the psychosocial and spiritual experience of patients. 2. An ecology network is embedded in the function of the hospital. This system can be used as a guideline for implementing health-positive ideas into the hospital’s physical environment. 3.The relationship between the hospital and city should be recognized with more active links rather than a void. 4.Bringing in personal emotions to the design process affirms the designer’s empathic connection with his/her users, and recognizes the patients as spiritual-beings rather than objects.
Stan Allen’s diagram of “field conditions” disringuishes different conditions of the context basing on the urban form. s1
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Research Summary According to the research, for a hospital to become a holistic healing place, improvement has to be made on many aspects, such as the environment, sociability and spirituality. The physical environment is fundamental and should be able to respond to the psychosocial and spiritual aspects of the healing process. In order to create an ecology of healing place, a clear network needs to be identified. All factors concerning holistic healing can be organized through a sequence of scales, from a hospital as a whole to divided community hubs, then to the basic units of patient rooms. Every scale responds to its context and content. For patients, those responses can be understood as two actions, giving and taking, which recognize the patient’s autonomy as opposed to the actions of imposing and receiving. To allow patients to have control over their surroundings, movable and inhabitable furnitures can be provided; access to the light control and access to help should also be clear. In the ecosystem of a hospital, the patient space, including the wards, the corridor, and the patient social area, cannot be mixed with the caregiver space, which includes the offices, the resting area and their social area. Green spaces and social spaces should be integrated into the ecosystem of healing, but in a way that distinguishes the patients and the caregivers.
[The Ecology of Healing Place] RESEARCH SUMMARY
A hospital as a community is a way to look at a hospital as a ecosystem, but not when this community is isolated from the city. The inseparable connection between the hospital and the city also calls for a reconsideration of their spatial relationship. Instead of using green buffer to isolate the hospital, more dynamic exchanges of views, information and social interactions need to be created by blurring the physical boundaries between the city and the institution. Yet the blurriness doesn’t necessarily suggests a flat mat building, because the specific strategy is hidden in the very logic that the city’s fabric possesses.
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To help patients reach a mindful experience of healing, the building of hospital should be viewed not only as a container of physical beings but more importantly as a container of sensations and emotions. A resting body shall be put in a space that accommodates inner silence, yet optimistic stimuli such as bright light and playful form and colors are needed to boost the mood in social spaces. It encourages us as designers to bring in our own experience and memories into the design process; nevertheless a respect to the local culture of the people should also penetrate through the strategizing phases of design.
Ronchamp Chaple by Le Corbusier.s2
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Project Framework [ the urban HOUSEpital ...
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Project Site
Site Details
Location: Tanah Abang District, Jakarta, Indonesia (6° 12’ 34” S, 106° 48’ 59” E) City Population: 9,607,787 Geography: low, flat basin Elevation: 5-15 meters above sea level Climate: Tropical Monsoon Climate Rainy Season: October – May Dry Season: June – September Average High Temp: 35°C Average Low Temp: 25°C [The Ecology of Healing Place] PROJECT FRAMEWORK
Karet Tengsin, Jakarta, Indonesia
History & Development Initially this area was not the center of Jakarta. Before the settlement, there was an agricultural land operated as a market garden along the banks of Kali Krukut River by a Dutchman. Settlement moved into this region immediately after the business man’s departure after the Second World War. The settlement expanded to its south west in the 1960’s with the development of Kebayoran Satellite City. Until the end of 70’s the informal sector had occupied and built the area into an established settlement. By the 1980’s, JI.KH Mas Mausyur Road was constructed, which brought commercial activities in and around Sudirman central business district. Karet Tengsin thus became known as the “Golden Triangle” as the economy picked up in the capital city.
