Inside the super lab by Hochparterre AG

Hochparterre special issue, January 2025

Inside the super lab The Swiss Center for Design and Health ( SCDH ) in Nidau tests, researches and teaches how design can improve health.

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The Extended Reality Simulation Area measures 560 square metres.

Front and rear cover: The SCDH’s experts are committed to improving health through design.

Special feature The contents of this special issue will also be published as a special feature on Hochparterre’s website: scdh.hochparterre.ch

Editorial

From every perspective

Contents

5 Putting well-being at the centre Founded in 2019, the Swiss Center for Design and Health ( SCDH ) in Nidau is dedicated to networking, researching and supporting.

10 The Holy Grail of design methodology Research Head Minou Afzali on evidence-based design and interdisciplinarity at the SCDH.

13 Understanding between cardboard walls The simulation space in the Living Lab is where construction drawings first take tangible form.

17 “ What would Florence Nightingale think ? ” Doctors, architects and nurses use precision simulation to test digital care models.

20 Experience, discuss, refine A look at current projects at the SCDH.

The challenges are huge: a healthcare system with overstretched financial and human resources; constantly changing operating procedures; patient and staff safety; long-term planning horizons; and complex construction schemes. Healthcare-related buildings, systems and processes are complicated undertakings in many different ways. Since 2022, Switzerland has had a unique centre of excellence that specialises in designing them. The Swiss Center for Design and Health ( SCDH ) in Nidau, adjacent to Biel / Bienne, provides a comprehensive offering for anyone who designs, plans, builds or works in healthcare and wants to test, review or optimise projects. This special issue takes a look behind the scenes at the SCDH and shows how the services it provides support and improve planning work on buildings, systems and processes in the healthcare sector. The focus is on simulations that make it possible to test projects and processes in realistic test environments. Planning errors are recognised at an early stage and can be resolved quickly and with little expense. The specialists involved in such planning activities meet at the SCDH. Architects can experience first-hand what it is like for nurses and surgeons to work in their floor plans. Hospital management can gain an understanding of the thought process that has gone into the architectural plans. All these professionals and stakeholders have a chance to develop a shared perspective in the SCDH’s spacious facilities. This benefits us all in turn when we come to receive treatment, surgery or care in the completed projects. Urs Honegger

The images in this special issue Bern-based photographer Marco Frauchiger visited the SCDH on three days to capture the busy activity in the Living Lab. His striking photographs guide readers through the special feature, documenting the huge range and dynamism of the services on offer in the SCDH’s large industrial building in Nidau.

This special issue / special feature is a journalistic publication produced in cooperation with partners. Hochparterre’s editorial team assesses the relevance of the subject matter and is responsible for research, conception, text and images, design, proofreading and translation. The partners fund the publication, approve the concept and give their consent to publication. Imprint Publishing house Hochparterre AG, Ausstellungsstrasse 25, CH-8005 Zürich, Telefon +41 44 444 28 88, www.hochparterre.ch, verlag@hochparterre.ch, redaktion@hochparterre.ch Board of management Deborah Fehlmann, Roderick Hönig Editorial management Axel Simon Special issues management Roderick Hönig Concept and editorial office Urs Honegger Photography Marco Frauchiger, www.marcofrauchiger.ch Art direction Antje Reineck Layout Jenny Jey Heinicke Copy editing Nathalie Bursać Translations Traduction Weiss Genossenschaft Lithograph Team media, Gurtnellen Print Stämpfli AG, Bern Publisher Hochparterre in cooperation with the Swiss Center for Design and Health ( SCDH ) hochparterre.ch / scdh Special issue also available in German and French ( Fr. 15.—, € 12.— ) and as an e-paper

Hochparterre special issue, January 2025 — Inside the super lab — Contents

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Nursing procedures are simulated and discussed in the realistic testing spaces.

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Stefan Sulzer is Managing Director of the SCDH. His declared goal is to establish the centre of excellence as a leading organisation at the interface between design and health.

Raphael Huber is a member of Extended Management and Co-Head of Workshops. As a qualified cabinet maker, he is an expert in planning, production and assembly.

Barbara Schwärzler is Co-Head of the SCDH’s materials collection. The colour designer and interior architect has developed numerous concepts for buildings in the health sector and is an expert in materials and colours.

Putting well-being at the centre Established in 2019 as a centre of excellence, the Swiss Center for Design and Health ( SCDH ) focuses solely on the healthcare sector. Its goals: to network, research and support. Text: Eveline Rutz

