Dissertation - Grace Jenkins

Biophilia in the Hospital Architectural Typology: Implementation and Impact Grace Jenkins

Bachelor of Interior Architecture Final Year Dissertation 2019

Plagiarism Declaration

Abstract This dissertation investigates the stagnant hospital architectural typology and the numerous ways in which architects can implement biophilic approaches into hospital design in order for these spaces to be beneficial to patients’ psychological state of mind.

Identification and categorisation of biophilic experiences and approaches are explored in order to understand the various approaches to biophilia and the numerous benefits these approaches have on patients’ psychological wellbeing. Key influences, both scientific and political, of the hospital typology are explored in order to understand the aesthetic and layout evolution of the typology. Various case studies are utilised to emphasise the drastic typology change which has occurred in hospital architecture.

In order to break away from unsuccessful hospital design, ethical design is discussed with emphasis on the need for new teaching strategies within architectural institutions in order to generate architects of the future that have a strong understanding of human-centred design. This theoretical framework is used to analyse two twenty-first century case studies that have successfully utilised biophilic approaches in order to beneficially improve patients’ mental state of mind.

Through this insight into biophilic design and hospital typology, it is evident that it is the responsibility of architects to not only design hospital spaces that are functional but also to design spaces that are beneficial to the patient’s psychological state of mind through implementing a variety of biophilic approaches.

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Acknowledgements I would like to express my deepest thanks to my supervisor Dr Belinda Dunstan for her enthusiasm, patients and guidance through the development of this dissertation. My greatest thanks is also extended to Colleen Hutchison, Catherin Bull and Nicole Porter for their help in gathering valuable resources needed to undertake this dissertation.

A special and warm thanks to Peter Jenkins for his time and effort in proofreading this dissertation and Susannah Jenkins, Justin Brunner and Phoebe Jenkins and for their constant encouragement and support.

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List of Figures Page

Figure 1.

Private patient room at Schoen Clinic (2018), London, United Kingdom, designed

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by Formula Interiors (Source: Formula Interiors 2019, IAG delivers first highlyspecialised hospital in London for German owned group Schoen Clinic, photograph,

Formula

Interiors,

20th

viewed

October

2019,

<https://www.isgplc.com/en/news/isg-delivers-first-highly-specialised-hospitalin-london-for-german-owned-group-schoen-clinic>) 2.

English Wych Elm (Source: Cris Veneer: wood and more, Blur Elm, photograph, Cris

Veneer:

wood

and

more,

viewed

17th

October

2019,

13 13

<https://www.crisveneer.com/en/avada_portfolio/burr-elm/>) 3.

Basílica de la Sagrada Família (not completed), Barcelona, Spain, designed by

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Antoni Gaudı (Source: Barcelona Turisme, Basílica de la Sagrada Família, photograph,

Barcelona

Turisme,

viewed

20th

October

2019,

<https://www.barcelonaturisme.com/wv3/en/page/2335/basilica-of-la-sagradafamilia.html>) 4.

Forest in spring, United Kingdom (Source: Trev 2011, English woodland in springtime,

photograph,

flicker,

viewed

19th

October

2019,

16 16

<https://www.flickr.com/photos/8636448@N04/5646263413>) 5.

Ward K of Armory Square Hospital, Washington, DC in 1865 (Source: PBS, 1865,

19 19

Behind the Lens: A History in Pictures, photograph, PBS, viewed 26th October 2019,

<http://www.pbs.org/mercy-street/uncover-history/behind-lens/hospitals-

civil-war/>) 6.

Ward 8A and 8B of the Mater Hospital in Brisbane, designed by Formula Interiors

21 21

(Source: Formula Interiors (2018) Mater Hospital Brisbane – Ward 8A & 8B, Formular

Available

Interiors.

at:

<https://www.formulainteriors.com.au/projects/#mater-hospital-brisbane-ward8a-8b >) 7.

Exterior of the Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects (Source: True, J 2018, Haraldsplass Hospital new main building, photograph, C.F. Møller Architects, viewed 2nd November 2019, <https://www.cfmoller.com/p/Haraldsplass-Hospital-new-ward-buildingi2862.html>) 3

23

8.

Diagram that shows direction of natural light and views in Haraldsplass Hospital new

24 24

main building (2018), Bergen, Norway, designed by C.F. Møller Architects (SourceTrue, J 2018, Haraldsplass Hospital new main building, photograph, C.F. Møller

Architects,

2nd

viewed

November

2019,

<https://www.cfmoller.com/p/Haraldsplass-Hospital-new-ward-buildingi2862.html>) 9.

Interior view of north atrium in Haraldsplass Hospital new main building (2018),

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Bergen, Norway, designed by C.F. Møller Architects (Source: True, J 2018, Haraldsplass Hospital new main building, photograph, C.F. Møller Architects, viewed 2nd November 2019, <https://www.cfmoller.com/p/Haraldsplass-Hospitalnew-ward-building-i2862.html>) 10.

View looking up to skylights in north atrium in Haraldsplass Hospital new main

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building (2018), Bergen, Norway, designed by C.F. Møller Architects (Source: True, J 2018, Haraldsplass Hospital new main building, photograph, C.F. Møller Architects, viewed 2nd November 2019, <https://www.cfmoller.com/p/HaraldsplassHospital-new-ward-building-i2862.html>) 11.

View from meeting room of north atrium in Haraldsplass Hospital new main

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building (2018), Bergen, Norway, designed by C.F. Møller Architects (Source: True, J 2018, Haraldsplass Hospital new main building, photograph, C.F. Møller Architects, viewed 2nd November 2019, <https://www.cfmoller.com/p/HaraldsplassHospital-new-ward-building-i2862.html>) 12.

Private patient room at Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects (Source: True, J 2018, Haraldsplass Hospital new main building, photograph, C.F. Møller Architects, viewed 2nd November 2019, <https://www.cfmoller.com/p/Haraldsplass-Hospital-new-wardbuilding-i2862.html

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28

13.

Gartnavel Hospital Maggie’s Centre (2011), Glasgow, Scotland, designed by OMA

29

(Source: Ruault, P 2011, OMA designed Maggie Gartnaval Opens Today, photograph,

archdaily,

2nd

viewed

November

2019,

<https://www.archdaily.com/173513/oma-designed-maggie-gartnaval-openstoday>) 14.

Diagram illustrating circulation and line of sight at Gartnavel Hospital Maggie’s

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Centre (2011), Glasgow, Scotland, designed by OMA (Source: METALOCUS 2019, The Maggie’s Centre Gartnavel by OMA, diagram, METALOCUS, viewed 2nd

November

2019,

<https://www.metalocus.es/en/news/maggies-centre-

gartnavel-oma>) 15.

Diagram illustrating floor to ceiling windows and solid internal walls at Gartnavel

30

Hospital Maggie’s Centre (2011), Glasgow, Scotland, designed by OMA (Source: METALOCUS 2019, The Maggie’s Centre Gartnavel by OMA, diagram, METALOCUS,

viewed

2nd

November

2019,

<https://www.metalocus.es/en/news/maggies-centre-gartnavel-oma>) 16.

