RESEARCH
2030
a transformational health environment
cycle of
wellness wellness
health
“a state of complete physical, mental and social well being and not merely the absence of disease or infirmity� World Health Organisation
healthcare
“healthcare should take place in a physical space that enhances a persons desire to improve themselves rather than waiting for a disease and seeking a cure� Dr Roy Brancatisano - Circle of Care
0 schemes for good health p3
the contents
1
the challenge p9
2
foundations that engage and empower p 19
3
exploring the anatomy of wellness p 21
4
NBRS+PARTNERS RESEARCH is a publication by: NBRS+PARTNERS Architects, Heritage Advisors, Interior Design, Landscape Architecture, Research, Strategy, Access, ESD and Compliance.
NBRS+PARTNERS Pty Ltd ABN: 16 002 247 565 Level 3 No 4 Glen Street Milsons Point NSW 2061 AUSTRALIA www.nbrsap.com.au
1
contents
8 7 6 5
the epilogue p75
the regenerative core p 61
the community hub p 47
the wellness neighbourhood p 35
ISSN 1839-0161 ©2012 NBRS+PARTNERS No part of this publication may be reproduced, stored in a retrieval system or transmitted without the prior written permission of the publisher.
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1
schemes for good health a prologue
eliminate institutional atmosphere The current institutional atmosphere in healthcare environments can create stress for patients; prolonging healing time and causing unnecessary discomfort, ultimately impairing the ability of the patient to fight illness. 1 In the future healthcare environment, to eliminate the institutional atmosphere consideration must be given to all human senses. As such, the following must be addressed: • Adjusting from the traditional large scale, to a comfortable human scale • Considering materiality, in the hopes of creating a more ‘homely’, familiar, personal environment. • Providing sufficient ventilation to combat the clinical odour of existing environments and combat the possible spread of infection • Facilitation of patient independence through a clear program and layout combined with better directory information systems
eliminate institutional culture The patient experience is impeded by divisions in the Australian healthcare system, which is imbedded in characteristics such as: • The funding model - the split levels of government and insurers undermines equitable and efficient delivery of primary health 2 • The fee-for-service model - varied pay arrangements has created barriers of access to healthcare professionals 3 • Market driven conservatism - reinforces the current medical culture of distinct tribal barriers, undermining patient-need driven service 4 The medical environment should facilitate intersectoral connections; producing a broad spectrum, allied health team approach to wellness. This includes: • Empowerment of the nurse practitioner - for the mutual benefit of the costing model and ultimately fuller patient care • Incorporating communication technology - e-health system will break down the barriers of communication between medical ‘tribal’ groups • Facilitating professional encounters - providing environments for meeting and collaboration
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“Life long health activism is the future for Australian Healthcare. A shift in focus to preventing the burden of illness on society rather than simply facilitating responsive episodic care must occur. This relies on a community wide wellness approach, comprising of three scales of healthcare environments.” ENVISION STUDENTS 2012
increase focus on the intermediary Medical built environments are designed as tools for medical professionals, meeting spatial requirements for equipment and beds, rather than a patient-focussed forum that encourages healthy living and wellness. A future healthcare centre should increase the focus on the intermediary spaces, eliminating the traditional waiting room in order to: • Increase patient comfort • Use the environment to increase awareness about healthy living and prevention • Facilitate the role of a support person to make doctor visits more efficicent • Facilitate a community/social approach to health The spaces outside the consultation room should be open planned and multi-functional. Such spaces would include: • Social areas for the community to congregate in • A variety of patient centred areas, providing multiple options for how to use their time • A library to provide the opportunity for patients to participate more in their own health through knowledge
dissolve tribalism Unproductive ‘tribalism’ pervades the different healthcare professions. Dr Leon Clark, CEO of the Sanitarium Hospital in Sydney states that the healthcare industry has to “provide what has been shown to be beneficial” to the patient, and that this is often neglected because doctors are ‘at war’ with alternate therapy, as each believe that they compete with the other for patient focus/ funding. Intermediary spaces that facilitate insectoral connections in a relaxed environment would lead to connected medical professionals working together for the better care of their patients. The following spaces should be included: • Communal facilities for medical tools • Communal kitchen/ lounge space for relaxation • A strategy room for a team of health professionals and patient to meet, to encourage a united approach • A noticeboard/ information, where professional knowledge can be shared between ‘tribes’
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1
schemes for good health
approachability A fundamental feature needed to encourage full spectrum wellness is approachability. 85% of people that visit a General Practitioner will return 6 times that year. 5 A healthcare centre should be inviting to the public by having a desirable and comfortable atmosphere. Considerations include: • Comfortable human scale • Considering materiality and aesthetics to create a familiar, personal and welcoming environment • Achieving patient convenience through location to amenities, and other vibrant hubs of social activity • Encouraging a sense of belonging to a healthy community through positive encounters; social, with nature and the built environment
privacy/ proximity In the current episodic model of healthcare, a single program for a doctors visit is experienced by all patients, no matter the ailment or illness. Varying levels of patient privacy and proximity within a future healthcare centre must be considered in order to develop a calm and comfortable environment for patient and doctor alike. Flexibility is required in all spaces, so that the mode in which a space is used can be determined by the patient; inhabiting them according to their needs for privacy and/ or proximity to other patients. A ‘well’ environment should provide all levels of interaction from solitary privacy to community engagement. As such the following factors are important: • Functional Community Spaces - encouraging engagement in a community-wide health approach • Private Spaces - allowing people who are very private or contagious to wait or recuperate in a personal space without onlookers • Connection between spaces - allowing for an efficient system
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prologue
creative distractions A healthcare centre should introduce and consider various forms and mediums (eg. nature, technology and exercise) to evoke all human senses. Factors to consider include: • Sight – colour, light, materiality for distraction and differentiation • Hearing – natural sounds, music, removal or negation of ‘medical beeping’, differentiating spaces (private/public) • Taste – food and drinks for incentivisation, pleasure, morale and education • Touch – materiality, play equipment for children, textures, gardens, comfort • Smell – natural scents, removal of sterile hospital odour, ventilation Introducing creative distractions using the five senses, along with diversional therapy provides ‘Therapeutic Interruptions’.