There is nothing unusual about construction site noise at the Swiss Center for Design and Health ( SCDH ). That’s because building work is still in progress two and a half years after the team moved in. Grappling with design processes is in the Nidau-based centre of excellence’s DNA. Draft new-build and refurbishment projects, visual communication concepts, processes and systems are evaluated in the brightly lit industrial building. The maximum available space for these activities is 2,500 square metres. Work focuses on the health sector. Designs created here are intended to promote well-being. “ We give project managers a neutral space in which to discuss things from various perspectives and broadly test ideas, ” says Managing Director Stefan Sulzer from his office on a gallery level above the lobby. The glass fronts give him a view of much of the premises. “ Professors and practitioners work together as equals here,” he says, talking not only about the 30 or so employees with backgrounds in different disciplines and professions. Sulzer is also referring to the people who use the services and offerings provided by the centre of excellence. The SCDH links up, supports and advises business, science and public-sector players. It conducts workshops,

operates test facilities, partners with higher education institutions, initiates research work and runs continuing education courses. It is where planners, designers, scientists and users meet and benefit from the wide-ranging design expertise on offer. “Anyone who works in a hospital or school knows plenty about its processes and pathways, ” says Sulzer, before explaining that it pays off to incorporate this practical knowledge into simulations at an early stage. “ That way you can avoid expensive mistakes during construction and the need for subsequent modifications.“ Moreover, taking account of users’ needs increases project acceptance. The SCDH was founded in 2019 as a public-private partnership. It is funded by the Confederation, Canton of Bern and private partners and operates as a company limited by shares. It has been in operation since 2022 and is due to become self-supporting from 2030. “ Nidau is the ideal location, ” Sulzer says. “ And not just because of the transport links. ” Its location between the German- and French-speaking parts of Switzerland makes it an enriching place to be. “ It gets you to look beyond your own part of the country. ” And in fact there are German and French speakers in the SCDH team. →

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The Living Lab

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depot

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1 Realistic testing spaces p. 17 The Living Lab is a place where spaces can be reproduced, designed, fitted out and tested. As a result, it is possible to simulate working and treatment processes and test products in a realistic spatial environment. The testing spaces are a platform for simulation and research and a showroom for manufacturers. Photos: SCDH

2 Kitchen / Catering The Living Lab has a kitchen and catering area – ideal for lunch or a break during work.

3 Open space area A collection of modelling equipment, domestic sewing machines, and printers that people from outside the SCDH can rent and use.

4 Materials collection p. 22 The collection, which exists in physical and digital form, is an index of materials found on the basis of scientific evidence to promote health and conserve resources. The SCDH’s intention is thus to provide a tool that planners, designers and architects can use to select suitable materials more easily and obtain an in-depth understanding of the materials and how they are used. 5 Extended-Reality Simulation Area p. 13 Switzerland’s biggest extended-reality simulation area, where floor plans can be projected onto the floor at full size and augmented by lightweight partitions and furnishings. Spaces that exist only on paper take on three-dimensional form and floor plans become something people can walk through and experience at firsthand. They are tested and optimised with all stakeholder groups in simulation workshops.

6 Testing systems The testing systems provide a way of investigating the effect of factors such as light, colour, acoustics and the feel of surfaces under controlled and reproducible conditions or of verifying accessibility. The testing systems can be reconfigured and re-equipped to suit the assignment or research issue.

7 Metalworking shop A well-equipped metalworking shop supports the SCDH’s services and research projects and facilitates co-prototyping.

8 Woodworking shop The Living Lab includes a woodworking shop that is equipped to professional standards. Here test or simulation environments can be adapted to the project question and ideas for innovations can be implemented.

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→ It is a well-documented scientific fact that design has The SCDH could not function without its workshops, says an impact on health. The SCDH plays a role in helping Stefan Sulzer. “ They help ensure that we can provide prothese findings make their way into real-world use. “ We fessional and efficient support for design processes. ” He take an evidence-based approach and engage in knowl- does not feel the SCDH is a competitor to private comedge transfer, ” says Head of Research Minou Afzali see panies, since it does not develop marketable products. “ The Holy Grail of design methodology ”, page 10. She and her team “ There should be much more simulation,” Sulzer concludes. contribute research findings to projects. They evaluate The interdisciplinary and participatory approach always ongoing work and publish the results. The centre of ex- yields better results. It is his opinion that the method cellence partners with universities, associations, founda- should become an established part of complex projects in tions and private-sector partners. It has a Scientific Board particular, as an additional tool in the planning process. and International Advisory Board. “ We are in regular dialogue, discuss current topics and take up relevant issues, ” says Afzali. Minou Afzali guides us through the Living Lab and four testing spaces that are currently set up there. These are used to test spatial concepts, innovations from start-ups and various materials see “ Realistic testing spaces ”, page 7. Depending on the project, materials may have to satisfy othStefan Sulzer, Managing Director er requirements. For example, static electricity must not be permitted to build up and discharge in operating theatres. “ The floor has to be capable of controlled dissipation to protect the people and equipment in the theatre,” says Barbara Schwärzler, interior architect and colour design-

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“ The SCDH could not function without its workshops.”

“Anyone who works in a hospital or school knows plenty about the processes and pathways.” Stefan Sulzer, Managing Director

er. Schwärzler has various samples at her workstation and points to a blue-grey floor covering, which would be particularly suitable. Finding the right material is time-consuming work, she says. “A good network and specialist knowledge help a lot. ” Schwärzler and design researcher Meri Zirkelbach are responsible for building up the SCDH materials collection. The aim is to work with suppliers and users to bring together a collection of products that have proven successful in healthcare buildings. They attach particular value to innovation. The first collection should be available digitally, as well as physically in Nidau, from the beginning of 2025 and will be continually expanded see “ Materials collection ”, page 7.