Kitchen at Gartnavel Hospital Maggie’s Centre (2011), Glasgow, Scotland,

30

designed by OMA (Source: maggie’s 2012, Our story, photograph, maggie’s, viewed 2nd November 2019, <https://www.maggiescentres.org/about-maggies/ourstory/2010-present/>) 17.

Diagram illustrating visual connection to surrounding landscape at Gartnavel

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Hospital Maggie’s Centre (2011), Glasgow, Scotland, designed by OMA (Source: METALOCUS 2019, The Maggie’s Centre Gartnavel by OMA, diagram, METALOCUS,

2nd

viewed

November

2019

,<https://www.metalocus.es/en/news/maggies-centre-gartnavel-oma>) 18.

Meeting space at Gartnavel Hospital Maggie’s Centre (2011), Glasgow, Scotland,

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designed by OMA (Source: Han, Y 2017, Maggie’s Centre – Garnavel, photograph, OMA, viewed 2nd November 2019, <https://oma.eu/projects/maggie-s-centregartnavel>) 19.

Small counselling room at Gartnavel Hospital Maggie’s Centre (2011), Glasgow, Scotland, designed by OMA (Source: Ruault, P 2011, Maggie’s Gartnavel by OMA,

photograph,

dezeen,

viewed

2nd

November

<https://www.dezeen.com/2011/10/05/maggies-gartnavel-by-oma/>

5

2019,

33

Table of contents Pages Abstract

1

Acknowledgements

2

List of Figures

3

Introduction

7

Chapter One: Biophilic experiences and their psychological impact on patients

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Chapter Two: Hospital typology and its influences

17

Chapter Three: A case study analysis of biophilic design

23

Haraldsplass Hospital new main building

23

Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre

28

Conclusion

35

References

37

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Introduction The majority of the world’s population will have been to a hospital at some point in their lives, whether it be birth, illness or death. Many rely on hospital care to live a long healthy life. So why has human-centred design not been incorporated into hospitals and can more considered hospital design benefit patients’ healing process? Today’s hospital designs emerged from scientific and political influences with little or no consideration of biophilic experience. This dissertation examines how the hospital typology has evolved over time to produce an undesirable space for fostering psychological healing and how it can be improved through the application of biophilic experience within a space.

Biophilia, as defined by American biologist Edward O. Willson (1929), as the ‘innately emotional affiliation of human beings to other living organisms’ (Willson, E.O 1993 p. 31). The first chapter of this dissertation identifies and categorises the many biophilic experiences that can be utilised by architects within hospital design. Leading theorists whose voices are heard throughout this chapter are Edward O. Wilson, Roger Ulrich (1946), Professor of Architecture and Centre for Healthcare Architecture at the Chalmers University of Technology, and Nikos A. Salingaros (1952), Architectural Theorist and Urbanists. The biophilic experiences that are discussed are direct, indirect and spatial experiences including the known psychological and physiological benefits of each approach. These approaches investigated are natural light, caring for plants, natural views, natural materials and their fractals, ornamentation and spatial qualities.

Chapter two investigates the historical influences on hospital design, ranging from the scientific to political views, and defines the major changes to the aesthetic and layout of the hospital typology. In particular, these changes to the typology are discussed in reference to the recommendations set out by Florence Nightingale’s 1863 guidelines for optimal hospital layout. Although Nightingale’s guidelines were written in 1863, her notions concerning the design of the hospital environment align remarkably closely with contemporary scientific findings regarding the effects of biophilia. This chapter moves through biological and scientific evolutions and how these developments have influenced government policies. The discussion leads to the evident necessity of a human-centred design within the hospital typology and the central and ethical obligations of the architect to respond and critically evaluate this typology.

Lastly, the final chapter within this dissertation focuses on two twenty-first century case studies that demonstrate the results of the evolution of hospital typology. This evolution is from its science and government lead past to the human-centred approach today. Both contemporary case studies focus on human-centred design, in particular biophilia, and are analysed in conjunction with the information discussed within chapter one. The first case study analysed is the Haraldsplass Hospital’s new main building, designed by C.F. Møller Architects (C.F. Møller Architects, 2019). This building was completed 7

in 2018 in Bergen, Norway. The second case study is the Gartnavel Hospital Maggie Centre, designed

by OMA, completed in 2011 and is located in Glasgow, Scotland (OMA, 2013). This spatial analysis explores biophilic design though the use of natural light, views, materials, fractals and spatial qualities, in particular prospect and refuge. The purpose of this spatial analysis of these two twentyfirst century case studies is to demonstrate the architects' ability to design biophilic spaces that successfully improves the patients' psychological state of mind, and hence, overall wellbeing.

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Chapter One Biophilic approaches and their psychological impact on patients Introduction The first chapter of this dissertation covers the direct, indirect and spatial links patients’ in hospitals have to the natural environment, and how these natural elements may facilitate a positive effect on patient mental wellbeing (Willson, 1993; Kellert, 1993; Ulrich, 1993; Evans, 2003; Joye, 2007; Kellert et al., 2011; Ryan et al., 2014; Salingaros, 2015; Gillis and Gatersleben, 2015; DuBose et al., 2018). According to Salingaros (2015, p. 6), ‘the best biophilic design, [is] design that effectively eliminates stress and anxiety from the built environment [and] is achieved by maintaining thoughtful connections with nature’. Through this review, this chapter explores the many ways biophilia can be introduced into built structures by architects and what must be considered in order to foster healing spaces. While a significant body of research exists concerning the resultant effects of implementing biophilia in architectural space, further research concerning implementation methodologies for architects is needed to foster these environments. Case studies of contemporary implementations will be examined in chapter three.

1.1

History

Biophilia is the human need to be connected to nature for psychological and physiological purposes (Willson, 1993; Evans, 2003; Joye, 2007; Ryan et al., 2014; Gillis and Gatersleben, 2015; Salingaros, 2015; DuBose et al., 2018). The term ‘biophilia’ was first used by Edward O. Wilson (1993, p. 40) in his 1984 book Biophilia. As Biophilia is a reasonably new term, its potential has not yet been fully discovered, however, it is evident that humans have been using biophilic elements for many years.

According to Catherine O. Ryan et al. (2014, p. 63), biophilia ‘is the codification of human intuition for what makes a space a good place for humans’.

According to Salingaros (2015, p.9), there are two ways human beings are subconsciously connected to nature. The first comes from our memory ‘from our evolution and development in the environment of the savannah long ago … The sophistication of our physical and mental development progressed over millennia without losing traces of the savannah in our inherited memory and instincts’ (Salingaros, 2015, p. 9). The second is our relationship to nature and how the geometries used within built environments cause us to relate to the visual elements as we share the same biological template (Salingaros, 2015, p. 9). In other words, we recognise artificial elements that have the same geometries to nature, this subconscious understanding of nature causes us to gravitate to these spaces.

There are many theorists, such as Salingaros, who believe architects rejected biophilia or used it sparing at the beginning of the 20th Century and it is only now that architects are starting to understand its 9

healing effects and thus employing biophilia again within their interior spaces (Salingaros, 2015, p. 20).