flexible space Public health institutions are often inflexible and inconvenient, providing a barrier to both patient and healthcare professionals aiming to receive or provide full spectrum healthcare. A healthcare centre must be flexible to meet the needs of the different generations in the community, as well as the demands of the community in the future. A future healthcare centre must be flexible so that multiple allied healthcare professionals can utilise shared spaces to service the local community in support of the general practitioner. This encourages the promotion of full spectrum wellness through a collaborative approach. Flexibilty should include: • A Modular Approach - An efficient and practical modular system can be the organisational solution to creating flexible environments adaptable to both professionals and community needs • A Flexible Storage Environment - Through an organisational storage framework, multiple professionals could occupy and operate out of the same space
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1
schemes for good health
navigation The complicated layout and programming of current institutions causes unnecessary stress and burden on occupants, ultimately mitigating their primary function. 6 A future ‘well’ environment would promote space where complicated procedures are translated into simple, clear spatial structures. Considerations for occupants include: • Human scale – providing an ease-of-use platform • Differentiating Materiality – allowing for subconscious understanding • Views – providing a reassuring sense of time and place • Program and layout – causing less stress and anxiety
community engagement The future for Australian healthcare lies strongly in a community-based primary healthcare model, which encourages full spectrum wellness throughout a patient’s lifecycle. A community-orientated built environment that encourages life long health activism needs to consider: • Connection to public amenities and cohesion with other health facilities • Connection between different generations, social groups and genders • Connection between nature and the built environment To achieve this community-based, holistic approach to wellness, the institutional environment has to be translated into the following: • An approachable environment • A built environment which is easy to navigate • A focus on intermediary spaces • Allowance for creative distractions in many forms • Privacy where appropriate and proximity where appropriate • Spaces which are interchangeable and flexible
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prologue
patient focus Healthcare is historically paternalistic. The patient’s values and perspective are traditionally given little consideration in the course of action taken. This is becoming increasingly problematic as modern medical practice undermines the patient-doctor relationship, so there is no underlying, trusting familiar relationship upon which healthcare can be administered to suit the patient. In order to encourage a patient focus within a healthcare centre there are two key elements that must be addressed: 1. Efficiency - to increase the value of the doctors time, the space in which the consultation takes place must facilitate an economical consultation. The average GP visit is 6 minutes, all of which has to be maximised 2. Patient Comfort - a consultation space with multiple zones can be a tool for easing a patient’s apprehension and encourage participation in their own healthcare
routine of wellness Providing education, public access, community programs and seminars is vital to prevention of chronic illnesses, early detection, and management of current illnesses. Negating the current stigma around health issues, and providing individuals with confidence to communicate with others will allow people to be more open in their community, reducing the incidence of physical, mental and social conditions. 7 An Australian’s approach to health is largely an episodic response to illness or discomfort. The future for the healthcare system lies in a strong preventative platform, which encourages full spectrum wellness throughout a patient’s lifecycle. To encourage patients to embrace a routine of wellness, which includes regular visits to a health care professional; medical facilities must be environments where patients are happy to spend time and embrace a healthy lifestyle. To achieve a ‘routine of wellness’ important explorations include: • The approachableness of the ‘well’ environment • The personal patient-doctor relationship • Where and why stigma is involved • The communal, flexible and social spaces within the wellness centre
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2
the challenge The challenges and growing pressures facing Australia’s health system, along with the changes in society’s health awareness and expectations, necessitates a transformation in our physical health environments and broader health culture. Increasingly in both Australia and overseas, there is growing recognition that the future of a sustainable healthcare system lies in a strong, community based primary healthcare system providing efficient, equitable and effective deliverance of preventative and responsive wellness throughout society. 8
Nicola Roxon announced the Labor government’s ‘Super Clinic’ initiative in the 2007/08 budget, instigated with the hope of strengthening national Primary Health Care and providing clinically and culturally appropriate, timely and affordable care to all Australians. 9 It was further contributed to with the ‘National Primary Health Care Strategy’ (2009) and funding in the 2010/11 budget. 10 Despite early intentions to embody principles of preventative medicine within the ‘Super Clinics’, the 18 which have been completed can be seen as simply small scale hospital-like institutions. Opportunities for a healthier Australia and a fiscally viable healthcare system lie in a holistic ‘wellness neighbourhood’, with a built environment aimed at strengthening prevention through community integrated health management, education and awareness.
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‘prevention is better than a cure’
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10
the future of healthcare The Australian healthcare industry is divided by tribal and organisational boundaries, which create road blocks in the delivery of multidisciplinary community based care. Practitioners, Allied Health Professionals, Social Welfare Initiatives and the community are distinctly separated, despite their common wellness goals and the opportunities to distribute care by more equitable, efficient and effective means. Opportunities to overcome these challenges lie in a paradigm shift for the delivery of health services. Studies conducted by the World Health Organisation have found that a healthcare system which includes strong primary healthcare, produces a higher level of health for the same investment and often lower rates of hospitalisation. 12 Opportunities for Australian healthcare lie in a ‘wellness neighbourhood’ that engages the community and empowers life-long health activism rather than episodic care. The built environment should engage the community in a mission for wellness, in the hope of empowering a routine of wellness, mitigating preventative chronic conditions and providing multidisciplinary support to manage significant health episodes. This increases the prominence of community based care and thus lessens the burden on acute institutions.