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Overall, Karet Tengsin lacks coherent development strategies. Within this area, wellbuilt and served formal sector housing exists alongside a deteriorated informal housing environment (“kampung�) where most houses do not have toilets or bathrooms and public facilities are inadequate. The Sudirman central business district in Karet Tengsin consists mainly of large-scale office towers rented out to private companies, nation and international banks and hotels. Retail provision in the large-scale commercial
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developments targets at the top end of the retail spectrum, like exclusive designer outlets, who can afford top-of-the-market floor space rent. Affordable day-to-day needs for the majority of the population in the region is somehow neglected in the business center. Still, residents living around the commercial center have benefited from the economic growth. Some residents provide accommodation to people working in the surrounding area while others have established small businesses in food, catering, petty trade in non-food items and services. For the majority, most social amenities and employment opportunities are within walking distance from their houses. Community Result of a sample household survey (2000) indicates that four of five households have lived in Karet Tengsin for over five years; almost half of the surveyed households have lived in this area for over twenty years or more. They have thus developed significant personal and professional attachments to this piece of land. The residential population is generally mixed like other part of the city. It consists of people born in Jakarta, migrants form other part go the country, visitors and temporary residents such as those working in near-by private companies. The demographic structure of this area is predominantly male dominated throughout the
age groups with the exception of the 12-18 age group where female are dominant. The Working age group, from 19 to 50, accounts for almost three-fifths of the total population in 2000. For kampung residents and municipal politicians alike, the concept that public services can or should be “demand driven” is entirely lost. With a political and electoral system that seems to actively discourage public accountability, nobody in the kampung expects government officials to assume any responsibility for their problems. The feeling prevails that only they and their families can be relied upon for help when it is needed. Culture • Indonesia is largest Muslim society in the world. • Soccer and badminton are two of the most popular sports in Indonesia. Other sports include swimming, tennis, bowling and bicycling. • Family life is very important in Indonesia and it is common for extended families to live together. Most Indonesian families are close and work hard to help each other. They are also expected to look after their parents in old age. Health Care The vast majority of people, even in rural areas, do have access to a state-supported system of health clinics – even if these clinics are understaffed and under-stocked in terms of the basic medicines they are supposed to have. Natural Disaster Flooding has always bothered Jakarta. Walls and sluice gates were built along part of the Kali Krukut River running through the middle of this region. The operation of the system regularly results in back flood of the storm drainage channels. Poor infrastructure and drainage facilities worsen the situation during heavy rains. Close to the river, flood can reach up to six feet in depth over ground floor dwelling level.
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Design Rational Being able to provide holistic healing experience to patients is becoming a goal for hospitals across the world, yet the research suggests that a solution to this problem is partially determined by its location. A thorough healing experience does not only have to provide people with the natural environment, technology and adequate functional spaces, but also has to deal with the local climate, local culture and the immediate urban environment. This project aims to identify all these aspects at its selected location and demonstrate how to mobilize all health-positive resources in the area. The project can be viewed on three layers, each happens on a different scale. The first layer is about the individuals, designing patient rooms that accommodate human scale and human comfort. Natural lighting, view of the natural environment, ventilation, furniture choice are all critical to the final result. In another word, design on this scale need to be empathic, the final result can be as objective as an art work that is usually more successful to evoke the sensations of its audiences/users. The next layer is about to create a community of these individuals
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through implementing a coherent system consisting of greenery, circulations, social spaces and infrastructures needed by the hospital. The caregivers come into play. Moderating the relationship between the staff and the patients is very important for this part of the design too. The third layer moves up to an urban scale, and aims to help the community in the building break its physical boundary and connect to the city network. On one hand programs in the hospital helps to bring social interactions close to the hospital, while on the other hand, the physical form of the building has to not only cooperate with these public programs, but also to be able to coordinate with people’s experience in the city and appear to the city with a friendly image. Ultimately, the project seeks to mimic an ecosystem in nature to encourage a sense of coherence for patients during their stay in the hospital, which means to provide them with suitable physical environment, let them to have control over their experience, and make them feel that, as part of the society, their life is still meaningful.
[M.Arch.] Jamie Lu
Design Objectives The project is to design a public hospital in the center of Jakarta, Indonesia. While its function includes outpatient clinics and inpatient care services, the emphasis remains on providing a more effective healing experience for inpatients who break their regular life patterns to stay in the hospital for treatments. The primary intent is to create a place that help these inpatients to regain their health more effectively. Three aspects of health are considered: physical, mental and spiritual. To help patients achieve physical health, the environment needs to be clean and safe and contains well-designed space for patients to exercise more often. To intervene patients’ mental condition, light and color in the space have to be carefully adjusted for different programs. Bringing natural environment and city activities in the hospital can also give patients positive feelings toward their future treatments. Finally, the design need to make the patients recognize that their lives are meaningful. Meaningfulness arises along with patients’ interactions with the outside world, therefore it determines that the architecture should blend into its surroundings. Overall, the project is patient centered. The
[The Ecology of Healing Place] PROJECT FRAMEWORK
design should respect its user group from their culture to their lifestyle. While the chosen site is with many advantages as for creating social interactions, the challenges are significant too. First, the climate is mostly humid and hot throughout the year, with frequent rain storms that can cause flooding in the region. Passive design strategies are required in this situation to make the hospital sustainable. Floods in Indonesia can turn streets into public spaces, especially for children, they always enjoy when the city turns into a continuous swimming pool. Regulating storm water through channels can be viewed as creating temporary public swimming pools. Second, the site locates between a highend commercial area and kampungs (low-income urban villages). As a public service building, the hospital is expected to bridge the dramatic gap. Appeasing the lower class by providing welldesigned public spaces to them is one possible solution. Third, the hospital might have to coordinate with an existing cemetery. Keeping the service of the cemetery uninterrupted while keeping it from imposing negative feelings to the patient is a critical issue to solve.