However, Edwards (1993, p. 31-32) believes that ‘when human beings remove themselves from the natural environment, the biophilic learning rules are not replaced by modem versions equally well adapted to artifacts. Instead, they persist from generation to generation, atrophied and fitfully manifested in the artificial new environments into which technology has catapulted humanity’.

Biophilia can be employed through the use of natural light, caring for plants, natural views, natural materials, ornamentation and spatial qualities.

1.2

Direct biophilic experiences

1.2.1

Natural light

There is much evidence that natural daylight within patient rooms affects their psychological state of mind (Verderber, 1983; Edwards and Torcellini, 2002; Evans, 2003; Barrett, 2009; Wirz-Justice and Fournier, 2010; Gillis and Gatersleben, 2015; Salingaros, 2015). More specifically, Paul Torcellini and L. Edwards (2002, p. 4), state that natural light ‘has been associated with improved mood, enhanced morale, lower fatigue, and reduced eyestrain’ within building occupants. Patients with little contact with natural light suffer from fatigue and sadness, with some suffering from clinical depression. Many patients, who have been hospitalised with chronic depression, recover faster in sunlit rooms than darker rooms (Evans, 2003, p. 541).

There are many ways natural light is psychologically beneficial to humans. Skin and eyes are two organs that require natural light (Salingaros, 2015, p. 10). These organs regulate circadian rhythms - internal clocks - by natural light (Salingaros, 2015, p. 10). Without natural light our circadian rhythm is disrupted which leads to chronic fatigue and loss of body function (Salingaros, 2015, p. 10). Another way natural light benefits mental wellbeing is the fact that it is a direct connection to the living environment outside (Edwards and Torcellini, 2002, p. 4). Patients are able to visually see the rays of light and are able to feel the warmth of the sun on their skin. According to Stephan Verderber (1983, p.

415), Professor of Architecture at the University of Toronto, natural light ‘offers a sense of spirituality, openness, and freedom from the prison-like confinements [that is a characteristic of] … windowless spaces’.

Natural light not only provides psychological and physiological benefits within patients’; it is also connected to clarity relating to depth perception and three-dimensional images which lets the patient analyse their surroundings (Salingaros, 2015, p. 10), allowing the patient to feel relaxed within the space. Natural light also has non-visual benefits that affect the patient's balance, body orientation and brain stimulation (Barrett, 2009, p. 11).

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1.2.2

Caring for plants

The introduction of plants into an interior space is the simplest definition of biophilia. Indoor plants provide psychological benefits to hospital patients (Shibata and Suzuki, 2004; Gillis and Gatersleben, 2015; Salingaros, 2015; Rappe and Lindén, 2004; Qin et al., 2014) as plants ‘directly bring green, living nature into the indoor environment’ (Gillis and Gatersleben, 2015, p. 953). Indoor plants have no connection to the design of the built structure. Studies have shown that indoor plants beneficially affect patients' pain tolerance and mental stress (Gillis and Gatersleben, 2015, p. 953). Salingaros discusses the intimate connection between plants and humans and it is this connection that nourishes the patient (Salingaros, 2015, p. 13). He states that as humans we ‘crave the companionship of plants’ and that the simple interaction nurtures the user (Salingaros, 2015, p. 13).

A study in Finland, undertaken by Erja Rappeand Leena Lindén (2004), delved into the psychological benefits seen in dementia patients when they care for indoor plants - watering, fertilising and pruning.

The results were that the plants helped patients recall memories, maintained the patient’s functional skills and made the patients more aware of time (Rappe and Lindén, 2004, p. 77). These effects all reduce stress felt by the patient. The results also showed a drop in the patient’s blood pressure a consequence of reduced mental stress (Rappe and Lindén, 2004, p. 77).

Psychological studies have also shown that there are specific plants that are most beneficial for reducing mental stress. One study, undertaken by Jun Qin, et al. (2014, p. 721), at the Shanghai Jiao Tong University in China, found that the most beneficial plants for reducing stress are green, have a light sent and are small in size.

1.2.3

Natural views

Views of natural environments are considered to be psychologically and physiologically healing (Ulrich, 1984; Ulrich et al., 1991; Ulrich, 1993; Evans, 2003; Edwards and Torcellini, 2002; Ryan et al., 2014; Salingaros, 2015; Gillis and Gatersleben, 2015). Many theorists, in particular, Ulrich, have undertaken studies on the mental and physical health benefits of different views from hospital rooms (Ulrich, 1984). According to Ulrich (1993, p. 90), views of looking down a grassy slope to green leafy plants, bodies of water and flowering plants reduced stress within patients, thus they recovered faster than those who had a view of the built environment. However, according to Ryan et al. (2014, p. 65), the most preferred view also consists of a hint of human inhabitation. These particular images on landscapes are ‘unthreatening … [thus] promote faster and more complete restoration from stress’ (Ulrich, 1993 p. 102). Results showed that patients had lower blood pressure, relaxed and less stressed psychologically and physically, all resulting in faster patient recovery (Edwards and Torcellini, 2002,

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p. 4). Ulrich (1993, p. 90) has also found that only a short amount of time spent viewing nonthreatening natural scenes can provide relief from slight and severe stress.

According to Gary W. Evans (2003, p. 545), Professor of Human Ecology at Cornell University, suggest that these same mental benefits from natural views are also found when patients are able to view indoor plants and landscape artworks. Ulrich (1993, p.105) has also undertaken studies on the effects landscape artworks have on a patient’s mental wellbeing. According to Ulrich (1993, p. 105), ‘patients felt less stressed on days when a large mural depicting a spatially open natural landscape was hung on a wall of the waiting room in contrast to days when the wall was blank’. Leading us to believe that images of nature can also be used to improve mental welling in patients when it is not possible to provide them with a natural landscape view.

1.3

Indirect biophilic experiences

1.3.1

Materials

Introducing natural materials into an interior space is another biophilic method that influences a patient’s psychological state (Nyrud, Bringslimark and Bysheim, 2014; Gillis and Gatersleben, 2015).

There is little information found on how and what natural materials influence a patient’s mental wellbeing (Gillis and Gatersleben, 2015, p. 955). However, there was one study undertaken that explored the amount of one natural material required to produce a result. This study, undertaken by Ander Q. Nyrud, et al. (2014), at a Norwegian hospital, only used wood as the natural material, as it has the most biophilic qualities – pattern and colour. As observed in [1, Fig. 1], the type of room that was most beneficial to a patient’s mental wellbeing was a room with a wooden floor, one wooden wall and wooden furniture (Nyrud, Bringslimark and Bysheim, 2014, p. 128). It was thought to have been the overwhelming amount of detail within the grain of the wood that caused patients to mentally react negatively to a room completely covered in wood (Nyrud, Bringslimark and Bysheim, 2013, p. 129).

These details are called fractals.