Swiss Center for Design and Health The centre of excellence in Nidau, Canton of Bern, promotes design that furthers health. It supports and researches design processes and is active in three areas – “ Visual communication ”, “ Objects and environment ” and “ Systems and processes ”. It supports project managers by providing analyses, consulting services, research, co-prototyping and simulations. The SCDH also runs continuing education courses and public events. It links up specialists from science, government and real-world practice. The centre was founded in 2019 as a public-private partnership. It is funded by the Confederation, Canton of Bern and private partners. It has been operating in Nidau since 2022. From early 2025, it will have its own materials collection to augment its offering. www.scdh.ch

Everything under one roof The SCDH can also create its own prototypes. Its workshops in Nidau are equipped to work with wood, metal, plastic, textiles and cardboard. “ The pathways are short, ” says Co-Head of Workshops and qualified cabinet maker Raphael Huber. As a result, the team can respond quickly when something has to be modified for a test or simulation. Moreover, ideas for innovations can be implemented in a straightforward, efficient way. The physical proximity of the individual units is truly unique, Raphael Huber tells us as we walk through the workshops. “ That proximity is inspiring and gives rise to interesting things.” For example, a direction board has been created by gluing sheet metal onto wooden boards. The metal is magnetic so that the signage can be changed. “ Different engineering skills and abilities come into play alongside each other, ” Raphael Huber says.

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Plans for hospital buildings can be flexibly tested by projecting their floor plans on the ground and adding easy-to-move cardboard partitions.

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How can you use design to promote health ? Minou Afzali, Head of Research at the SCDH, says the question needs an interdisciplinary answer.

The Holy Grail of design methodology

Text: Meret Ernst

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The Swiss Center for Design and Health ( SCDH ) is a place for anyone interested in the points where architecture and design interface with health-related questions. “ These interfaces don’t only become tangible in built environments, ” explains Head of Research Minou Afzali. The environments she refers to include digital spaces, such as a platform that provides oncology nurses with information and a forum for dialogue, or hybrid settings that support us at home, such as telemedicine. Putting people at the centre As a doctor of social anthropology, Minou Afzali is interested in how people interact in analogue, digital and hybrid spaces when it comes to their health. And as a design graduate, she knows that everything is designed – not just spaces, but also the interactions and objects that exert an effect within those spaces. These range from plasters for children to anaesthesia tubes, from urologists’ waiting rooms to operating theatres, and from home nursing visits to telemedical consultations. The healthcare system is also designed because politicians want it that way. It also provides the SCDH’s system horizon. Embedded within this are the development of continuing education and cooperation with various real-world and research partners. The SCDH’s activities are divided into three areas: “ Visual communication ”, “ Objects and environment ” and “ Systems and processes ”. “ Our goal is to research and develop design solutions and standards in all these areas that will promote health, ” Minou Afzali explains. In pursuit of this Holy Grail of design methodology, the SCDH’s offerings are people-centric, participatory and iterative. “ We put people at the centre of everything we do, factor in all stakeholder perspectives right from the outset, and we know we can find a design solution by a process of constant review. ” As a researcher, however, Minou Afzali is particularly interested in the fourth cornerstone of the SCDH – an evidence-based approach. Does architecture have curative properties? This is because the question that overarches all these efforts is whether it is possible to relate health with design, and, if so, how. After all, the built environment, the products with which we interact and the services we use impact our well-being as part of our daily experience. But can architecture help ? Certainly not on its own, says Minou Afzali, anxious to head off exaggerated claims. “ Our health is determined by a large number of other factors. ” The part of her that is a scientist is keen to know exactly what quantifiable effect architecture and design have on health. There are already reliable findings relating to this issue. The publication of a study in “ Science ” in 1984 marked the start of evidence-based design ( EBD ) as a research discipline. A research team headed by US professor Roger Ulrich evaluated the medical records of 46 patients who had their gallbladders removed at a hospital in suburban Pennsylvania between 1972 and 1981. The 23 patients with a window view of a natural setting spent less time in hospital, received fewer negative evaluative comments in the nurses’ notes, and took fewer potent analgesics than the other half of the group, who were in similar rooms but with windows facing a brick wall. When it comes to health, the demonstrable stress-reducing effect of being able to relate to the natural environment is just one of many factors. Since then, a range of