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challenge
present divided & insulated
future integrated
12
the cycle of wellness
prepare
health: “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity�. World Health Organisation
Prepare an individual through health awareness to live out a routine of wellness. Preparation will prevent avoidable health issues.
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challenge
respond
remember
Respond to individuals episodic healthcare. Most responsive care takes place when they are born, child rearing or aged. This is the primary focus of the current healthcare system.
Remember key health awareness initiatives experienced earlier in life, applying them in a routine of wellness. Remembering healthy ways of living minimises medical impact on life.
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pushing in the boundaries of the respond zone The health consequences of the average Australian’s health risk factor profile are confounding in their economic burden and impact on society. We are facing a situation of overloaded hospitals, health and welfare services, a situation made more acute by the aging population. Therefore, preventative healthcare must be seen as an integral part of the healthcare professional’s role, and of the community. Studies have found that the returns on investments in proven community-based disease prevention are substantial, US$6.60 for every US$1 invested. Traditionally, an individual consumes the largest healthcare resources when they are born, child rearing or aged. These responsive episodes involving healthcare professionals is but one portion of a person’s healthcare lifecycle and is the current focus of our healthcare system. A person’s healthcare lifecycle involves three phases, each may be characterised by its preventative or responsive nature. To lessen the burden on the ‘respond’ zone, prevention must be everyone’s business. By increasing the resources allocated to prevention in both the ‘prepare’ and ‘remember’ portion of a person’s life, we can shift the drivers of detrimental health behaviours which result in poor health and chronic illness.
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challenge
“Healthcare should take place in a physical space that enhances a persons desire to improve themselves rather than waiting for a disease and seeking a cure” Dr Roy Brancatisano Circle of Care
present prepare
respond
remember
widening the boundaries
future prepare
respond
remember
pushing in the boundaries 16
the healthcare spectrum
hospital
acute
17
challenge
the transformational health environment moving towards life long health activism
Wellness
super clinic
the wellness
neighbourhood everyday
specialist gp
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3 foundations that engage & empower
To encourage the life cycle approach and life long health activism, the foundations that engage and empower have been considered. Based on the needs of our current healthcare system and the goals of the Wellness Neighbourhood, the foundations act as a support for the design, and are referred to regularly throughout the document. A detailed examination of the foundations is covered in the preamble. The illustration explores three different levels of the foundations. The lower level revealing what the Wellness Neighbourhood eliminates, the middle row exploring the tools of engagement and the upper level expressing the goals of empowerment.
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foundations
engage To enact positive health change in a member of the community, empowering them with knowledge is the key. Engaging activities can be used as a vehicle for the introduction of empowering knowledge. Knowledge and information transcends direct activity, and thus can have a lasting effect on the participant; in this way healthy action becomes a part of everyday life through helpful, healthy messages.
empower Engagement is the method used to get individuals to participate in both the community and its pursuit of wellness. The foundations establish what will be eliminated in the existing framework and the replacement tools/ techniques that will be used to engage the community, and ultimately facilitate empowerment.
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4 hub
three scales of a well environment
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neighbourhood
core
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the wellness
neighbourhood
the community
hub
the regenerative
core 23
well environment
the three scales A series of community fixtures that engage patrons in physical, mental and social health in order to empower a sense of familiarity in the broader health environment. which functions like
the circulatory system
An educative and medicinal centre of the Wellness Neighbourhood - that engages community participation and empowers patrons through the facilitation of encounters with formal knowledge, professionals and others. which functions like
the heart
A culmination of served and serving space, integrated within the Hub – empowering the wellness of patrons through formal engagement with their Health Care Professionals.
which functions like
the lungs 24
the anatomy of wellness Furthering the exploration of the three scales of wellness has found a parallel with bodily processes and the circulatory system. The blood within the body has become a metaphor for the patrons within the community; similarly the oxygen within a body has been compared to the health care professional within the Hub. Within the body, blood is transported around the circulatory system, directing flow of unhealthy blood through the heart and lungs, then once restored, back to the extremities. The Wellness Neighbourhood takes on a similar role; directing and creating connections to and from the Community Hub. The Community Hub, much like the heart is the home of the Regenerative Core. It pumps patrons to their venue of restoration, the lung. Patrons are engaged and empowered through the combination of a medicinal and educative centre, where they encounter regenerative healthcare professionals , the oxygen, within the lung. Developing the body concept has allowed for further study of the three scales of wellness, and in doing so, has looked back at nature creating a simplified, more efficient program.
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well environment
oxygen supportive healthcare professional A role that facilitates information sourcing and auxiliary service delivery to patrons of the regenerative core, to enable an efficient process for the practise health care professional.
practice healthcare professional Refers to a broad spectrum of roles from Allied Health Care Professionals to General Practitioner and Specialist, encompassing both ‘hard’ and ‘soft’ medicine.
blood as patron A member of the wellness community, encompassing both traditional patient and active participant in community wide health.
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wellness neighbourhood circulatory system The circulatory system moves healthy blood from the heart and lungs around the body (the wider community), and facilitates unhealthy blood returning. The journey through the system compliments the workings of the Community Hub by delivering different activities that regenerate the physical, mental and social health of the patrons. The different community organs are also engaged throughout the system by ‘heartbeats’ that engage and empower patrons in a specific health moment. These empower patrons to take charge of their health not just within visits to direct healthcare facilities, but within the community and as a part of their everyday lives.
