Nightingale THiNK by IBI Nightingale

Nightingale THiNK

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Nightinga le THiNK

IBI Ni ghtingale

THiNK

Urban l and facilities Transportation Intelligent systems Urban l and facilities Transportation Intelligent systems Urban l a Transportation Intelligent systems Urban l and facilities Transportation Intelligent systems Urban l and facilities Transpo Intelligent systems Urban l and facilities Transportation Intelligent systems Urban l and facilities Transportation Intellige Urban l and facilities Transportation Intelligent systems Urban l and facilities Transportation Intelligent systems Urban l a

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IBI Group has expanded its practice through Nightingale Associates, a UK based firm, a global leader specializing in research and facilities for healthcare, education, and science. Urban Land

Facilities

Transportation

Intelligent Systems

Nightinga le THiNK

Our Firm

IBI Nightingale is a branch of IBI Group, a multi-disciplinary consulting firm that offers comprehensive local service delivery and international design excellence for sustainable environments. Our firm is renowned for the highest professional standards with particular emphasis on creative design and planning. We are committed to working with clients to fulfill their needs while achieving excellence; it is a constant pursuit involving all disciplines at every level of our organization.

A holistic approach that balances the functional, economic, aesthetic, and environmental. IBI Nightingale integrates the leading best practices in North American healthcare delivery with the largest European specialist in healthcare design. The firmâ&#x20AC;&#x2122;s commitments to innovation within the health field, contributions to ongoing learning, and the development of sustainable health facilities are demonstrated by an award-winning portfolio, dedicated research department, and successful relationships with clients, suppliers, contractors, and consultants worldwide.

Collaboration is the key to our success. Our firmâ&#x20AC;&#x2122;s international offices and high quality support network unite to provide a flexible, specialist resource that ensures clients have accessible project leadership while benefiting from the firmâ&#x20AC;&#x2122;s embodied international expertise. Established, formalized systems for project management, delivery, cost, and quality control ensure that projects adhere to schedule and budget targets. Our firm commits the most appropriate specialists to every project, utilizing all resources around the clock and around the world to deliver high quality healthcare, education and science facilities.

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Nightinga le THiNK

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Nightingale THiNK One of the founding principles of Nightingale Associates was to ensure that the practice stayed at the forefront of their specialist field by actively participating in and often leading the debate about new trends in healthcare architecture. This was achieved by a combination of the experience and talent of the team, having clear aspirations and taking planned actions to achieve our goals. We were founder members of Architects for Health and the RIBA Health Client Forum, have contributed regularly to the architectural and medical press and speak at and chair conferences on healthcare design. Over the last 10 years, during which we have added education and science to our specialist portfolio, we have, deliberately, applied a similar level of thought leadership to these fields.

and lasting local connections. We realised as soon as we grew from one studio to more than one, that, if we were to successfully maintain a top position as specialist architects in and expanding federal structure, we had to have a clear plan to achieve this.

Peterborough City Hospital, Cambridgeshire, UK

Our solution to this challenge was twofold. We maintained and evolved a strong and appropriate management structure, focussing on sharing business development and project resourcing to maximize efficiency. A key example of this is the development of the ‘in sourcing’ production information studio in Cape Town that allows us to efficiently resource very large projects without compromising our federal network of design studios. Old Road Campus Research Building, University of Oxford, UK

A second founding principle of the firm was to listen to and provide the best possible service to our clients by being local to them. We have stayed true to this aspiration by managing growth by the formation of new studios of an average size of 30 people headed by people that have real

The second element in this federal approach to growth was to create and maintain a highly respected in-house research and development team that has the primary remit to act as a catalyst to help all parts of the practice to be recognised as thought leaders and architects of choice in their specialties. This has enabled us to support and expand IBI Group by providing global thinking and local innovation.