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studies has shown how carefully thought-through and designed spaces, objects and processes can reduce healthcare-associated infections, medical errors, patient falls or staff injuries, patient and staff stress, safety and productivity, as well as improving environmental and financial sustainability. This fund of reliable knowledge provides the foundation for new research and design work, including the work done by the researchers at the SCDH. “ We review current research, then work with our research and real-world partners to develop a starting point. If there’s no evidence, we try to find it, ” explains Minou Afzali, outlining the approach. “ Building on that, we identify potential solutions and sources of optimisation. ” Functional requirements for healthcare spaces have a long history. There is no doubt that a lot of knowledge has gone into directives, standards and specifications. So why is there still a need for fresh evidence? “ It’s true that people have been building health-related spaces for hundreds of years, ” says Minou Afzali. “ But our research and design work relates to specific contexts and varying needs. ” Something that could be beneficial to one group of patients might be alarming for another. The evidence can be contradictory, depending on the context. Design is always context-dependent and involves psychological issues of perception. And that takes us to the heart of the matter: How do you set about gathering aesthetic evidence? To answer this question, the SCDH also has a design and architecture team. Highly interdisciplinary The SCDH team uses a broad definition of evidence. “ Collecting data, observing, designing and testing are all part of evidence-based design,” says Minou Afzali. “ And, as in any research activity, we always use the existing knowledge as our starting point. ” The SCDH takes an active approach to managing this knowledge by organising symposia on health-related issues and inviting guest researchers or project partners from the higher education institution environment to share and jointly advance their knowledge. “ The researchers bring their expertise and use our skills or infrastructure. That way they can obtain specific knowledge for their projects, ” Minou Afzali explains. This dialogue is highly interdisciplinary in nature. This is also essential for the enormous research area covered by health. This is because the WHO defines health not merely as the absence of disease or infirmity, but as a state of complete physical, mental and social well-being. It therefore makes sense to combine forces to tackle the huge task of translating this into research.

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Minou Afzali is a university-trained product designer who holds a PhD from the Institute for Social Anthropology at the University of Bern and researched and taught at Bern Academy of the Arts as a professor of social design in design and health. Minou Afzali is a member of the SCDH’s Extended Management and its Head of Research.

Evidence-based design ( EBD ) The term was first coined in healthcare and began with the publication of Roger S. Ulrich’s study “ View Through a Window May Influence Recovery from Surgery ” ( Science 224 ( 4647 ) :420 – 1 ). Since 2007, “ Health Environment Research & Design Journal ” ( HERD ) has been publishing articles and research papers on the relationships between health and environmental design. EBD methodology requires design decisions that are based on validated research results. This demands a rules-based approach that follows scientific working principles. A rationale is given for design and construction decisions and the results are reviewed, which in turn leads to fresh evidence. Research in the field shows that the way analogue and digital environments are designed has an impact on system participants’ wellbeing. As a method, EBD is also discussed in user experience ( UX ) design. Studies of the efficiency of using digital interfaces are based primarily on findings from usability research conducted since the 1980s.

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Specialists from diverse disciplines come together in the Living Lab to develop a shared perspective.

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Monika Codourey is a member of the SCDH’s Extended Management and Head of its Living Lab. She has a PhD in architecture and specialises in transdisciplinary research and healthcare expertise.

Understanding between cardboard walls The SCDH is home to the largest simulation area in Switzerland, where floor plans and spaces can be reproduced and tested in full size. Text: Urs Honegger

The Living Lab’s Extended-Reality Simulation Area measures 560 square metres, making it the biggest facility of its kind in Switzerland. The SCDH can project floor plans onto the floor in original size, augmenting them with lightweight partitions and mock-ups from its workshops as well as with real furnishings. As a result, spaces that exist only on paper take on three-dimensional form and floor plans become something people can walk through and experience at first hand. Simulation workshops are held while projects are still at an early stage to identify and avoid planning errors. This approach optismises planning reliability and work processes and can save costs.

you would on a computer in a virtual space, ” says Monika Codourey. Weak spots generally already become obvious during set-up, she explains – a passage that is too narrow, for example. Less noticeable shortcomings can be spotted during simulation, which is led and facilitated by SCDH staff members. “ We run through several scenarios in a realistic way, ” Codourey explains. These include logistical processes or emergency situations as well as normal working procedures. In the Living Lab, participants experience the planned spaces in full size. “ They are much better able to assess things, such as walking distances, and they grasp spatial contexts that they would barely notice on paper, ” says A step closer to reality with role play Codourey. Nobody is more familiar with work procedures The idea of simulations is based on the method devel- than the people who will use the spaces – not even the oped by American critical care paediatrician Nora Colman planners and architects. However, users often have diffisee “ Simulation improves architecture ”, page 14 during the design culty understanding plans. Simulation thus provides a way process for Atlanta Children’s Hospital. “ She trained us in of improving communication between participants. the criteria-based use of the simulation method when she Roughly half the people taking part in a simulation act was a guest researcher here, ” explains Monika Codourey, as observers and carefully take notes. The other half asHead of the Living Lab. The first step is to decide with the sume roles familiar from their everyday work. Attendees real-world partner what is going to be tested and in which collate their observations during the debriefing session. scenarios. The approach varies, depending on the ques- “ Even small changes can have a big impact, ” says Monika tion to be addressed. Construction drawings first take Codourey. As a result, spaces that serve users are creattangible shape in the simulation area. “ When you’re be- ed. This is particularly crucial given the current shortage tween cardboard walls, you obtain different findings than of skilled staff. →