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well environment
28
community hub the heart of wellness The heart assists the regeneration of unhealthy blood as it pumps the un-oxidised blood through the lungs and then once healthy again out to the extremities of the body. The process of moving through the Community Hub is much the same as blood pumping through the heart. Just as there are two pumps in the heart, there are two journeys through the hub. As the inward pump provides an avenue to the educational and medicinal centre (the Regenerative Core), so does the outward pump provide an enlightening journey back into the community. Much like the heart’s pumps, this journey is made up of two parts, that which engages the community (the atrium) and that which empowers them with knowledge (the ventricle).
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well environment
30
regenerative core the lung The unoxidised blood is pumped into the lung rorm the heart, where it is oxidised and made healthy. The lungs primary function is the combination of oxygen and blood. The process of moving into the Regenerative Hub is similar as it combines both professional and patron - the oxygen being the professional, and the blood being the patron. Much like the lung, the Regenerative Core is made up of a series of variables and constants defining the overall size through inflation or deflation. Much like the lung, the built environment is determined by the amount of services (oxygen) needed. From the lung, the patrons (oxidised blood) are pumped back into the heart and then out to the extremities via the circulatory system.
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well environment
32
future terms of the cycle of wellness circulatory system the nutritive zone
the active zone
A space to engage community members in their nutritional wellbeing promoting healthy eating as a regular part of everyday life.
A space that incentivises physical exercise across generations.
neighbourhood
the heart the open door
the check-in pod
A gateway that forms an invitation to community members to participate in their own health through The Heart.
An efficient organisational portal that engages patrons with The Regenerative Core.
gateway pods
the practice zone
Supportive facilities used prior to and following practice visits, designed to increase the efficiency/ flexibility of patient care and aid professional processes.
Flexible spaces for facilitating primary multidisciplinary care for both consulting with and examining patrons.
hub the lung
core 33
well environment
the vessel
vessel
A navigating ribbon that fluctuates form and function to seamlessly enrich the cycle of wellness.
the interactive zone
the reflective zone
the park
A space for social gathering and community networking with the goal of encouraging socially inclusive, expressive activities.
A space for introspection within a tranquil environment, which encourages impromptu reflection for a community member’s mental wellbeing.
The roof space of the Hub that combines Active, Nutritive, Interactive and Reflective spaces.
the cloud
the care zone
the social zone
An accessible and interactive framework that enables engagement with formal knowledge resources.
A platform that initiates the personal wellness community member’s connection with professional, servicing emotional and physical nutrition.
A local gathering space that is a venue for enriching encounters with other members of the community and health care professionals.
talk pod - Facilitating patron centred care and comfort in consultive forms of practice. touch pod - Facilitates patron centred examinative care in a resource rich environment. tree pod - Facilitates patron and professional comfort through connection to nature.
the re-zone A transitory care environment for supervised out-of-hospital services.
my pod - A personal space for patrons with a strong connection to supportive health professionals. the breakout space - Flexible communal space providing a private venue for engagement amongst re-zone patrons.
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5 hub
circulatory system the wellness neighbourhood
35
neighbourhood
core what if the healthcare environment expanded throughout the community?
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home
the vessel that connects the neighbourhood
B active physical health
Like the circulatory system in the body, healthy knowledge and lifestyle is pumped from the heart (Community Hub) into the community through Active, Nutritive, Interactive and Reflective zones. These spaces cater for the World Health Organisation’s definition of health as a ‘state of complete physical, mental and social well-being’, and are a means of making participation in health an everyday occurrence. Connecting these elements is the ‘Vessel’ that runs through the community; combining mental, social and physical activation spaces to bring Patrons into a routine of wellness. Naturally different areas will have different key community pillars, that will become connection points within the Wellness Neighbourhood.
C nutritive physical health
education CIRCULATORY SYSTEM
37
neighbourhood
social
D interactive social health
A connective
E reflective mental health
spiritual
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A connective
The Wellness Neighbourhood relies on engaging the community in order to pass on empowering concepts that benefit the individual and health of the community. Perhaps most importantly, accessibility is vital to successful engagement; thus positioning and infrastructure have to be considered, with public transport, bike and foot access being prioritised because of its inherently social connectivity. Wide footpaths with a connection to nature encourage their use and subtly reinforce physical activity in everyday life. Also of great and increasing importance is information networking for social and organisational purposes. By proliferating information ‘kiosks’ that not only relate health information to the user and act as an external check-in point, but also act as a networking tool throughout the community, connection throughout the healthcare environment and key community pillars is facilitated. The opportunity for education and awareness these also bring is invaluable to the further empowerment and social connectivity of members of society.
CIRCULATORY SYSTEM
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neighbourhood
walking & cycling
accessibility
information kiosk
40
B active Physical activity and exercise should be an everyday occurrence for a healthy individual, however busy lives and lack of knowledge are common obstacles. By providing a system that caters for different types of physical activity, older generations have the opportunity to connect through exercise with the young. However, it is important to recognise that incentivising physical activity transcends simple provision of areas and equipment. Games should be an integral part of community life, not only because they reinforce exercise as a part of the routine of wellness, but also because they can be a force for social inclusion, empowering many to take part in physical activity who otherwise wouldn’t. Similarly, turning physical activity into a uniquely fun experience is vital to encouraging participation. By turning a balance board into a virtual game, Patrons need not even realise they are partaking in useful physical/ coordinative exercise.
physical games
CIRCULATORY SYSTEM
41
neighbourhood
C nutritive Nutritive spaces also cater for the physical health of the body. In order to engage the community with their nutritional well-being it is important that they understand nutrition from the vegetable garden to the dinner plate. Providing community garden space is a tool to not only allow for empowerment through the transmission of knowledge, but connecting generations in a therapeutic and socially inclusive activity.
nutritional pod
Similarly, by providing pods that pass on nutritional information and guidance as part of the process of preparing a healthy meal, the individual not only benefits on that occasion, but will take that knowledge with them into the community. This process empowers by allowing everyday people to take charge of their nutritional well-being.