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Research, Development and Innovation naturally evolved into the THiNK brand. Much progress has been made in developing the services, activities and profile of Nightingale THiNK over the past three years. With the emphasis being on the â&#x20AC;&#x2DC;iâ&#x20AC;&#x2122; for innovation this has been good for external promotion but also for internal communication with the desire not only to disseminate the work being carried out by a few but to create an approach that is being adopted by all.

Passion Nightingale Associates, through the passion of key individuals, have been developing a reputation for research and innovative thinking over the last 20+years. This has supported the development of a breadth of knowledge and understanding of the sensory impact the built environment has on the building user, particularly in healthcare. This knowledge capital has been furnished with findings from medical and psychological fields which are then applied to design solutions. Innovation Through Design The process of design research is inherent in a number of clinical design solutions developed by Nightingale such as the cruciform ward. The process of taking information from other sectors such as clinical research and applying that information to design solutions often provides another way of looking at a recurring problem. Providing accommodation for multiple patients in one room whilst minimising the risk of cross infection and maximising privacy and dignity has been a problem for many hospitals. Utilising findings into the impact of the built environment on the well being of patients as well as key factors relating to cross infection offered an alternative solution. This process of design research, approaching a recurring problem in a different way is being applied to other sectors across IBI.

Peterborough City Hospital, Cambridgeshire, UK

Childrenâ&#x20AC;&#x2122;s Centre, New South Glasgow Hospital, UK (2015)

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Collaboration The validity of research is often provided by the credibility of the source of information and for this reason it is important that strong relationships are created between THiNK and research institutions. These connections provide the credibility associated with the rigorous process of academic research but also the potential to support and benefit from projects funded by a third party such as a funding council. This funding would not normally be available to a private company. A number of long term relationships have been forged with universities that are now bearing fruit. It also seemed important to be aligned, if not a core partner, to pieces of research funded by a well known and respected funding bodies in a subjects highly relevant to its field.

themselves apart from their competition. Another good example of this is the relationship with Loughborough University and their Adaptable Futures project which is being developed as part of the THiNK research into future flexibility and adaptability of buildings and their settings.

Value added – value quantified

The HEAD project in which THiNK is collaborating with the School of the Built Environment at Salford University is a good example. The partnership and initial study that had been financially supported by NA allowed Professor Peter Barrett to submit a strong application and ultimately be awarded the £432k grant. Leveraging the work done by others in this way is an excellent way for NA/IBI to set

To understand the importance of research and development (R&D) to a company it is vital to quantify the value it brings whether this is supporting successful project wins, delivering a product that meets the clients’ aspirations or even attracting the right people to the company. THiNK is regularly used as a differentiator between us and our competitors to show the added value we can bring to a project.

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groups. Where ever possible this has been published in industry and national publications. As well as working to develop the body of knowledge at our disposal we are showcasing this intellectual capability to a wider audience, leading the field and positioning IBI Nightingale.

Photo Credit: Victor1558

By recording this value it is then possible to track the progression of R&D support. It is common problem that not enough innovative or research driven ideas are carried through a project whether this is due to value engineering or commitment of the design team and client. It is important for THiNK to support design research and innovation throughout a project to ensure innovative ideas are delivered in the final product. Having the idea is not the end it is just the beginning.

The THiNK review process provides a template for informal review sessions to take place at key stages of a project from the initial blue sky thinking session when a project is first won to evaluating the impact of the ideas when the building is complete. This will also support the cradle to cradle approach. Thought Leadership THiNK members have been presenting the idea of design research and work by Nightingale across the sectors for many years both to industry professionals as well as client

Nightingale has helped to shape the UK documentation, for example, being part of the steering groups for both NHS Environmental Assessment tool (NEAT) and its replacement BREEAM Healthcare as well as supporting regular updates of UK Department of Health (DoH) briefing documents. We have provided much needed peer review and guidance for the DH over a number of subject areas and now involved in steering the new â&#x20AC;&#x2DC;guidance lightâ&#x20AC;&#x2122; approach. Although the balance of supporting the wider body of knowledge versus maximising commercial reward is sometimes difficult to reconcile it is important that we identify where it is possible to maximise return on our substantial knowledge capital in these areas. This is one of the many challenges for R&D in a commercial environment.