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“ Simulation improves architecture ” Nora Colman, how do you persuade hospital managers and architects that simulation pays off ? Nora Colman: By highlighting the potential safety gains and cost savings. We know that the built environment has an effect on patient safety. Poorly designed spaces push up staffing costs because they operate inefficiently and they can cause expensive safety issues. Who usually has the idea of using simulation during planning processes ? During the planning process, architects will hit on questions that hospital management have difficulty making a decision on. That gives the architects a chance to say: “ Let’s test this in a simulation. That way, we will gain a fuller set of information to help with the decision.” At the same time, management has an opportunity to say: “ This space will look completely different from what we’re used to. We want to ask our clinical teams for feedback so we can make the right decision. ” How does simulation benefit architects during the planning process ? “ Work as imagined ” is rarely the same as “ work as done ”. Planners can design a space and imagine what it will be like in use, but the reality is often different. Clinical staff may interact with it completely differently. Simulation makes these differences visible. What do clinicians gain from simulation ? They often find it hard to translate a two-dimensional drawing into the context of their work. If a space does not meet their needs, they will develop alternative solutions to simplify their work. However, these alternatives may be unsafe or inefficient, which is why it is important to involve clinicians at an early stage of planning. Can you give an example ? When we were building our hospital in Atlanta, we planned how the space was to be divided up and made sure all items of equipment had their place. It all looked great on paper. But when clinicians used the space in simulation, they were no longer able to reach the head of the bed once the patient was hooked up to equipment. Simulation forces architects and hospital managers alike to think beyond the typical planning process. It helps everyone see the architecture from the perspective of the people who will actually be using the space. So architecture not only has an effect on quality of care, it also affects employees’ well-being ? Designing rooms without clinical input leads to overstretched employees. Clinical staff do not want to work in spaces that are not designed for their needs. Hospitals that do not involve their employees in planning process-

es are sending out a message that they do not value their opinions, which further undermines morale and increases employee turnover. And that turnover costs a lot of money. In your experience, are architects willing to embrace the simulation process ? We are seeing a shift in culture in the United States. Architects are increasingly involving end users in their processes, but hospital management teams also have to be open to the idea. Simulations often lead to design changes and both parties have to be willing to accept these. The aim of simulation is not to criticise the architecture, but to refine and improve it so as to achieve the best possible result. Can’t hospital architecture be standardised ? There are very subtle differences in the way healthcare is delivered, and delivery can vary tremendously from hospital to hospital, country to country or even team to team. There is no “ one size fits all ” solution to hospital design because each system organises care in a different way. Architects have to find a balance between standardisation and individualisation. They can only do that if they work with clinicians to understand how care is delivered in their specific environment.

Nora Colman is an Assistant Professor of Paediatrics and a Critical Care Medicine Physician at Children’s Healthcare of Atlanta ( USA ). The simulation expert researches the effects of architecture and design on patient safety. Colman has organised many large simulation projects in hospital planning and led a two-day workshop entitled “ Hospital design and care delivery ” at the SCDH.

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How do you make sure that architects and hospital managers communicate effectively with each other during the simulation process ? All participants need to share an understanding of the goals and limitations of simulation. There may be design features that cannot be changed, and that needs to be clear from the outset. We also use tools such as failure mode and effects analysis ( FMEA ) to prioritise problems by safety and efficiency criteria. It is important that the architect and hospital owner agree on how decisions are to be made once simulation has taken place. Decisions have to be taken right to the top to ensure that the findings from the simulation are implemented. Simulations are expensive and cost is often a stumbling block. Cost is a particular issue for hospitals. Simulation needs time and people, which is off-putting at first. But it doesn’t have to be expensive. We can scale simulations for anything from a single space to a complete department. The aim is to make the long-term cost savings clear to the hospitals. The earlier you detect planning mistakes, the cheaper it is to fix them. Do you have an example ? We use an approach called the cost-influence curve, which shows how changes involve little cost during the early planning phase, but get a lot more expensive once construction has begun. In one case, an emergency department had to be completely rebuilt at a cost of millions. Using simulations, we can identify such problems at an early stage and make long-term savings in both construction and operating costs. What role can the SCDH play in this process ? Using simulations to review hospital design is a relatively new application. Very few people know how to conduct them correctly. Even using a hospital simulation for training isn’t the same as investigating a physical environment.

And architects who specialise in hospitals don’t have the knowledge either. The SCDH provides the space and expertise needed to perform simulations. Can this expertise extend beyond planning individual projects ? The SCDH is neutral and not affiliated to any particular firm of architects, hospital or supplier. That makes it the ideal place for cooperation and innovation. It provides a space in which to bring architects, clinicians and hospital management together. It is a unique platform that could set a new standard in architecture for healthcare facilities all over the world. What does that mean for architects ? Architects could use the SCDH to develop skills that they could use in various countries. You could integrate healthcare professionals from ten different hospitals into a universal architectural design. A design of this type with these specific features would work for many projects. And you could further improve this basic design and adapt it to individual needs. Interview: Urs Honegger

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“ Cost is a particular issue for hospitals.” Nora Colman, Intensive care specialist and simulation expert

Impact of Simulation-based Hospital Design Testing on the cost influence curve Curve adopted by Wideman ( 2001 ) and Christensen and Manuele ( 1999 ) Project Completion

Low Cost

High Cost

Project Start

Project Timeline Checking the design through simulation Preconstruction: Ability to influence cost Postconstruction: Design modifications and retrofitting with increased project costs

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How do digital processes affect patients, nurses and doctors ?