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Design Program Programs of the project can be divided into six major components, and they are:
Spatial breakdownject can be divided into six major components, and they are:
the reception area: the entrance for all patients, families and visitors. where traffic distributes into different areas of the hospital
reception area: entrance + lobby + reception desk where traffic distributes into different areas of the hospital
the outpatient service area: where will accommodate frequent interaction between the professionals and the patients. where patients only stay for short times.
doctor’s office + knowledge center + meeting area + exam room + emergency + surgery
the inpatient service area: the major healing space. patient-dominant area. the administration: having a separate administration that consists of professional administrative staff is a feature of the modern hospital.
knowledge center is a place for doctors to colaberate with eachother, therefore it has to have work stations and a small library
patient room + common space + nurse’s station + dining area + support services administration: reception + offices + meeting room the modern hospital. area for recreational activities:
area for recreational activities: serves for both the inpatients and the public living/working around the hospital. where engagements between the normal and the abnormal happens. with a hardscape area that can be used as a temporary storage for storm water.
sport facility + public spaceliving/working around the hospital. where engagements between the normal and the abnormal happens. with a hardscape area that can be used as a temporary storage for storm water.
green space: infusing into the building, especially the inpatient area. requires adequate sunlight.
green space: infusing into the building, especially the inpatient area. requires adequate sunlight.
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END NOTES 1. The Cult of Asclepius, http://www. followtherabbi.com/world/encyclopedia/ article/the-cult-of-asclepius
13. Lahey, Tim, “A Watchful Eye in Hospitals”, The New York Times, Feb. 16,2014.
2. Risse, G.B., Mending bodies, saving souls: a history of hospitals. Oxford University Press, 1990. p. 56
14. Peliken, Jurgen M. & Dietscher, Christina. (2014), The 21st International Conference on Health Promoting Hospitals and Health Services (HPH): Body and Mind. Gothenburg, Sweden.
3. Risse, G.B., Mending bodies, saving souls: a history of hospitals. Oxford University Press, 1990. p. 138 4. Wirzburgensis, Joannes & Wilson, Charles W.. Description of the Holy Land. Palestine Pilgrims Text Society, 1896. 5. Harman, N.B., “The Modern Hospital Conception”, The British Medical Journal, Nov. 27, 1926. 6. Porter, Roy, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. New York: W. W. Norton & Company, 1999. pp. 316–317. 7. Risse, G.B., Mending bodies, saving souls: a history of hospitals. Oxford University Press, 1990. p. 56 8. Ulrich, R., Aimring, C., Quan, X., Joseph A., and Choudhary, R., Role of the physical environment in the hospital of the 21st century, the Center for Health Design. 9. Ulrich, R. S., Lawson, B., & Martinez, M. Exploring the patient environment: An NHS estates workshop. London: The Stationery Office, 2003. 10. Burgio L., Engel B., Hawkins A. (1990), “A descriptive analysis of nursing staff behaviors in a teaching nursing home: differences among NAs, LPNs and RNs.” Gerontologist, 30:107–112. 11. Openshaw, Scott, “Hospitals by Design: Solving the Problem of Medical Information Overload”, Continuum, Mar. 8, 2013.
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12. Tummala, A., and Roberts, L. W., “Ethics Conflicts in Rural Communities: Stigma and Illness,” Common Ethics Issues in Rural Communities.