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D interactive Social interaction and connectivity is as important to well-being as any other physical or mental activity. By providing socially interactive spaces throughout the Wellness Neighbourhood, social gathering and interaction is encouraged. However, incentivising social interactivity goes beyond providing space and opportunity for interaction. Encouraging participation in expressive and socially inclusive activity is vital for social well-being. Music, drama, art and other group activities such as games bring social connectivity throughout the Wellness Neighbourhood. For instance, by providing facilities for games that require several participants, the chance for social connections is increased.
socially inclusive spaces
CIRCULATORY SYSTEM
43
neighbourhood
E reflective Reflective spaces cater for the health of the mind. In order to engage Patrons in their mental well-being, ‘Reflective’ spaces promote introspection through a tranquil environment; separate from the stress and worries of everyday life and the healthcare environment.
introspective opportunity
By manipulating the ground level, privacy and space can be achieved despite proximity to other activity. Having a bit of space and a conscious break allows an individual to empower themselves through the provision of reflective opportunities. This is important as a balanced mind is more open to participation in other healthy activities, and more likely to be healthy overall.
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active
nutritive
neighbourhood park At the centre of the Wellness Neighbourhood is a community-oriented central hub. By having an activated roofscape, the healthcare environment can become a desirable place to be – whether actually taking part in medical activity or not – thus normalising the experience of wellness in everyday life and breaking the negative associations and stigma of visiting healthcare facilities. The cental location combines Active, Nutritive, Interactive and Reflective concepts in one area. The spaces in this area compliment the spaces in the neighbourhood in order to make a natural centre that engages the community. For instance, game space, bike parking and showers relate to the Active spaces throughout the Wellness Neighbourhood. Furthermore communal gardens and stalls to sell fresh produce compliment the gardens and nutritional pods in the community, as well as being socially connective and therapeutic. By placing these spaces together adjacent to healthcare facilities, the community is tied in to the facility through the different Wellness Neighbourhood approaches.
CIRCULATORY SYSTEM
45
neighbourhood
interactive
reflective
46
6 the heart the community hub
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hub
neighbourhood
core
what if waiting time empowered your healthcare experience?
48
the vessel that connects the hub
A the open door
The Community Hub is the educative and medicinal heart of the Wellness Neighbourhood. It engages community participation in a routine of wellness and empowers Patron independence and confidence through the facilitation of encounters with formal knowledge, professionals and others. As an innovative new Wellness Neighbourhood feature, the Hub increases the focus and function of a traditional clinical intermediary space. It facilitates a dual purpose: • As a seamless avenue to/from the Regenerative Core, and • A meeting place for those looking to actively engage and participate in their own health The program for interaction within the centre is implicit within the form, as the Vessel navigates the inward and outward pump of the centre, flawlessly unifying the Regenerative Core and the supporting heart environment. So that a Patron is inclined to unconsciously gain knowledge the function of the Vessel fluctuates throughout the journey, acting as a creative distraction and emphasising the key moments of transition and interaction within the Community Hub.
THE HEART
49
hub
B the check-in pod
E the social zone
C the cloud
A
B D E
C
D the care zone
50
A the open door The Open Door is an invitation for Patrons to participate in their health through the Community Hub. It aims to create a sense of ownership in both the place and the community’s wellness agenda. It engages Patrons by eliminating the institutional atmosphere of the traditional clinical setting and providing an approachable transition into a healthy environment. The key features of the Open Door are: • Directing Path – The path should bend from the road to meet the building, creating a sense of approach and destination. • Encouraging – The bike racks and public showers encourage visitors to use alternate modes of transport en route to the hub, for the betterment of their health. • Gather Zone – Free public access to the roof creates a congregation area to encourage community ownership of the space. • Human Scale – A human scale creates a sense of belonging and comfort. • Local Architectural Language – Maintaining the local architectural aesthetic and language will aid approachability by making the building comfortable and familiar. • Transparency – A visual relationship with the interior of the building provides a clear message to visitors of the program that lies ahead.
THE HEART
51
hub
encouraging
human scale
transparency local language
gather zone
directing path
52
B the check-in pod The check-in process aims to increase the efficiency of a Patron’s engagement with the Regenerative Core. It introduces an interactive framework designed to assist a Patron in navigating the Hub, gathering information on the purpose of their visit and acting as a guide to encounters with a healthcare professional. The nature of the checkin process is flexible. It can take place within the Check-in Pod tucked just inside the entrance, using a Kiosk within the broader neighbourhood, or through a wireless network connection. The Check-in Pod is designed to provide privacy and creative distractions to an individual, while the framework gathers information in a non-obtrusive way. The key features of the Check-in Pod are: • Attactive Distraction - The chicken enclosure is a diversional tool aimed at engaging the patron in the Regenerative Core program. • Materiality - The mixture of transparent and opaque materials reflects the juxtaposing needs for proximity and privacy. • Proximity to the Open Door- A clear visual and spatial relationship with the Open Door, further strengthened by the path of the Vessel establishes the role of the pod. • Privacy Screen - The screen creates an embracing cocoon around the patron, shielding personal information.