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“ What would Florence Nightingale think? ” Doctors, architects and nursing staff can test what digital care models are capable of by accurately simulating them. The potential is as great as the challenges. Text: Mirjam Rombach

An elderly man sits slumped in a cosily furnished living room. His chest rises and falls laboriously. He seems to be almost drifting away when he is aroused by a knock at the door. With considerable effort, he pulls himself out of his armchair and opens the door to a young woman. She is wearing a green scrub top and is carrying a bulging black case, which she places carefully on the wooden table. Straight away the man begins to talk, explaining that his heart is racing and he is worried about losing consciousness. Both are wearing felt slippers over their shoes and there are giant spotlights suspended high above their heads. The scene is part of the “ Building trust: Designing for remote care ” symposium run by the Swiss Center for Design and Health. A group of observers follow proceedings attentively, making notes and filming on their smartphones. Many of them are members of the SCDH team that has prepared four test scenarios for the two-day event. The simulations are intended to show how incorporating digital processes into healthcare delivery affects patients, nurses, doctors and family members. The case study is the story of a man with heart disease who has just been discharged from hospital and has been hospitalised at home. “ Hospital at home ” is an approach that delivers clinical care in people’s own homes.

And there is plenty of discussion. Each movement, each decision made by the participants is analysed in the debriefing session. “ Wasn’t the process almost too perfect? ” Deane Harder asks the participants. “ Are people actually so patient in real life? ” The professor from Bern University of Applied Sciences is one of the symposium organisers and a member of the SCDH’s Scientific Board. Various members of the International Advisory Board, who have travelled in from the USA, Canada and Sweden, are also in attendance. There are people with backgrounds in public health, nursing, medical informatics, social anthropology, surgery, emergency medicine, design and architecture in the spacious building. The group assesses the use of digital communication tools with particular concentration. According to the script, the district nurse makes a video call to the patient’s cardiologist for a remote consultation, during which the cardiologist gives instructions and reassures the patient. The screen that she uses is built into the black case, which also contains medical accessories. Although the professionals present see advantages in the two-stage treatment process they have just witnessed, they also spot critical issues. These relate primarily to the role played by the nurse, whose task load has increased as a result of the technological support. Collecting users’ knowledge Digital care models are an issue that needs to be urThe protagonists are nurses, doctors and staff mem- gently addressed. Gaining experience with them is the bers. There are actors too. Although they lack the patients’ only way of determining which tools are needed and how experiences, their feelings during the role- play exercise they should be handled. Nurses assume a central role are important indicators. “ Simulation is a very valuable as the interface between patients, their families and the technique in design research, ” says Minou Afzali, Head of hospital. It is important to share their knowledge with the Research at the SCDH. “ Experiencing these scenes first technology developers. “ They need to develop technolohand is a good starting point for a discussion. ” gies that help us help patients, ” says the medical infor- →

Hochparterre special issue, January 2025 — Inside the super lab — “ What would Florence Nightingale think? ”

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Technical progress means that some day, patients will only be hospitalised if they have no other option.

“ What would Florence Nightingale think about all this ? ” Nirit Pilosof, Head of Research at Sheba Medical Center in Israel, asks the group. She is another of the symposium organisers. “ She’d certainly appreciate having technology that provides so much data to help design surroundings.” Florence Nightingale, a British nurse and statistician who died in 1910, is regarded as the founder of modern nursing. One of the things she worked on was how surroundings affect health.