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Figure 1: Private patient room at Schoen Clinic (2018), London, United Kingdom Fractals – ‘repeating patterns when viewed at increasingly fine magnifications’ (Hagerhall, Purcell and Taylor, 2004, p. 248) – are commonly seen within nature (Hagerhall, Purcell and Taylor, 2004; Ryan et al., 2014; Salingaros, 2015). Fractal geometries can be seen within materials used in buildings, such as the grain of stone and wood (Ryan et al., 2014, p. 68). An example of fractal geometry can be seen within the wood grain shown in [2, Fig. 2]. According to Salingaros (2015, p.28), the use of these natural materials with fractal geometry provides information through symmetry, patterns and order which in turn causes reduced mental stress within the viewer. The reason for this is due to the fact that ‘our survival mechanisms are tuned to relax upon feeling the influence of certain patterns and symmetries characteristic of an accommodating environment’ (Salingaros, 2015, p. 28). Fractals within natural materials create details that need to be viewed at close distances so that the information from the most minute details through sight and the texture of these details to be felt can be collected (Salingaros, 2015, p. 12), positively influencing psychological states.

Figure 2: English Wych Elm depicting blur grain fractals 13

1.3.2

Ornamentation

The use of biophilia to improve mental wellbeing can also be viewed within an artificial space through the use of ornamentation, which is often directly copied from nature (Joye, 2007; Gillis and Gatersleben, 2015; Salingaros, 2015). There are two forms of ornamentation – natural and abstract (Salingaros, 2015, p. 25). Although both are very different forms, they both positively reduce psychological stress (Salingaros, 2015, p. 25). Abstract ornamentation does not mimic nature however it does follow the elements of contrast, balance and detail seen within nature (Salingaros, 2015, p. 25).

According to Yannick Joye (2007, 314), some reasons as to why ornamentation can cause psychological benefits is because it is associated with nature, visual symbols of nature and geometry seen within nature. Salingaros (2015, p. 26) further explains this by stating ‘positive, healing response to our environment occurs whenever we perceive in our surroundings certain characteristics akin to the organized complexity of nature common to traditional ornament’.

Fractals that are seen within nature can also be applied to architecture to create a psychological healing environment and is generally viewed in historic buildings (Joye, 2007; Ryan et al., 2014; Gillis and Gatersleben, 2015; Salingaros, 2015). According to Salingaros (2015, p. 12), humans expect to observe fractal details within artificial spaces, thus, the lack of detail within a space causes us to view the space as ‘chaotic’, and not easily understood or read; as a result stress levels are heightened. An example of biophilic ornamentation can be seen in Antoni Gaudı’s (1856 - 1926) Basílica de la Sagrada Família (not completed), Barcelona, Spain [3, Fig 3], where the fractals on the ceiling becomes a leafy canopy and the columns sybolise tree trunks.

Figure 3: Ceiling of Antoni Gaudı’s Basílica de la Sagrada Família (not completed), Barcelona, Spain

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According to Ryan et al. (1983, p. 170), fractals that are generated in nature have a fractional dimension of 1.3 to 1.8 (fractal dimensions measure the complexity of the line (how many angles the line has) and generally for plane fractals this dimension lies between 1 and 2 (Joye, 2007, p. 315; Ryan et al., 2014, p. 68). According to Christopher Alexander, these forms that copy complex organisation and geometric properties of living plants are ‘living structure[s]’ (Salingaros, 2015, p. 25).

1.4

Spatial biophilic experiences

1.4.1

Spatial qualities

Spatial connection to nature provides psychological healing qualities (Gatersleben and Andrews, 2013; Gillis and Gatersleben, 2015; Salingaros, 2015). Spatial qualities that are considered biophilic are forms, spaces, and structures that can be seen universally in nature (Salingaros, 2015). Biophilia can also be introduced into artificial spaces through the use of prospect and refuge- clear lines of vision and concealment (Gillis and Gatersleben, 2015, p. 956).

A study was undertaken by Birgitta Gatersleben (2013), Senior Lecturer in School of Psychology at the University of Surry and Matthew Andrews (2013), which examined the different natural environments and their psychological healing effects on the user. These environments consisted of different levels of prospect and refuge (Gatersleben and Andrews, 2013). This can be seen within spaces in many different ways, however one example is sitting or standing with ones back against a wall and having a view to the rest of the room or raised above other points in the building. The results were that ‘environments with high levels of prospect and low levels of refuge [are] more restorative because they demand less attention to find one's way, to identify possible dangers or to avoid tripping over. Such an environment is associated with less threat and fear’ (Gatersleben and Andrews, 2013, p. 99), thus reducing mental stress. Such spaces are called medium prospect and refuge spaces (Gatersleben and Andrews, 2013).

An example of medium prospect and refuge within nature can be seen in [4, Fig. 4).

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Figure 4: Medium prospect and refuge, forest in spring, United Kingdom According to Catherine O. Ryan et al. (2014, p. 69), prospect views must be a ‘minimum of 6 meters and … incorporate information-rich prospect view[s] by designing with or around an existing or planned savannah-like ecosystem, body of water, and evidence of human activity or habitation’.

Conclusion This chapter has explored the many ways architects can introduce biophilia into the built environment in order to create healing qualities. These natural and architectural elements have been reinforced through the use of studies and theories throughout this chapter. According to Salingaros, biophilic architecture is recognised within humans, however, today's education rejects it due to the fact that the designs ‘look old-fashioned’ (Salingaros, 2015, p. 34). Thus is it important to bring biophilic design into the light as architscts must ustilise these biophilic experience in order to create ethical spaces that benefit the user. Architects must push back against the old fashioned ideas in responce to new research.

These ideas - scientific, political and human centred influences will be further ecxplored within chapter two.

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Chapter Two Hospital typology and its influences Introduction Within the architectural landscape, the typology of hospitals has changed dramatically over the years (Verderber et al., 2000; Kisacky, 2005, 2013, 2019; Adams, 2008; Burpee, 2008; Tesler, 2018).

Typically, these changes to the typology have been scientific and government-led. Contemporarily, the influence of architectural thinking has seen a rise of human-centred design. Architects are starting to design for greater and more diverse human needs beyond the physical, thus creating spaces that reduce mental stress. This chapter explores these influences that led to hospital design changes throughout American history. The influences discussed within the chapter originated in America and these ideas have been internationally adopted. Photographs of historical and modern hospitals are used throughout this chapter to illustrate the ideas explained. Throughout this chapter, it is evident there is a rise and fall of biophilia within architecture. As biophilic spaces beneficially impact the users’ mental state it is important that architects critically engage with, and challenge, the current way of think and lead a strong movement into human-led design.

2.1

Scientific influences

As early as the third millennium BC (Tesler, 2018, p. 1), religious orders looked after the infirmed in hospitals, while the sick were looked after in their homes (Kisacky, 2017) and this was the case until the nineteenth century (Tesler, 2018, p. 3). According to Nancy Tomes (1998) in the late 1700s, the transmission of disease was due to bad air ventilation – Miasma Theory. It was thought that by creating a clean and pure environment within the wards the mortality rate of patients would improve (Burpee, 2008, p. 1; Kisacky, 2013, p. 84). As a result, hospitals were designed around the patient, natural light and the most important factor maximising the fresh air flow through the building to reduce miasma – bad air that carried airborne disease (Kisacky, 2013, p. 86). In the early 1870s views on disease prevention were based on the worry of airborne diseases floating on dust – Germ Theory (Kisacky, 2013, p. 86). These views resulted in hygienic design (Burpee, 2008, p. 1) – a space that is easily disinfected (Kisacky, 2013, p. 90).