THE HEART
53
hub
you Existing patient? Name ? Date of birth?
who
why
go
cue
Which healthcare professional are you here to see? Type or specific.
What’s troubling you? Identify on body illustration.
Informs the patron which supportive pod to visit and when.
Provides friendly health reminders based in notes on the patrons file or age/seasonal cues.
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0-15
C the cloud The Cloud empowers Patrons by facilitating personal encounters with formal information sources. It is a fixture within the Community Hub that operates as a base for formal information that is flexible in nature and can be taken or accessed throughout. The cloud consists of spaces for five designated age groups tailored with relevant fixtures and appropriate information mediums so as to make the information highly accessible and interactive.
THE HEART
55
hub
15-30
30-45
45-60
60+
The key features of the Cloud are: • Proximity to the Regenerative Core Creates a distracting and comfortable waiting area where Patrons are encouraged by the environment to increase the effectiveness of their time. • Open Plan - Visual relationships and a clear transition pathway allow for flexibility to interact with other patrons and elements of the Community Hub. • Flexible Modes of Being - A variety of seating, study and viewing areas are ergonomically integrated into the Cloud’s structure to facilitate engagement with different mediums and the comfort of Patrons.
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D the care zone The Care Zone is a space that empowers Patrons by encouraging a sense of personal ownership, belonging and importance within the Community Hub. It takes the form of a community kitchen that is the platform for the ‘Host’ to provide emotional and physical nutrition. The key features of the Care Zone are: • Visual Relationship - The positioning of the care zone at the heart of the largely openplanned Community Hub, and as such in a highly visible area from all other key elements assigns programmatic significance to this moment. Emphasising the importance of the personal atmosphere and connections intended in the design of the Hub. • Intimacy - Intimacy is created by familiar home-like kitchen fixtures, which enable a sense of comfort and reassurance within a public building. • Graphics - Large graphic murals printed on glass provide helpful hints to patrons about nutrition, specifically vegetable, fruit and water dietary requirements. • Glazing - The highly transparent nature of the boundary to the outdoor, places the orchard in close vicinity to the Care Zone; further highlighting the importance of healthy eating whilst allowing in natural light.
THE HEART
57
hub
the host A guide to the Heart, a companion that encourages community ownership in both their personal health and the features of the neighbourhood that support this.
By streamlining the greeting and registration process, new efficiencies have created the potential for the traditional ‘receptionist’ to take on the role of ‘host’ within the Care Zone. An effective role in the deliverance of wellness, she provides a personal connection to the Community Hub for all patrons, further engaging them, encouraging a sense of ownership and empowering them with knowledge in an non confrontational manner.
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E the social zone The Social Zone is an attractive community feature designed to engage Patrons in the Community Hub. An inviting hive of activity at the core of the Hub, it aims to empower patrons through informative encounters with other like-minded, health aware Patrons of the Wellness Neighbourhood. It is a flexible, open-planned environment designed to facilitate routine community engagement as well as educational seminars and events.
private pods The Private Pods are a moment of pause. Essential in the journey of a Patron visiting the Regenerative Core, it acts as a place of restful sanctuary on their inward path and reflective solace during the transition outward. The key features of the Private Pods are: • Intimacy - Created by the Pod’s delicately human scaled form and screened privacy. • Proximity - Auditory proximity to other dynamic elements of the Hub promotes a sense of belonging during a potentially lonely experience. • Nature - Organic materiality, natural light and visual relationships with nature have a calming influence on Patrons by providing a diversional distraction.
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active environment The Active Environment is a dynamic community gather space that requires Patrons to partake in physical activity through the innovative integration of traditional gathering space fixtures and those used in a gym environment. The key features of the Active Environment are: • Open Plan - The extensive open plan creates an inviting active core with strong visual connections to other program moments. It also provides flexibility in function including the opportunity for various sized groups to gather. • Implicit Activity - Physical activity equipment integrated in place of seating creates an imperative for activity while socialising. • Play - An adult-sized play area located near the outdoor space allows for Patrons of all ages to engage in an entertaining physical activity.
passive environment The Passive Environment is a sedentary community gather space where fixtures actively encourage encounters with other Patrons, with the intent of being guided and gaining information through positive interactions. The key features of the Passive Environment are: • Approachable Distractions - The integration of natural elements draws Patrons into the central calm gather environment. • Boundary - Defines the space and human scale, creating a sense of calming seclusion within a dynamic environment. • Flexible Modes of Being - Multiple forms of seating and fixtures set the scene for unconscious connections with other patrons.
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7 hub
the lungs the regenerative core
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neighbourhood
core
what if you wanted to spend time in a healthcare environment?
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the vessel connecting the regenerative core The Regenerative Core is a series of served and serving spaces catering for formal engagements between Patrons and various multidisciplinary Health Care Professionals. The spaces have the flexibility to expand and contract, similarly to the lung – dictated by the number and needs of patrons. The served element of the Regenerative Core is comprised of three core zones; the Gateway Pods, the Practise Zone and the Re-zone, that are each different in function and permanency, with the common aim of a close connection to services provided, whilst mitigating the negative visual cues often associated. The zones are seamlessly connected to the Community Hub via a fluctuating ‘Vessel’, which navigates Patron encounters and unifies the two spaces, creating a distractive transitory form.
served spaces Are venue in which the Patron is ‘served’ by the Healthcare Professional.
serving spaces Are resource centred spaces that assist the Healthcare Professional in efficient service provision.
A
Each served zone is connected to the Professionals and linked by the ‘Service Bronchi’. Neither accessible nor visible by the Patron at any time, this is the clinical area and also includes various staff, meeting and educative facilities.