Remote care Being able to stay in the familiar surroundings of their own home has a positive impact on patients’ recovery. Studies show that people who receive “ Hospital at Home ” care spend less time in bed and return to health more quickly. The suitability of this treatment approach is determined by the nature of the patient’s disease and their home situation. While home care is widespread among senior citizens in Switzerland, it does not extend to acute care. Other countries, such as Norway, Israel or Japan, are at a more advanced stage here. Spurred on by the pandem→ matics specialist and former nurse who played the role ic, Switzerland is now also keen to make progress. Techof the district nurse. It is clear that the black case with the nical progress means that some day, patients will only be built-in screen does not take account of nurses’ needs – it hospitalised if they have no other option. Everyone else weighs in at twelve kilograms, hardly practical for people could be treated at home. Patient well-being is not the sole consideration. The who spend their days criss-crossing towns and cities to new model also promises to relieve pressure on hospivisit patients. tals and could potentially deliver cost savings. However, initial findings show that it is above all time-consuming Designing hybrid rooms The simulation has raised a lot of technology-related and staff-intensive. A Zurich media outlet reported in May questions. However, physical space is an important fac- that an expert claimed this situation could improve with tor too. In many places it lags behind the pace of develop- growing experience and efficiency. The same expert also ment. Hospitals are often very short of offices and there praised the United Kingdom, where “ four specially trained are rarely any for nursing staff. So where will the video nurses can take care of up to 60 patients simultaneously calls that are an essential part of telemedicine take place? using electronic monitoring.” While it is doubtful whether If they take place in an environment where there is a lot this is a desirable scenario, it does not alter the potential of noise and visual distractions, patients are unlikely to of remote care. No one at the SCDH doubts that the techfind the experience inspires trust. Yet trust is essential to nologies in question will soon be in use. That’s why they successful treatment. Factors such as light, colours or ma- want to make sure that they are implemented in a way that terials and the effect they have on users’ experience can benefits users. And that planners, architects, designers be tested in the “ realistic testing spaces ”, as the mock-up and software developers learn to think from the perspecflats are known within the SCDC. tive of care providers and patients. More important though is the ability to put treatment procedures to the test in these facilities. Although patients do not physically enter an office or surgery during a remote consultation, the design of those spaces is nevertheless fundamentally important. The way they are fitted out needs to be carefully planned and attuned to a range of scenarios. If a therapist is conducting an online consultation from a sofa, the screen needs to be at eye level and the design of the furnishings has to be appropriate. After all, doctor and patient also look each other straight in the face during a physical consultation. “ Therapy and technology should be thought of together because they form a system, ” is how a psychoanalyst in attendance sums it up. “ The technology shouldn’t only be implemented afterwards ”. Hospitals are becoming increasingly hybrid places, built for both conventional and digital healthcare delivery. Just how complex planning them will be becomes apparent at the SCDH. You only need to imagine the user journey that goes with a digital consultation, starting with the wait in the practice’s digital waiting room, to get an idea of how much thought and care the team has put into preparing the script for the test scenarios. The focus is precisely defined. “ In an operating theatre, for example, the risk of infection plays an important role, whereas in a care home residents’ safety tends to be the main consideration, ” says Minou Afzali.

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If a therapist is conducting an online consultation from a sofa, the screen needs to be at eye level and the design of the furnishings has to be appropriate.

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Which patients will be admitted to hospital in the future and what facilities will they find there ?

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Experience, discuss, refine

The SCDH offers services in its three areas of activity – “ Visual communication ”, “ Objects and environment ” and “ Systems and processes ” – from analysis, consulting and continuing education to simulation and co-prototyping. An overview of current projects. Photos: SCDH

A new acute-care hospital A project competition was held in 2023 as part of a quality-assurance process for the new-build Biel-Brügg hospital. This will be a compact acutecare hospital with around 200 beds, and the design takes particular account of the likely future transition to out-patient treatment. Process optimisation considerations dictate that the new building must be clearly distinct from out-patient services and geared to in-patient and technical services. Workshops are being held with users in the SCDH’s Extended-Reality Simulation Area to review and optimise the new hospital’s floor plans using projections, lightweight partitions and context-specific furnishings and mock-ups. The workshops focus on patient safety, staff well-being and work processes. The simulations cover patient rooms and corridors, operating theatres with pre-op and recovery rooms, the emergency and intensive care units, as well as the radiology and out-patient departments. The findings from the simulation workshops will be used to further flesh out the design of the new hospital. Simulation workshops for new-build Biel-Brügg hospital, 2025-2026 Activity area: “ Objects and environment ” Offering: Services Platform: Extended-Reality Simulation Area

Rethink during the design process How should we design the hospitals of the future? This was the question addressed by the “ Hospital design and care delivery ” workshop. In her opening presentation, simulation expert and critical care medicine physician Nora Colman see “ Simulation improves architecture ”, page 14 addressed the three most important considerations in hospital design: Patient safety, operational design and architectural design. Several times, discussions between participants brought country-specific differences to light as regards the planning and design challenges of hospital new-build and modernisation projects. However, constructing healthcare institutions, particularly hospitals, is a highly complex undertaking everywhere. Dealing with this complexity requires the involvement of all stakeholders, as well as a design approach driven by an ongoing dialogue and decision process. Hospital management also needs to be trained to better understand architectural design processes, while architects need a better comprehension of hospital operating processes. Following fascinating breakout sessions and full-group discussions, attendees used the second day to familiarise themselves with simulation techniques in the Extended-Reality Simulation Area and evaluate and optimise spaces and processes at 1 : 1 scale. “ Hospital design and care delivery ”, June 2024 Activity area: “ Objects and environment ” Offering: Continuing education Platform: Extended-Reality Simulation Area