Florence Nightingale (1820 – 1910), American founder of modern nursing (Burpee, 2008, p. 1), developed the pavilion hospital design that was centred around the masima and germ theories (Nightingale, 1863). The pavilion plan consisted of a centralised corridor with the wards (pavilions) running perpendicular to the corridor (Burpee, 2008, p. 1). Each pavilion housed 30 to 40 patients in one large single room (Adams, 2008, p.10) and became its own small hospital.

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In Nightingale's book, Notes on Hospitals (1863), she meticulously details what needs to be done by architects and designers to achieve a hygienic hospital. Such headings seen within her book are; the type and care of linen, the number of beds to a single-window and water supply. According to Nightingale (1863, p. 67), ‘one window at least should be allotted for every two beds; the window to be not less than 4 feet 8 inches (1.42 meters) wide, the sill within 2 feet (61 centimetres) or three feet (91 centimetres) off the floor, so that the patient can see out, and up to within a foot (30 centimetres) off the ceiling’. She further details the position of windows in the ward to be opposite each other, the material and colour the window frame should be and the particular glass that should be specified (Nightingale, 1863, p. 67). High ceilings were preferred as it facilitated an increase in airflow (Nightingale, 1863, p. 152) Nightingale (1863, p. 68) also mentions that diseased airborne organisms could cling to surfaces.

According to her, the walls and ceiling should be covered in a durable white material that can withstand being polished and frequently washed with water and soap (Nightingale, 1863, p. 68). The woodwork must be ‘polished or varnished wainscot oak’, as it is durable and uniform in colour (Nightingale, 1863, p. 68). As wood is a porous material polish or varnish was to be used to eliminate the absorption of germs. Polish and varnish also meant a surface was able to be easily cleaned (Nightingale, 1863, p. 68).

Wood was also used for the floors; oak wood or pine wood was preferred; however, tiles were also acceptable (Nightingale, 1863, p. 69). Light colours were selected for all materials as it meant they ‘looked clean’ (Kisacky, 2013, p. 85). The furniture used within the wards were specified as oak furniture (Nightingale, 1863, p. 79). All finishes needed to be plain, joints seamless, details smooth and corners rounded to create a space that can be easily cleaned and disinfected. It was clear to John Maynard Woodworth, the first American general surgeon, that the wards ‘should be free from all unnecessary angles and ornamentation upon which dust would be liable to lodge’ (Kisacky, 2013, p.

85) These architectural qualities have been illustrated in [5, Fig. 5]. It is evident there is a strong link to biophilic experience mentioned in chapter one. Although these experiences have been used for other reasons, for example hygienic design, they still provided biophilic benefits that might not have been understood at the time, such as the inclusion of natural materials, a view to the landscape and natural air flow and light.

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Figure 5: Interior of Ward K of Armory Square Hospital, Washington, DC in 1865 2.2

Political influences

Nightingaleâ&#x20AC;&#x2122;s pavilion hospital plan became internationally adopted by the late nineteenth century (Kisacky, 2019, p. 9), however the growth of medical knowledge and the introduction of new medical technologies meant that the pavilion plan no longer suited the needs of staff and patients (Kisacky, 2013, p. 86). Medical care moved from the home and into hospitals, which catered for all who needed medical attention as a way to bring medical attention to all. Hospitals became a place where people were sent to get better and live, in contrast to the historical practice where they were considered a place where people were sent to die (Kisacky, 2019, p. 288). The poor were placed in large wards whereas the wealthy were placed in private rooms (Kisacky, 2019, p. 290).

At the beginning of the twentieth century the introduction of new technology and medical care lead to pavilions becoming dependent on each other (Kisacky, 2013, p. 86). This communication between pavilions was difficult as it compromised the isolation of disease (Kisacky, 2013, p. 86). Thus, it was thought that high-rise hospitals would be a perfect balance of communication between the pavilions whilst still isolating patients (Kisacky, 2013, p. 87). This shift in design was called aseptic design.

According to Jeanne Kisacky (2013, p. 90), aseptic design â&#x20AC;&#x2DC;added the need to control the movement and interaction of goods, people and air. Aseptic materials and details facilitated decontamination; proper placement of walls, barriers and decontamination fixtures prevented germs migrating from the infected areas of the hospitals to the cleanâ&#x20AC;&#x2122;.

Aseptic design meant that all details and joins must be seamless and flush (Kisacky, 2013, p. 90). This meant that there was no ornamentation - walls had to meet flush to the floor and ceiling and door and window trims had to be placed into the walls (Kisacky, 2013, p. 90). Aseptic materials consisted of plaster walls covered in a hard-white enamel paint and a flooring material that was non porous, would 19

not crack, consistent in colour, easily cleaned and most importantly ‘germ proof’ (Kisacky, 2013, p.

90). Glass was considered the ‘king of aseptic materials’ as it was seamless, resilient and allowed light in that made the dirt immediately visible ( Kisacky, 2013, p. 90). Furnishings were to be plain and made of iron (Kisacky, 2013, p. 90) as they could be easily wiped down.

After World War II there was an increase in hospital construction as there were many communities without access to medical services (Kisacky, 2017, p. 1). The urgent need for hospitals meant that there was little time to rethink the hospital layout. The Hill Bruton Act was introduced to set a standardisation of hospitals across America. This act meant that hospitals had to be designed according to the pre-war designs. If an architect or client desired a more innovative design the government would not fund it.

Accordingly, many out of date hospitals were built (Kisacky, 2017, p. 4).

Scientific influences impacted political views of the time, thus both influences became intertwined. The introduction of antibiotics meant that patients were no longer dying from infections (Kisacky, 2017, p.1). This led to design choices that artificially provided comfort and a controlled environment, such as the introduction of air conditioning, small windows that could not be opened and ultraviolet lighting (Kisacky, 2017, p. 3). According to Kisacky (2017, p. 3), the introduction of antibiotics ‘provided an effective treatment rather than an effective prevention’.

These types of hospitals were known as deep plan hospitals. This design moved away from the patients' health and comfort and focused on efficiency (Burpee, 2008, p. 2). These buildings have become larger and taller over time, which limits access to natural views, air, and light. According to Heather Burpee (2008, p. 2), architects ‘are still building hospitals with very deep floor plates and subterranean spaces with little or no relationship to the outside environment’. These hospital designs have become internationally employed.