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15. Tummala, A., and Roberts, L. W., “Ethics Conflicts in Rural Communities: Stigma and Illness,” Common Ethics Issues in Rural Communities. p.195 16. Florence Nightingale’s Environmental Theory, nurseslabs.com 17. Kaplan S., The Restorative Benefits of Nature: the psychological perspective. New York: Cambridge University Press. 18. Ulrich, R. S. (1991), “Effects of interior design on wellness: Theory and recent scientific research.” Journal of Health Care Interior Design, 3(1), 97-109. 19. Van den Berg, A.E., Hartig, T., & Staats, H. (2007), “Preference for Nature in Urbanized Societies: Stress, Restoration, and the Pursuit of Sustainability.” Journal of Social Issues, 63 (1) p.79-96. 20. Ulrich, R. S. (1991). “Effects of interior design on wellness: Theory and recent scientific research.” Journal of Health Care Interior Design, 3(1), 97-109. 21. Benedetti, F., Colombo, C., Barbini, B., Campori, E., & Smeraldi, E. (2001) “Morning sunlight reduces length of hospitalization in bipolar depression.” Journal of Affective Disorders, 62(3), 221-223. 22. Kuller, R. (2000), “The Influence of Light on Circa Rhythms in Humans”, Jounal of Physiological Anthropology, 21 (2) p.87-91. 23. Kuller, R. (1995), “The Color’s Effect on Humans”, Experience of Color and Painted Environments, p.13-30.
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24. Goldstein, K. (1942), “Some experimental observations concerning the influence of colors on the function of the organism.” Occupational Therapy and Rehabilitation. 25. Dilani, A.. “A New Paradigm of Design and Health in Hospital Planning.” World Hospitals and Health Services, 42(4) 17-21. 2006. 26. Gast, P. L., & Baker, C. F. (1989), “The CCU patient: Anxiety and Annoyance to Noise.” Critical Care Nursing Quarterly, 12(3), 39-54. 27. Edvardsson, D. J., Sandman, P-O., & Rasmussen, B. H. (2005), “Sensing an atmosphere of ease: a tentative theory of supportive care settings.” Nordic College of Caring Sciences; 19, 344-353. 28. Altman, Irwin, “The Effects of Crowding and Density.” The Environment and Social Behavior: Privacy, Personal Space, Territory, Crowding, Brooks/Cde, 1975. 29. Press Ganey, Inc.. National patient satisfaction data for 2003. 30. Van der Ploeg, H. M. (1988), “Stressful medical events: A survey of patients’ perceptions.” In S. Maies, C. D. Spielberger, P. B. Defares & I. G. Sarason (Eds.), Topics in Health Psychology ,pp. 193-203. New York: John Wiley. 31. Harris, D. (2000), “Environmental quality and healing environments: A study of flooring materials in a healthcare telemetry unit.” Doctoral dissertation, Texas A&M University, College Station.. 32. Sallstrom, C., Sandman, P. O., & Norberg, A. (1987), “Relatives’ experience of the terminal care of long-term geriatric patients in open-plan rooms.” Scandinavian Journal of Caring Sciences, 1(4), 133-140.
33. Mazzariol, G., (1966), ‘Le Corbusier in Venice: His Project for a New Hospital’, Zodiac 16: 241 34. Sarkis, H. (2001), Le Corbusier’s Venice Hospital, Munich, London, New York: Prestel Verlag. 35. Allard, P. (2001), ‘Bridge Over Venice: Speculations on Cross-fertilization of Ideas
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between Team 10 and Le Corbusier [after a Conversation with Guillermo Jullian de la Fuente]’, in Sarkis, H. (ed.), Le Corbusier’s Venice Hospital, Munich, London, New York: Prestel. 36. “Prentice Women’s Hospital”, Bertrandgoldberg.org, http:// bertrandgoldberg.org/projects/prenticewomen%E2%80%99s-hospital/, accessed on Nov. 3. 37. Goldberg, “Oral History”, p.156 38. “The Goldberg Effect”, Architecture Record 160, July 1976, p.110 39. “Orbis Medical Center”, Orbis Medisch en Zorgconcern, http://www.bendigohealth. org.au/content/2010studytour/Hospital_ Tours/Orbis_Sittard_10-06-10_comp.pdf, accessed on Nov. 17. 40. “Orbis Medical Center”, Architizer.com, http://architizer.com/projects/orbismedical-center/, accessed on Nov. 18. 41. “Orbis Medisch Centrum, Sittard (NL), Siemens”, http://www.siemens.com/bt/ file?soi=A6V10309765, accessed on Nov. 18. 42. Dunmall, Giovanna, “The Recovery Position”, Hospitals, p.110-120. 43. M. Theis, Tony Lloyd-Jones, W. Erickson Mark Povey, S.B Mulyawan, R. Kalra (2000), “Guide to Good Practice in Core Area Development: Jakarta Field Studies and Workshop”, University of Westminster & Institute of Technology Bandung, Indonesia. 44. McCarthy, Paul (2003), “Urban Slums Reports: The Case of Jakarta, Indonesia”, UNDERSTANDING SLUMS: Case Studies for the Global Report on Human Settlements, World Bank (Jakarta Office).