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Optimal extension The Hasliberg rehabilitation clinic is known for the work it does in rehabilitating patients with general medical, oncological, psychosomatic and musculoskeletal issues. The clinic has around 80 beds 2024 symposium and is planning various construction activities, inMembers of the Scientific Board, International cluding the renovation of two floors and an extenAdvisory Board, SCDH team and invited guests sion with 20 new rooms. The new infrastructure came together in July 2024 for the third SCDH is scheduled to open in May 2028. In preparasymposium. The event focused on developments tion for the renovation and new build, the people in remote care and the integration of telemediinvolved in the construction process joined a cine technologies in hospitals and patients’ home team from the SCDH on a visit to REHAB Basel. environment. The presentations and subsequent This clinic specialises in neurorehabilitation and discussions provided insights into the interaction between remote care technologies and the built paraplegiology, treating patients and helping them return to a worthwhile life. Despite the highenvironment and the effect on human experience. ly complex clinical environment, the clinic attachThese were followed by live simulations of varies great importance to ensuring patients feel at ous remote care scenarios in the Extended-Reease during their stay, which can often last sevality Simulation Area and in the realistic testing eral months. Designed by architects Herzog & de spaces of the Living Lab. Various public presMeuron in 1999, the clinic is an example of good entations and a panel discussion rounded off the design practice for Swiss hospitals. The concept symposium. The SCDH’s aim is now to translate and philosophy behind the building have stood the findings of the symposium into recommendathe test of time extremely well. Following their extions and guidelines that will provide information cursion to Basel, the representatives of the Hasfor decision makers, healthcare managers, archiliberg rehabilitation clinic visited the SCDH’s Livtects, designers, developers of new technologies ing Lab for a training session in, and to raise their Sitting better and medical staff, and enable them to exploit the awareness of, health-promoting architecture. The commune of Muri bei Bern wants to make its full potential of remote care models. public spaces more appealing to its elderly citiHealth-promoting architecture for zens, who, among other things, would like circular 2024 symposium: Remote Care, July 2024 Hasliberg rehabilitation clinic, December 2023 Activity area: “ Objects and environment ”, walking routes and seating areas that are suited Activity area: “ Objects and environment ” “ Systems and processes ” to their needs. In preparation for a public vote, the Offering: Continuing education, simulation Offering: Consulting Platform: Extended-Reality Simulation Area SCDH built a bench designed by the komform Platform: Extended-Reality Simulation Area, agency as both a mock-up and prototype. Devel- realistic testing spaces opment work factored in age-equitable properties, cross-generational use, low-cost production and the need for the commune’s engineers to be able to disassemble and maintain the bench. The SCDH’s prototype is being tested alongside an existing municipal bench and one designed by the senior citizens’ council and the public. Age-sensitive seating, autumn to winter 2024 Activity area: “ Objects and environment ” Offering: Services Platform: Simulation and co-prototyping

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Real-world website testing What does a user-friendly website look like ? This was the question asked by SCDH experts, the “ Oncology Care ” academic association, Eastern Switzerland University of Applied Sciences, Insel Gruppe hospital company and St. Gallen Cantonal Hospital when they reviewed Oncology Care Switzerland’s website. They looked at where it is difficult to find certain information and what could be done to improve the legibility and comprehensibility of the user interface on Onkologika.ch. In keeping with the SCDH’s participatory approach, users from various care settings and regions of Switzerland were involved. The first step was to conduct a design analysis. This found that a more contrasting typeface would improve the legibility of the landing page, “ last updated ” dates would improve the transparency of information sheets and navigation aids and filters would bring a clearer hierarchy to the user journey. The second step involved an online survey of 60 nurses to obtain information on what users expect from Onkologika.ch. The results of the design analysis and online survey were discussed in workshops with nurses and the team from Onkologika.ch. A final report for Oncology Care Switzerland summarised the results and provided specific recommendations for improving the website.

New surgical centre To safeguard Bülach hospital’s future, its operators are endeavouring to actively develop its offerings and expand its range of in-patient services. The key project is an out-patient surgical unit sited on the hospital campus. Planning for the surgical centre in the new treatment wing reached the detailed design stage in spring 2023. A simulation workshop, attended by the hospital’s surgical teams, the architects carrying out the design work and the SCDH’s experts, was held to evaluate the floor plans for the surgical centre. The simulation workshop identified the architectural challenges associated with the construction project in terms of patient safety, staff well-being and the establishment of frictionless operational procedures. The findings were incorporated into ongoing design activities for the surgical centre. Surgical centre simulation workshop Bülach hospital, March 2023 Activity area: “ Objects and environment ” Offering: Simulation and co-prototyping Platform: Extended-Reality Simulation Area

Materials collection

Usability analysis of Onkologika.ch, April 2023 to January 2024 Activity area: “ Visual communication ” Offering: Analysis Platform: At client premises

The SCDH’s materials collection is a platform for curated materials that promote health. Choosing the right materials for any new-build or refurbishment project is a major challenge. The materials have to satisfy varying, sometimes very stringent and specific requirements. The SCDH’s materials collection is a tool that planners, designers and architects can use to simplify research, select suitable materials more easily and obtain an in-depth understanding of the materials and how they are used. All materials are validated against current research findings and experience, accompanied by detailed information and shown in their real-world setting. The collection offers digital and physical tools, a growing knowledge base, evidence-based planning aids and events. Materials collection, January 2025 Activity area: “ Visual communication ”, “ Objects and environment ” Offering: Analysis, consulting, simulation and co-prototyping Platform: Materials collection

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What role will people play in the hospital of the future ?

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Inside the super lab At the Swiss Center for Design and Health ( SCDH ) in Nidau, anyone who designs, plans, builds or works in the healthcare sector can test, review and optimise groundbreaking projects. The spacious facilities at the SCDH are a place for professionals to develop a shared perspective in pursuit of one goal: To use design to improve the health and well-being of our society. www.scdh.ch

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