Ward 8A and 8B of the Mater Hospital in Brisbane [6, Fig. 6], designed by Formula Interiors, is a dementia ward that has been designed with the focus on bettering infection control and improving the wellbeing of the nursing staff (Formula Interiors, 2018). As seen in [6, Fig. 6] there is a lack of all biophilic experiences mentioned in chapter one. One biophilic experience that is known to benefit patients’ with dementia is the use of natural light within the space as it helps them to remember the time of day (Linebaugh, 2013, p. 16). Views of natural scenery also helps patients’ with dementia to remember the time of year (Rappe and Lindén, 2004, p. 80). By incorporating these two biophilic elements within a space, the patient is mentally relaxed as they are able to gain some control over their own memory. As illustrated in [6, Fig. 6] there are two small windows located at one end of a long room that caters to four patients. This design is also very different from what Nightingale (1863, p. 67) stated within her book where each patient must have access to a window that provides natural light and views.

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Figure 6: Ward 8A and 8B of the Mater Hospital in Brisbane, designed by Formula Interiors

2.3

Human-centred design

It is the architect’s responsibility to design spaces that are beneficial to the user (Ellis, 1986; Wasserman, Sullivan and Palermo, 2000; Di Cintio, 2014; Cuff and Murry, 2017), thus the architects’ role is to design spaces that give consideration to human ethics. According to Barry Wasserman, et al.

(2000, p. 17), architecture and ethics are linked as it is ‘the processes of designing and constructing our habitat, with the presumed intention of improving the quality of life, implicitly require a judgment of the “right” thing to do’. In this role, architects have taken on the ethical responsibility to serve all members of the community (Wasserman, Sullivan and Palermo, 2000, p. 78). Thus, it is important for architects to become activists and demonstrate the path that needs to be followed in order to created stress-reducing environments but responding to emerging research concerning the benefits of biophilia, within the hospital typology (Di Cintio, 2014, p. 2).

As evident within [6, Fig 6] architecture has moved away from benefiting the users' mental state of mind. To return to human- centred design that benefits every aspect of human wellbeing, a change must occur. According to many (Di Cintio, 2014; Salingaros, 2015; Cuff and Murry, 2017), this change must start with the institutions that are teaching our future architects. It is important that these institutions provide new ways to practice and learn. Students have been taught how to satisfy the clients' needs, for example through designs that generate cash flow and further the client’s agenda. Whilst it is important to consider the client’s needs, it is also vitally important to consider the users' needs as well. According to Salingaros (2015, p. 14), by ‘bringing … living qualities back into architecture’s toolbox, we can 21

better incorporate healing strategies’ within future designs. According to Dana Cuff (2017), architecture students must ‘take the opportunity to act with conviction ... toward creating the world we want to live in. Students are the architects of the future; thus, they must have an understanding of the current world issues that need design solutions. As mentioned by Cuff (2017), students must design to the needs of the user, thus providing better quality of life, ‘that’s exactly what it means to … act like an architect’.

Students' learning needs to adapt to current issues to achieve a positive change to produce ethical architecture (Di Cintio, 2014, p. 2).

Biophilic experiences within designs have been filtered out of hospital design for many reasons as discussed previously in this chapter. However, one main reason that hospitals today lack these biophilic experiences, is due to the emotional distance the architect holds to the project. One way architects are hindering this connection to the environment being created is the use of computer-aided design software (Salingaros, 2015, p. 14). According to Salingaros (2015, p. 14), such software ‘have sidelined the traditional roles of immediate feeling and mutually adaptive response in generating architecture’.

As hospitals require high sanitary levels, which may be affected by biophilic experiences, architects have resorted to designing healing care centres which encompass biophilic design. These healing care centres have been designed separately to the main buildings of the hospital. This allows architects to design biophilic environments without sanitary constraints. The Maggie’s Centres are an example of such biophilic architecture and will be further analysed within chapter three. Although these centres are affiliated with a hospital their design is very different to traditional hospital facilities so as to include the mental healing process of patients.

Conclusion This chapter has analysed the ideas that have influenced hospital design within America since the eighteenth Century – scientific influences, political influences, and human influences. From this chapter it is evident that modern hospitals have been designed for doctors instead of patients. According to Annmarie Adams (2008, p. xx) , ‘doctors played an active role in the development of twentieth-century architecture’. Thus, these influences have tendered to change hospital typology towards the needs of health care professionals and away from patients. Contemporary recognition of the adverse conditions this creates for patients’ has reinforced the importance of biophilic experiences which are now beginning to be implemented within hospital design. Some major architectural firms that focus on designing biophilic environments are C.F. Møller Architects, Hassell, Herzog & de Meuron, Hopkins Architects, OMA and nbbj. Glasgow, Gartnavel Hospital Maggie’s Centre designed by OMA and the Haraldsplass Hospital new main building designed by C.F. Møller Architects will be further explored in chapter three.

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Chapter Three A case study analysis of Biophilic design Introduction Within the third chapter of this dissertation, there will be two case studies discussed through a visual analysis of diagrams and photographs. As discussed in chapter two there has been a major shift in the hospital typology via scientific, political and architectural influences. These two case studies have both been designed with consideration of biophilic experiences to successfully create a space where the patient feels relaxed and comfortable, thus reducing psychological stress and promoting physical recovery. These case studies have been chosen to demonstrate the successful use of biophilic experiences at the Haraldsplass Hospital’s new main building, designed by C.F. Møller Architects, and the Gartnavel Hospital Maggie’s Centre, designed by OMA. These two examples have been chosen as they show the shift in the architectural approach to the recovery and care of patents within the hospital typology as discussed in chapter two.

3.1

Case study one: Haraldsplass Hospital new main building: C.F. Møller Architects

The Haraldsplass Hospital new main building [7, Fig. 7], located in Bergen, Norway, is designed by C.F. Møller Architects and completed in 2018 (C.F. Møller Architects, 2019). C.F. Møller Architects mission is to ‘holistically create solid, quality solutions based on Nordic values adapted to future global challenges … [and to] serve both clients and users with great value from start to finish.’ (C.F. Møller Architects, 2019). One challenge C.F. Møller Architects focused on within this hospital design was biophilia and how architecture can influence the healing process of patients.

Figure 7: Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects 23

C.F. Møller Architects have implemented many of the biophilic apprached discussed in chapter one. As a result, this hospital design does not only create a fictional space to attend to patients' medical needs but also creates a therapeutic space that helps improve the patients’ mental health. These biophilic considerations are natural light and ventilation, views of the surrounding mountainside and rushing river, spatial qualities and the considered use of natural materials and their fractals.

As depicted in [8, Fig. 8], there are two large atriums positioned at the centre of the building. The southern atrium is the largest (right atrium) and includes the foyer on the ground level. The large skylights over each atrium have been positioned in a way so that only the morning and afternoon sun will enter the interior space. The light from these skylights’ filters into the common spaces and workspaces that surround the atriums. Views from these public spaces are of the atriums. Private patient rooms are located around the external side of the building so that patients have views of either the Ulriken mountain or Møllendalselven river. C.F. Møller Architects have tried to break the boundaries of standard hospital spatial planning of long corridors; thus, they have designed short corridors with many open common areas. This creates prospect and refuge within the space, where patients are able to see the path they are taking; as well there are resting spaces to relax and sit comfortably.