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Applied Research

Cradle to cradle

The only way to maximise the financial and human input into research is to apply the findings to real life situations. Knowledge from many different areas is reviewed, analysed and applied to design solutions in order to find an innovative solution to a given problem.

In all other industries developing an idea means iteration, making something, using it and evaluating how it performs then using this information to adjust and improve. The cycle is continuously repeated. The term cradle to grave is often used to describe the life of a building but we think itâ&#x20AC;&#x2122;s more important to talk about a cradle to cradle approach where at the end of the project you evaluate what you have created and this then informs the beginning of the next.

Photo Credit: Neil Palmer, Centre for International Tropical Agriculture

The key value of research and development within a multi disciplinary company is that it must keep developing and never stand still. The knowledge capital that is inherent across the company in the individuals that work within it needs to be nurtured and encouraged. Across a network like IBI Group the key is to apply the knowledge capital from one sector to the problems of another, bringing different groups of people together. This is why we believe research is something that everyone should engage with and be actively involved with right across the IBI network. We have held regular practice-wide charettes, where all members of staff are encouraged to get involved.

Post Occupancy Evaluation should be an inherent part in the process of any project, learning how the object you have delivered for the people that are going to use it is performing. This is also an important part in the management of the knowledge capital inherent in the team that delivered that object, be it a building, a product system or a masterplan. To develop innovative ideas you have to understand what has gone before. It can also be seen as pre-project evaluation, where learning about potential clients existing facilities and how they use them can provide valuable insights into a new scheme.

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Developing a practice strategy for Post Occupancy Evaluation is a THiNK priority. As architects we are well placed to offer building owners an intelligent POE service encompassing all levels from estate utilisation to user perception. This also offers the opportunity for THiNK to develop a standalone service with the potential to earn a fee as well as open new doors. In a multi-disciplinary company like IBI Group there is potential for a cross sector service developing a new revenue stream. One example of this could be to use the techniques developed in converting laser scans of existing buildings into comprehensive BIM models for continued estate management. Providing POE will also require collaboration with external partners to help support the development of a sound strategy but also to fill the gaps in our capability where necessary. A relationship has been developed with Performance Consultancy who has been advising on the most appropriate means by which IBI Nightingale can develop a competent approach to POE. Existing relationships with INSIGHT and Centre for Research in the Built Environment (CRiBE) at the Welsh School of Architecture are also being maintained. Innovation: Failure to Success To be truly innovative, to come to the same problem with a new solution there is an inherent risk. Trying something new means that you don’t always know the answer. This fact has to be understood in order to embrace design innovation on our projects.

2012 Olympic Games Post Occupancy Evaluation

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Full Circle Review Process

THiNK Structure Diagram, Cradle to Cradle Design

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Structured approach “The more wild ideas you want to realise, the more dry, rational, professional and rigorous you have to be in your approach.” Bjarke Ingels, BIG.

Photo Credit: ellenm1

The development of the BedPod is an example of this. The Design Council competition ‘Design for Patient Dignity’ provided an opportunity to develop the BedPod, a component based, prefabricated, integrated bed environment for hospitals. Working with a manufacturer as well as an industrial design company the difficult issues of patient privacy and dignity were addressed. Following the successful creation of a 1:1 prototype the Department of Health decided to take this concept further into their Showcase Hospital programme where it could be evaluated in use. Taking an exhibition prototype into a real life ward environment has presented a wide range of challenges and has meant working at risk for the entire team. This risk has been taken in the belief that the product has significant mileage particularly to address the current emphasis on refurbishment over new build within the UK NHS.