B C
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A. gateway pod Supportive facilities designed to increase the efficiency/ flexibility of Patron care whilst not decreasing the patient/ professional relationship. They are used prior to and following visits to health professionals to update patient information and to facilitate simple diagnostic services, for example pathology testing. The Gateway Pods are connected not only to the Practise and Re-zones, but also to the pharmacy and other facilities within the Bronchi to increase efficiency and patient comfort.
B. practice zone Flexible spaces used by various forms of health professionals for both consulting with and examining Patrons. The Practise Zone is a combination of various Pods, facilitating multidisciplinary care for Patrons whilst also assisting Patron/ Professional relationships and increasing Patron comfort and experience. The Patron uses the Practise Zone often during their time spent within the Re-zone.
C. re-zone Combination of both private and communal spaces used in facilitating ‘day care’ – assisting and taking pressure off hospitals and current rehabilitation elements in the existing healthcare system, whilst also minimising the chance of re-occurring visits. The Re-zone facilities have a strong connection the Gateway Pods, the Practise Zone and also the Service Bronchi – all assisting the Re-Zone in its functioning.
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A the gateway pod The Gateway Pods are supportive spaces, which facilitate the Patron’s encounter with the Supportive Health Care Professional as the initial and final step of all interactions with a Health Care Professionals. Recognisable to Patrons as the gateway to their Health Care Professionals the pods offer an engaging connection to the Community Hub, whilst also providing a union with the Service Bronchi. These connections, along with need considerations of the Patron within each pod are achieved by: • Circular pod layout – The Supportive Health Care Professional is central to each pod, providing the patron with a sense of being cared for, whilst increasing efficiency of service • Organic pod form – Offers Patron comfort and various distractions through the sweeping curved enclosure. It achieves a privacy barrier for occupants within, yet provides a visual link to Supportive Health Care Professionals • Pod interior – Assisting Patron ease and comfort, through personalisation with various forms of distraction, including an interactive screen, flexible furniture and format. Each pod also supports efficiency for each professional through hidden accessible storage spaces a • Materiality – Engaging Patrons with comforting distraction and connection to nature through the timber pod construction, and the direct relationship with the green-walled service core, allowing for natural light and ventilation THE LUNGS
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gateway pod plan
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B the practice zone
pods
modular The Practise Zone consists of permanent modular spaces which facilitate the primary function within the Regenerative Core. They are Patroncentred, resource based parcels, offering a forum for multidisciplinary care when consulting and examining patrons. With the the flexibility to expand and contract according to need.
parcels
touch parcel
A Practise Zone is a variable parcel of a touch, talk and tree pods. Talk and Touch pods are optional and which pods are utilised depends on the form of care. 1. Talk Pod Facilitates consultative forms of care between professional and Patron.
full parcel
2. Tree Pod External pod which provides patron and professional comfort through a distracting connection to nature. 3. Touch Pod Facilitates examinative multidisciplinary forms of care for the Patron. The circular layout of the pods creates an efficient connection to the Service Bronchi from each parcel of pods – therefore offering ease for the professional, whilst also providing substantial amounts of privacy and connection.
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talk parcel
talk parcel layout
touch parcel layout
full parcel
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full parcel The Practise Zone encourages a strong Patron/ Health Care Professional relationship, by having a close connection to services provided, whilst negating the often negative visual cues associated. The ‘Full Parcel’ includes one of each the Touch, Talk, and Tree Pods – catering for a professional, which requires both examinitive and consultative spaces. Features that achieve this include: • Organic pod form – Offering Patron comfort and privacy in an organic enclosure. The Pod provides a welcoming entrance and a recognisable form to facilitate relaxation and ease. The form doubles as an interesting distraction, dividing and segregating the spaces, whilst also blurring the line between architecture and furniture - the roof sweeping internally to become both the examinative beds within the Touch Pod, and the consultative chairs within the Talk Pod. talk • Patron-centred care within a resource basedpatron platform – The patron experience is central to all interactions within the Practise Zone, around them revolves the efficient encounters with the resource Healthcare Professionals and their resources. • Division of three pods – Segregating spaces to allow for a close connection to the service Bronchi from the Touch Pod, and a strong connection to the Tree Pod from both occupied pods. Within the Talk Pod, the visual connection to the more-intrusive Touch Pod is limited – with the connection to nature through service bronchi the Tree Pod being strong, creating a higher level of comfort in the Patron. Similarly, within the Touch Pod, the visual connection for the Patron to the Service Bronchi is restricted, with the connection to the neighbouring Tree Pod overstated.
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practice zone plan
touch
patron
talk
touch
resource patron
patron
service bronchi
• Flexible wall and floor capsules – offering both storage and personalisation for the Professionals. This not only allows for an efficient access point to supplies, but also provides and in doing so, incentivises the Professional to take ownership of their space – empowering both Professional and Patron with comfort and ease.
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C the re-zone The Re-Zone is a ‘day care’ retreat space providing the supportive reassurance of the Regenerative Core facilities - with the aim of taking pressure off hospitals and rehabilitation centres. It is composed of private ‘My Pods’ and a communal Breakout Space, which allow Patrons to choose privacy levels, activities and spaces. The My Pods are permanent fixtures, the primary design features including: • Common entryway – for Professional and Patron reinforces equality between the two, whilst also allowing for an efficient connection to the Service Bronchi. • Individual connection to nature – the back exit of each My Pod provides both a physical access point and also a strong visible connection to the natural environment – decreasing healing time through distraction and comfort. • Pod interior – creating a homely atmosphere by including interactive sources of distraction as well as unscripted areas for personalisation of space, giving ownership to the Patron and thus increasing comfort. • Varying levels of privacy – through the use of flexible furniture and dividing walls between the ‘back door’, the Breakout Space, entryway and Service Bronchi, increasing levels of comfort within the Patron and reenforcing their individual ownership of space.