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IMAGE CREDITS
CASE STYDIES c1. The Building is the City: Le Corbusier’s Unbuilt Hospital in Venice, http://socks-studio.com/2014/05/18/the-building-is-thecity-le-corbusiers-unbuilt-hospital-in-venice/ c2. Network Sensibility, http://networksensibility.blogspot.com/2013/11/ review-indra-alam.html
BACKGROUND b1. Photo series by Angelo Merendino, The Battle We Didn’t Choose: my wife’s fight with breast cancer, http://mywifesfightwithbreastcancer.com/ b2. Photography by Patrick F. Tobin, http://patrickftobin.wordpress.com/ b3. Ibid b4. Ibid b5.http://www.citylit.ac.uk/courses/Science_and_ nature/779 b6.http://en.academic.ru/dic.nsf/enwiki/1019834
c3.Future Prentice: ideas for saving endangered Bertrand Goldberg building subject of Chicago Architectural Club’s 2012 Chicago Prize competition, http://arcchicago.blogspot.com/2012/08/futureprentice-ideas-for-saving.html c4. How we imagined it would be, http://howweimagined.tumblr.com/page/5 c5.Prentice Women’s Hospital, http://bertrandgoldberg.org/projects/prenticewomen%E2%80%99s-hospital/ c6.Documentation: it’s more than just a pretty picture, http://blog.preservationleadershipforum. org/2013/06/27/documentation/#.VHrz24vF_e4 c7.http://www.citylab.com/design/2012/11/evolutionurban-planning-10-diagrams/3851/
b7. Medical and Healthcare, http://www.rickdavisphoto.com/#studio
c8. Kenzo Tango, Tokyo Bay Masterplan, 1961. http:// www.d-a-s.hr/aktualno/3603/izlozba-strugglingcities-japanski-urbanisticki-projekti-iz-sezdesetih-urijeci/
b8. Dayton Ohio Birth Photography, http://daytonbirthphotography.com/2011/08/20/ loving-hospital-birth-dayton-ohio-birth-photography/
c9. Ibid
b9. Blue Morpho Center New Blog, http://bluemorphocenternews.com/2013/05/24/ourhealing-sanctuary-at-envision-festival/ b10. Genral Design, http://www.asla.org/2013awards/374.html b11.http://www.downtoearth.org.in/dte/userfiles/ images/50L_20130228.jpg
c10. Orbis Medisch Centrum, Sittard, The Netherlands http://www.buildingtechnologies.siemens.com/bt/ global/en/references/total-building-solutions/pages/ orbis-medisch-centrum-sittard.aspx c11.http://gerlo.photoshelter.com/image/ I0000bMuCch.6r3s
b12. Duplex in Saint Foy Les Lyon, Dank Architects, http://dankarchitectes.com/portfolio/amou-duplex-asaint-foy-les-lyon/
c12. Revolutionising Healthcare (Part 3): Privacy and Community in Wards, h t t p : / / s p a c e a n d o r g a n i s a t i o n .w o r d p r e s s . com/2012/11/24/revolutionising-healthcare-part-3privacy-and-community-in-wards/
b13. http://www.mimdap.org/?p=66503
c 13 . h t t p : / / w w w.v e l d h o e n c o m p a n y. c o m / e n /
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referenties/casus/268/orbis-medisch-centrum-sittard/ c14. http://iseco.eu/case/orbis/
RESEARCH SUMMARY s1.Peter Hudac notes on field, http://peterhudac.wordpress.com/2010/09/22/from-object-tofield/ s2. Ronchamp-color, https://bmyshot.wordpress.com/tag/le-corbusier/
PROJECT FRAMEWORK f1. Pemandangan Jakarta dari RuSun Karet Tengsin, http://www.panoramio.com/photo/71986569
[The Ecology of Healing Place] END NOTES
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Hammons School of Architecture Drury University 2014