In order for creative ideas to be generated into realised solutions it is vital there is a structure within which they can flourish. Not only to understand how it fits within the business development plan for the company but also to prove to those that are buying that idea that it has been generated in a way that can be examined and trusted. For free thinking and creativity to flourish there has to be a structure to support it, to give it boundaries and a mechanism through which the ideas can be shared. It is important for THiNK to work within a framework, one which can be adjusted and developed as it grows but that allows other people to understand the process and the focus. BedPod

To explore new ideas and push the boundaries both of industry knowledge and capability as well as the practice’s experience is a risk. Risk is necessary in order to achieve innovation and therefore success.

To maximise the return, the investment in time and cost has to be clearly understood taking into consideration the value of success. Any R&D project has to clearly fit with the business development plan to support and enhance our service offering but also push the boundaries of those sectors (see THiNK structure diagram on Page 13 ). It needs to promote IBI Nightingale at the leading edge. It’s therefore important to have a set of criteria that any potential research project must meet (see R&D project criteria).

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THiNKing outside the box Evaluated THiNKing

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We have to protect what we do, believe in the value that it brings and make sure it is not given away. One of the best ways to maximise the financial and human input into research, whatever industry you’re in, is to apply the findings to real life situations. The success of truly innovative companies is in their investment in the thing that makes them innovative, the people and their creative ideas. It is important that we collate and share the creative and innovative work going on across all our studios and areas of practice and maximise the impact of the knowledge capital on the entire network.

There are some interesting examples of where individuals across the practice have taken positive steps outside the routine delivery of a project to apply creative and innovative ideas, whether that is in product, materials or process. The Firm developed a strong relationship with furniture designer and manufacturer Knightsbridge across a number of schemes such that between them they developed a new chair which answered specific needs of a client. The Norbury Chair was designed for the Norbury ward of a mental health scheme in which the staff had specifically requested a chair which could not be thrown at them but that enhanced the internal environment for the patients. This chair was highly commended in the Building Better Healthcare Awards in 2009. This initiative to strive to better solutions, to look a problem in a different way should be promoted through the company, the ethos of THiNK.

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Sense Sensitive Design Sense Sensitive Design in Healthcare The effect of light on health is critical. Essentially we crave light. Light is life. With little or no natural light, melatonin tells the body to ‘log off’. Sense Sensitive Design is about maximizing daylight and good views and reducing mechanical and electrical interventions. We can ‘duct’ natural light. We can manufacture it. We can even control its colour and intensity to influence our behaviour.

Photo Credit: Eren Sea

The environment is perceived through the main sensory receptors. This data is relayed to the brain, which, in turn, will affect the physiological, emotional, psychological, and ultimately, physical condition of the bulding’s users.

The five senses are sight, hearing, touch, smell and taste. It is through understanding the true dimensions and limitations of these senses and sensibilities that allow the designer to design with greater skill and enable him or her to create a truly responsive environment. The senses are tools by which we measure our environments.

Colour is one of the most powerful healing tools. It is not an expensive medium and is extremely potent. Certain colours slow one’s perception of time and others accelerate it. Recent research has proven that the very colour of medication can partially predetermine a patient’s outcome. Colours can have both positive and negative effects on patients and it is the understanding of these principles that allow us to create the most powerful healing environments. For example, a patient receiving chemotherapy will feel sicker receiving treatment in a green room, yet apple green can relieve depression. There are fundamental psychological and physiological responses to certain stimuli. Noise increases heart rate, blood pressure, respiration, and even blood cholesterol levels. It lowers pain thresholds, keeping the brain over stimulated and increasing the need for medication.

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Photo Credit: Aaron Gilson

Pleasant sounds create a sense of well being. They improve the function of the autonomic nervous system. Music can distract a patient from their pain and therefore has a painkilling effect. It can also reduce blood pressure, heart rates and respiration.