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re-zone plan
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the service bronchi connecting the neighbourhood The Service Bronchi is an efficient service zone that implicitly encourages the coexistence of multidisciplinary health services and Health Care Professionals. Physically, it is a spine-like connective area allowing for the flow of ‘oxygen’ – or flow of professionals operating within the Regenerative Core – and yet not visible or accessible by Patrons. All three served spaces within the Regenerative Core – the Gateway Pods, the Practise Zone and the Re-Zone – are connected to the Service Bronchi, and thus connected to each other. Each of the three served zones have a central ‘core’ serving area within the Service Bronchi providing storage, preparation spaces and resources. The Service Bronchi includes a range of spaces which assist in providing a well-rounded care model for Patrons, and promote the collaboration of health care professionals. These include: • Simple Diagnostic services – pathology, pharmacy • Educative spaces for students to receive hands-on experience • Multidisciplinary passages – flexible connective points between spaces which function as meeting rooms, staff rooms, information resource centres and multidisciplinary care rooms
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multidisciplinary passages Multidisciplinary Passages are flexible connective points between spaces placed throughout the Service Bronchi, encouraging the collaboration and resource sharing of Multidisciplinary Health Care Professionals. Functioning as meeting rooms, information resource centres and multidisciplinary care rooms, the key features of the Passages are: • Flexibility to act as a channel for the Professionals, or to be completely closed off and offer privacy to the Professionals within • Connection to nature through views into courtyards or skylights offering comfort and distraction, encouraging time spent in passage and socialisation within • Interactive resource space within to be easily accessible and encourage the sharing of information
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8 the epilogue The future of Australian healthcare lies in engaging the community in and empowering them through a Lifecycle of Wellness - in order to encourage a healthy lifestyle, based on increased health awareness and preventative multi-disciplinary care. A paradigm shift that takes the view of health as a holistic, lifelong investment, and not as simply episodic medical intervention is required in response to the challenges facing the current Healthcare system. The Wellness lifecycle embodies a three levelled approach, based on the efficiency of bodily regenerative processes. It engages the community in a transformational health environment, increasing awareness, creating a routine of wellness and providing an effective, comforting system to respond to medical need. From the broader Wellness Neighbourhood, through to the Community Hub which blends seamlessly with the Regenerative Core, health is delivered on a community wide platform.
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epilogue
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ENVISION STUDENT PARTNERSHIP TEAM 2012
Ben Selke
Alex Harrington
Russ Harding
References 1 Sternberg E., Healing Spaces: The Science of Place and Well-being, Belknap Press, 2009, p 230 2 Nursing Federation, Primary Health Care in Australia, 2009, p 23 3 Ibid. 4 Ibid. 5 Harris, Kidd, Snowden, New Models of Primary and Community Care to meet the challenges of chronic disease prevention and management: a discussion paper for NHHRC, 2008, p5 6 Churchill Lynn, Rockhampton Hospital, Artichoke iss.36 2011, p 104 7 Kaba R, Sooriakumaran P. The evolution of the doctor-patient relationship, 2006 AND Låzaro J, Gracia D., The doctor-patient relationship in history, 2006 8 Department of Health and Aging, Primary Health Care Reform Australia, Commonwealth of Australia, 2009 p 22 9 Department of Health and Aging, GP Super Clinics: About the GP Super Clinics Program, http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-gpsuperclinic-about, (17/12/2011) 10 Australian Treasury, Australian Budget: A National Health and Hospital Network for Australia’s future, Commonwealth of Australia, 2010, p 2 11 Preventative Health Taskforce, Australia: The Healthiest Country by 2020, Commonwealth of Australia, 2008 AND Department of Health and Aging, Primary Health Care Reform Australia AND Lang J., Workshop Paper: Prevention and Wellness, Commonwealth of Australia, 2008 12 Department of Health and Aging, Primary Health Care Reform Australia, p 8
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ENVISION Student Partnerships The Cycle of Wellness is the culmination of the ENVISION Student Program 2012, one of many creative partnerships that NBRS+PARTNERS has realised. In upholding the architecture firm’s vision to create life-changing environments, the student partnership reinforces the importance of multiple perspectives and collaboration in the design process. In an innovative collaboration NBRS+PARTNERS engaged with these three students of Architecture to dream a little, and to create a 21st Century response to health and wellness within our communities. The result is an imaginative, thoughtful representation of an integrated community wide wellness platform creating “a state of complete physical, mental and social well being”.
Acknowledgements The ENVISION Student Team team would like to thank and acknowledge the following people for the time to help us achieve an understanding of the current Australian healthcare environment. This contribution to the Cycle of Wellness is warmly appreciated.
Dr John Best Dr Roy Brancatisano Mrs Anne Bryce Dr Stephanie Butler Dr Leon Clark Mrs Elizabeth Harding Mrs Sue King Mr Andrew McAnulty
Ms Allison Moffit Mr Keith Morgan Mrs Wendy Morris Dr George Quittner Mr Evan Rawstron Mr Robert Ten Kate Ms Nerida Thorburn Mrs Jill Wrathall
We would also like to pay special thanks to our mentors at NBRS+PARTNERS, Andrew Duffin, James Ward and Rodney Drayton, who helped us realise the potential of the Cycle of Wellness and develop a transformational health environment. For more information call: James Ward NBRS+PARTNERS. (02) 9922 2344
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Š NBRS+PARTNERS 2012