Red: view from patient rooms of surrounding landscape Blue: view from meeting rooms and workstations into interior atriums Yellow: sun direction

Figure 8: diagram that shows direction of natural light and views in Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects As shown in [9, Fig. 9] of the northern atrium (left atrium as illustrated in [8, Fig. 8]) is comprised of a common meeting area bellow large overhanging windows that house common meeting spaces and workspaces. The interior of this atrium is clad in lightly coloured timber slats. The repetition of the slats and pattern of the windows create a space that is visually linked to nature through fractals. Thus, when the timber slats are read in conjunction with the uneven surface of the walls an image of a mountain 24

scene is formed towering over the viewer, making the viewer feel protected and enclosed within a safe and relaxing space. These chosen design elements mean that the surrounding natural landscape is accessible to all who use the space.

Figure 9: interior view of north atrium in Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects This space can also be interpreted in another way that connects the viewer to nature. The skylights that are located at the top of the atrium have a functional use (seen in [10, Fig. 10]), which is to let natural light into the interior spaces of the building; they also provide another visual aid that links the viewer to nature. The overhanging windows and timber slats also aid in this vision. When looking up at the skylights to the moving clouds passing above and the rays of sunshine streaming down, the viewer feels a sense of looking up though a large canopy of trees to the sky above. This spatial connection the nature, as mention in chapter one, reduces the patients stress.

Figure 10: view looking up to skylights in north atrium in Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects 25

The small private meeting spaces that surround the atrium can be seen in [11, Fig. 11]. As mentioned in chapter one, prospect and refuge are a biophilic experience that relate to the viewers' sense of threat and comfort. These spaces are considered refuge spaces from the corridors surrounding them. They provide a sense of comfort as there is a place to retreat to if a patient feels uncomfortable in the open corridors and provides a physical space to rest if they are fatigued and offers a space to privately meet friends and family.

Figure 11: View from meeting room of north atrium in Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects As noted in chapter one; fresh air, natural light, and views of nature are proven to improve the mental wellbeing of patients. All three biophilic experiences are achievable through just one design choice – the use of windows. As this is so, C.F. Møller Architects have designed these spaces to be beneficial to the user by giving careful consideration to the placement of windows as seen in [9, Fig. 9] and [11, Fig. 11].

As the private patient rooms are located on the perimeter of the building, all rooms face towards either the Ulriken mountain or Møllendalselven river, thus every patient room has access to the surrounding 26

landscape. Each room consists of three different window openings. One window, in particular, is a floor to ceiling window that allows for even the patients unable to sit up to have a view of the lush green landscape beyond the solid walls. The hospital bed is positioned next to this floor to ceiling window so that the patient only has to turn their head to be able to look out over the natural environment. As mentioned in chapter two Nightingale gave specific instruction within her book of the measurements architects ought to follow when positioning windows and stated that all patients must have a view to the outside world, as well, in chapter one evidence is provided by Ulrich, that proves a view to the natural world is beneficial to the patient both psychologically and physiologically (Ulrich, 1984).

The wall that houses the windows is clad in wood as seen in [12, Fig. 12]. It is the same rich warm tone of wood that is used on the external side of the windows, as seen in [7, Fig. 7]. By using the wood to frame the tree scattered landscape seen beyond, it brings the view closer to the patient. The patient is able to see and touch the wood from close up, letting the viewer experience the most minute details. As mentioned in chapter one by Salingaros (2015, p. 12) this physical connection to fractals and natural details positively impacts the patients' mental state.

As one side of the private rooms are windows, patients have access to natural light. The patients are able to relax in the warmth of the sun, relieving them of mental stress, as discussed in chapter one. C.F. Møller Architects allow the patients to create their optimal atmosphere within their private hospital room. A curtain is able to be drawn over the windows and within each room there is a window that is able to be opened. This allows for fresh air to flow into the space, which is sometimes preferred over air conditioning.

When comparing the Haraldsplass Hospital patient rooms [12, Fig. 12] to the Mater Hospital Brisbane ward 8A and 8B, [6, Fig. 6], mentioned in chapter two, there are subtle differences. However, it is these differences that make the space not just a place to recover in but a space that beneficially assist in the healing process by reducing stress. One major difference between the two examples is the use of views, natural materials and natural light. It is evident that C.F. Møller Architects are designing hospital rooms similar to the standards that Florence Nightingale recommended.

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Figure 12: Private patient room at Haraldsplass Hospital new main building (2018), Bergen, Norway, designed by C.F. Møller Architects

3.2

Case study two: Glasgow, Gartnavel Hospital: OMA

Maggie’s Centres are cancer centres where patients can recover from cancer treatment and also is also a place where their families and friends can meet and discuss the future. The foundation was founded

by Maggie Keswick Jenks and her husband Charles Jenks. According to Edwin Heathcote, it is a space where cancer patients start to ‘help themselves … [and] take control of their own circumstances’ (Heathcote, 2006, p. 1304). To help patients achieve this state of mind Maggie’s Centres are designed with a strong consideration of nature through the use of biophilic experiences stated in chapter one.

According to Charles Jenks (Jenks, 2017, p. 69) the connection to nature is vital because ‘when you are faced with cancer, a life-threatening disease based on rogue-life, you are likely to orient yourself to nature’. One Maggie’s Centre that achieves the biophilic experiences discussed in chapter one, is the

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Gartnavel Hospital Maggie’s Centre [13, Fig. 13] located in Glasgow, Scotland (OMA, 2013). This building was designed by OMA with its completion in 2011 (OMA, 2013).

Figure 13: Gartnavel Hospital Maggie’s Centre (2011), Glasgow, Scotland, designed by OMA As seen in [14, Fig. 14], the Gartnavel Maggie’s Centre layout is in the shape of a ring. This centripedal design is intended to create a sense of unity within the space through the way patients and visitors interact with the built form and surrounding environment (Hollendonner, et al., 2012, p. 6). By using this layout at a small scale, the patients and visitors are able to walk in and out of rooms as they wish, whilst always being connected to nature. These open rooms are linked to other rooms not only by circulation but also by sight lines illustrated in [14, Fig. 14]. Prospect and refuge – a biophilic experienced noted in chapter one – is used here to create spaces that feel non-threatening.

Figure 14: Diagram illustrating circulation and line of sight at Gartnavel Hospital Maggie’s Centre (2011), Glasgow, Scotland, designed by OMA 29

The external sides of the ring are clad in glass with the internal walls being solid structural walls as illustrated in [15, Fig. 15]. The glass windows provide high levels of prospect by offering clear linear lines of the surrounding environment, whilst the ridged structural walls provide refuge by delivering a sense of concealment and protection from the elements. The kitchen, seen in [16, Fig. 16], is the first room patients and visitors are led into when they first arrive at the centre. Here the occupants are protected by a semi-opaque wall [16, Fig. 16] which provides them with concealment from the large floor to ceiling windows providing the user with uninterrupted views of the outside world. By viewing the surrounding landscape through these large windows patients are able to put their mind to rest and focus on healing and getting better.