Touch is the ‘confirmatory’ sense. Touch gathers information confirming data received by the other senses. It is the haptic sense of living and acting in space. Textural surfaces form an integral part of a child’s world of learning.

Photo Credit: E Minty-Berger

Touch can aid a partially sighted patient to navigate through space, forms blind person’s total environment, and assist a mental health patient’s transition from an ethereal world to reality.

Smells are retained more acutely in our memory than are visual images or sounds. Designers have a real opportunity to affect people’s moods, perceptions and motivation through smells and fragrances. Unpleasant odours increase heart rates. One forgets that some of the smells that inhabit hospitals are formaldehyde, formulin, iodine, glutaraldehyde, bone, dust, urine, burnt skin/ hair, testosterone, disease, body odour etc. Fear per se is communicated through smells. Good ventilation systems are sufficient to remove these smells. Smells can also relax muscles and aid concentrating. Kajima- a contracting firm - has coupled up with Shiseido - a perfume manufacturer - to produce a unique air conditioning system in the Kajima HQ in Tokyo. The system emits citrus smells that invigorate staff early in the morning followed by floral smells that aid concentration and then woodland

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smells at lunchtime to relax. The same cycle commences after lunch. In a healthcare environment ‘baby smells’ can reduce aggression in Accident and Emergency Units. Vanilla fragrances encourage pre-term babies to feed in the Neonatal Intensive Care Unit (NICU’s). Pleasant smells help the body produce endorphins, the body’s natural ‘feel good’ drug, which in itself may reduce the amount of anaesthetic administered during a surgical procedure.

Photo Credit: Devon Walker

Understanding of the sense of balance and this sensory receptor in the healthcare environment is vital. The sick, very young, the disabled, the elderly, the partially sighted and the blind will all rely heavily on their own sense of balance. It is crucial that the environment must be perpetually true and honest in terms of vertical and horizontal plains. A sudden change in floor finish from light to dark may feel like a chasm to certain patient groups. Variable height furniture, fittings and sanitary ware helps further support the patient.

By working with the above set criteria in mind, it is possible to create environments that have the most positive effect on the patient’s well-being. Emotional Mapping and Design Prescription Emotional Mapping enables clinicians and designers to navigate through the emotions and feelings of patients within varied healthcare environments.

Design prescriptions are reached through ‘Prescription Spreadsheets’ that define optimum conditions for the healing process within hospital departments, single rooms and individual patients.

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The London Clinic, UK

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Sense Sensitivity Design in Education Within the education field, interest is growing in the relationship between the learning environment and its potential impact on learning, achievement, engagement, motivation, behaviour and sense of well-being for both the student and teacher. Over the last eight years, Nightingale Associates has been researching and developing design tools and guidance based on the way the body perceives and responds to sensory stimuli within our environment. These tools have enabled us to design spaces more skilfully and incisively, focusing on key design issues that include – but are not limited to – physiological and psychological effects of colour, light, sound, views, touch, smell and the passage of time.

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School Workshops THiNK has developed a service that can be offered to schools to improve their learning environment. The idea is to hold sensory workshops with children and teachers and capture their feedback in a sensory audit. Once their needs have been analysed, designers can offer solutions to the problems with simple ‘design interventions’ like basic fixtures and fittings or the implementation of sensory aids such as calming sounds and scents.

The pilot for this service was Bladon School, Oxfordshire which involved workshops with primary school children, during which they learnt the importance of the five senses and THiNK was able to examine their learning environment in detail allowing them to advise the school on design interventions. To further this research, THiNK is working with Salford University’s Research Centre for Education in the Built Environment, which is looking at the optimal learning environments of primary school children.

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Sense Sensitive Design in the Workplace

> Pain

> Satisfaction

DIURNAL

Acuity Adapt rooms

Nursing plan

Decentralised Supplies

Family zones

> Falls

MUSCLETONE POSTURE MOVEMENT PATTERNS

> Length of stay

x x

> Injuries

MUSIC

VIEW

COLOUR

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Views of Nature

3DIMENSIONAL

2DIMENSIONAL

> Depression

Single bed rooms

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Access to daylight

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VIEW

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Appropriate Lighting

Design Interventions

DIAGNOSTIC

Good lighting can reduce stress and absenteeism as well as increase productivity. Significant improvements have been reported in the performance of both simple and complex tasks when acoustic conditions have been optimised.

TOUCH

Views of Nature

NATURAL LIGHT

Access to daylight

SENSES

SOUND

TEXTURE

SIGHT

As stated earlier, essentially the environment is perceived through the main sensory receptors. This data is relayed to the brain which in turn affects our physiological, emotional, cognitive, psychological, and ultimately physical condition within the working environment.

PLEASANT

A perfect and inspiring work environment actively dialogues with all the senses. We are multi-sensory beings constantly being influenced by our surroundings. The total choreographed environment is a key source of motivation and drive as well as improving personal wellbeing, health, selfsatisfaction, self-esteem and increasingly a sense of affinity with colleagues, work activity and the overall organisation.

x x x

SLEEP AWAKE WEAK RESTLESS ANXIOUS

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> Pain >xSatisfaction x x

x - Patients x - Staff Evidence Based Design Sensory Spreadsheet

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Differences in productivity, as high as 25%, have been reported between comfortable and uncomfortable staff. People cannot work at their best if they are distracted by not being able to breathe, hear or see properly. Individuals react differently to different stimuli, some being hypersensitive or hypo sensitive to sound and others more gender sensitive to temperature.

The most important factors in achieving health and comfort are air quality, temperature, overall comfort, noise and lighting. In this rapidly changing world of work, the implications of linking office design with business performance are so profound that innovation is as important in the conduct of research as in the ways that offices are developed, designed and managed.

Productivity vs. Temperature

Relative Productivity

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Conceptual design for commercial offices

ÂŠ2008 Productivity-Science.com

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Innovation Barn Operating Theatre Cardiothoractic Centre Broadgreen Hospital, Liverpool • • • • • •

Open Plan configuration, encompassing four operating zones Surgical teamwork and sharing of expertise Automated pharmacy POE, after two years of use showed: Reduced infection rates compared with conventional theatres What concerns did you have prior to 85% of all staff categories preferred working in inthe theatre working thebarn Barn Theatre? 0%

None Patient privacy / dignity / awareness Noise distractions Infection Movement of staff / traffic Anaesthetic room size Disposable items used No defined area for theatre table None Social aspect Patient privacy / dignity / awareness No music Noise distractions Less staff employed Infection Movement of staff / traffic Anaesthetic room size Disposable items used No defined area for theatre table Social aspect

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No music Less staff employed

None Staff noise level Overlooked by all Anaesthetic rooms too small Distractrions / interruptions Patient transport to Recovery Music Lots of traffic None Doors not used properly Staff noise level Limited use of equipment / x-ray Overlooked by all Disposal of used items Anaesthetic rooms too small Infection control Distractrions interruptions Patient /confidentiality Patient transport to Recovery Music Lots of traffic Doors not used properly Limited use of equipment / x-ray Disposal of used items Infection control Patient confidentiality

Teamwork / other staff support / emergency help Better working conidtions / clean / daylight Social Excellent for visiting surgeons / students Better staff management Good observation of standard practice Everything in one place Able to view other operations if not scrubbed Teamwork / other staff support / emergency help Asepsis Better working conidtions / clean / daylight Not getting forgotten about Social Excellent for visiting surgeons / students Better staff management Good observation of standard practice Everything in one place Able to view other operations if not scrubbed Asepsis Not getting forgotten about

20%

40%

60%

80%

100%

What do you see are the advantages of working in the Barn Theatre? 0%

20%

40%

60%

80%

What disadvan working in the B 0%

20%

Do you prefer Barn Theatre to

What do you see are the advantages of working in the Barn Theatre? 0%

20%

100%

Yes (87%) No (10%) No difference (03%)