Figure 15: Diagram illustrating floor to ceiling windows and solid internal walls at Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre (2011), Glasgow, Scotland, designed by OMA

Figure 16: Kitchen at Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre (2011), Glasgow, Scotland, designed by OMA 30

The same experience is found in the internal courtyard and the surrounding natural landscape. This connection is achieved through considered placement of large floor to ceiling glass windows and doors.

As illustrated in [17, Fig. 17] one is able to view the internal courtyard and surrounding natural landscape from every room. These uninterrupted and circulating views of the surrounding natural landscape means the viewer is able to mentally relax. Through the use of reflective materials on structural walls the surrounding landscape encloses and comforts the viewer from all angles (as seen in [18, Fig. 18]), creating a sense of being enveloped and cradled by nature.

Figure 17: Diagram illustrating visual connection to surrounding landscape at Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre (2011), Glasgow, Scotland, designed by OMA

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Figure 18: Meeting space at Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre (2011), Glasgow, Scotland, designed by OMA

There is only one room within this design that does not have glass walls. This is one of the small counselling rooms available as seen in [19, Fig. 19]. It provides a relaxing and comfortable space that promotes confidentiality and privacy through the use of many biophilic experiences. The user is enclosed in a continuous organic wall. The soft natural shapes reduce mental stress as there is no uncertainty within the space â&#x20AC;&#x201C; no sharp edges or places of unknown creating a cave-like experience.

Through the oculus, the users are provided with an abstract view of the ever-moving and always changing sky through fallen autumn leaves on the roof. The oculus allows for warm rays of sunshine to fall onto the users below warming their skin as they discuss the future. As mentioned in chapter one, natural light is important in the process of mental healing as it enhances morale and improves mood.

The organic undulating walls are clad in timber strips that have been moulded to the curving surface.

The pattern created by the horizontal repetition of the thin strips of wood mimics the natural grain of the timber, causing the viewers to shift their attention to the details on the wall. These details allow the patients eyes to wander as they reflect and think, and as suggested by Salingaros (2015, p. 28), these details provide order within the space that reduced mental stress.

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Figure 19: Small counselling room at Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre (2011), Glasgow, Scotland, designed by OMA

Conclusion This third chapter has explored in depth the biophilic experience described in chapter one within two existing buildings - the Haraldsplass Hospital new main building designed by C.F. Møller Architects and 33

the Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre designed by OMA. Through this analysis, it is evident that by considering biophilic experience within design a successful space can be created that benefits the users' psychological state of mind, as well as their physical wellbeing.

All biophilic approaches demonstrated in chapter three could be scaled up and used in the design of larger hospitals in the future. Both these examples, the Haraldsplass Hospital new main building and the Gartnavel Hospital Maggieâ&#x20AC;&#x2122;s Centre, are situated within the natural landscape, however as cities expand natural light and views become harder to obtain. Therefore, the biophilic experiences mentioned in chapter one must be applied in a different manner. For example, a hospital that is surrounded by buildings can boast a vibrant and lush internal courtyard for patients to sit and relax within. All patient rooms that surround the internal courtyard could have views of the lush green canopy that is brought into the space through the considered use of natural materials. The courtyard and patient rooms could have access to the natural light streaming through the open ceiling of the courtyard that also draws fresh air into the centre of the hospital. Smaller, enclosed spaces can provide a sense of comfort through the considered geometry of the space, ornamentation and natural materials. Hospitals that wish to provide a space within the natural environment might wish to adopt the use of healing centres that can be located away from the hustle and bustle of the city, just like the Maggieâ&#x20AC;&#x2122;s Centres. As is demonstrated in chapter three there is a need for architects to think beyond the simple solutions stated in chapter one to achieve biophilic design that beneficially impacts the patients psychological state of mind.

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Conclusion Hospitals are designed to have functional spaces for healing patients’ physical conditions (injuries, diseases), however many believe hospital design can offer better healing properties by also taking into consideration psychological aspects related to design. This dissertation explored a variety of biophilic approaches that can be used within hospital design through notable influences that have drastically changed the hospital typology which have informed the spatial analysis of two twenty-first century case studies. This analysis combines to reveal the need to change the typology from scientific and political influenced design to human-centred design.

This dissertation describes the need for human-centred hospitals through analysing numerous ways biophilic experiences can be used within hospital designs and the need and importance of ethical design within this typology. Chapter one discussed various approaches of biophilic design, in order to support the spatial analysis in chapter three. This dissertation begins by identifying and characterising the beneficial biophilic experiences that improve patients’ psychological wellbeing. Each biophilic approach is supported by evidence that demonstrates it success, through the numerous studies provided.

These studies have proven the various ways biophilia can affect the patient’s mental wellbeing, from being able to see time pass to combating fatigue. From the studies provided in chapter one, it is evident that these biophilic approaches are beneficial in providing a hospital space that improves the patients' psychologically state of mind, hence providing physiological healing.

Investigation into hospital typology is necessary as it provides an understanding as to why this typology has become wildly stagnant even into the twenty-first century. Thus, it is important to determine the influences that have caused this to be the case. As discussed in chapter two these influences are scientific and political. The evolution of hospital typology has been examined according to Florence Nightingale's publication in 1863 and a twenty-first century case study. This exploration has shown the drastic change that accrued as a result of scientific and political influences discussed in chapter three. This investigation into the typology concludes with explaining the role of the architect and how it is the architect’s duty to design ethical spaces, thus incorporating biophilic experiences into the designed spaces. Therefore, from this investigation it is concluded that in order to move away from the stagnant state of the hospital typology it is the architectural institutions' responsibility to teach the architects of the future their role within society and to emphasise the importance of ethical design and human-centred design.

Finally, this dissertation concludes with two case studies that demonstrate the different approaches to biophilia and the success of these spaces in benefiting the patient’s psychological wellbeing. This chapter uses the theoretical context discussed in chapters one and two to analyse two twenty-first century case studies. The case studies that are analysed are the Haraldsplass Hospital’s new main building, Bergen, Norway, designed by C.F. Møller Architects (C.F. Møller Architects, 2019), and the Gartnavel Hospital Maggie’s Centre, Glasgow, Scotland, designed by OMA (OMA, 2013). This spatial 35

analysis focuses on the location of windows to allow for natural views and light, the use of natural materials, and spatial qualities such as natural geometries and prospect and refuge. Through this analysis, supported by chapters one and two, it is evident that these spaces are beneficial to the users beyond its function. They provide psychological benefits as well as a place to heal.

In summary, it is evident that hospital design needs to move away from being purely functional towards broader human-centred design. This can be achieved through the use of biophilic experiences that are proven to beneficially impact the patient's psychological state of mind and physiological condition.

Through investigating the hospital typology, it is evident that this typology has become stagnant throughout the twentieth century and into the twenty-first century. Thus, it is the individual architectâ&#x20AC;&#x2122;s responsibility to respond to contemporary research regarding biophilia and incorporate these into new and critical hospital design. Through the analysis of two twenty-first century case studies it is evident that these biophilic spaces can be achieved and are successful in improving patientsâ&#x20AC;&#x2122; psychological wellbeing and health.

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