Do you prefer Barn Theatre to

Nightinga le THiNK

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Cruciform Ward IBI Nightingale’s experience in the healthcare market underlines that providing 100% single room accommodation is often unaffordable or inappropriate for the intended purpose or patient group. The cruciform ward addresses this problem, providing a cost effective, staff efficient and patient centered alternative to current multi-bed bay models. The cruciform ward layout is configured to emphasise individual bed heads for each patient, thereby creating a sense of personal space and preventing the spread of infection. The innovative layout allows the integration of en-suite sanitary accommodation as well as areas for informal seating or patient dining. The ward can be deployed with varying percentages of single room accommodation. THiNK carried out a Post Occupancy Evaluation on the cruciform wards of Princess Elizabeth Hospital, Guernsey. 80% of staff preferred the cruciform ward to the traditional four bed layout, and felt that it made observation easier. Patients also felt reassured by seeing nurses passing by.

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Health Innovation 100% Single Bed Accomodation There is ongoing debate as to whether single bed accommodation is the future of the UK NHS. Single occupancy rooms are a successful way of increasing infection control and providing improvements in privacy and dignity, however this configuration is more costly.

Single Bedroom 19.0sqm

En-‐suite 4.5sqm

in-board

En-‐suite 4.5sqm Single Bedroom 19.0sqm

out-board out-‐board

IBI Nightingale designed Wales’s first 100% single room hospital, Ysbyty Aneurin Bevan. The practice undertook a Post Occupancy Evaluation on the scheme. Whilst some patients enjoyed the privacy when they had visitors, others missed social interaction and felt lonely. This was compounded by the fact that most needed assistance to reach communal areas, which also impacted the staff workload.

En-‐suite 4.5sqm Single Bedroom 19.0sqm

back–back in-board back -‐back

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The development of the form and layout of the hospital is influenced by the functional and spatial requirements of the single bedroom. Studies of the preferred room layout will influence the plan, section and elevations of the new hospital. 3D studies and full scale mock ups have been constructed to determine the detail of every aspect of the room. Grouping single rooms into wards coupled with the desire to provide views, along with maximising the benefits of natural light and ventilation creates a narrow plan. Grouping the wards together to respond to site constraints and minimise travel distances results in the distinctive plan form shown.

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Salutogenic House of the Future

Photo Credit: Harold Groven

With an ever increasing elderly population facing chronic health challenges and lessoning filial support one’s understanding of healthcare strategies has to be recalibrated. Clearly focus must be toward delivering a service within the community – from assisted living, self-care and tele-care and tele-medicine within an evolved housing unit to multiples constituting communities supported by social care services, nurses, doctors, physiotherapists, occupational health visitors, psychiatric nurses and local pharmacists.

The ‘baby boomers’, are finally retiring. We now hear of the “Silver Tsunami”. By 2050 nearly one in five people in developing countries will be over 60. In China alone the aging population statistics have been increasing alarmingly. In 2010 alone 177 million people were over the age of 60 and 22 million of these were over the age of 80.

How can the design of tomorrow’s home symbiotically respond and evolve to the ever changing needs of an ageing population and its healthcare needs? Can this be achieved in an innovative, elegant, supportive, dignified and exciting way without it appearing mentally/visually debilitating, degrading and stigmatising with the usual proliferation of awkward hinged/swing metal grab rails, handrails, frames, slow moving stair-lifts and inappropriate, awkward looking furniture and fittings. Key ergonomic and anthropormetric data will help design a supportive home with details, fabric of finishes, furniture and fittings, equipment and devices that will truly accommodate the ageing body – it’s predicted movements, weight, size, properties and cognitive abilities. Technology and communication networks are examples of real-time clinical telehealth + Telecare that will help alleviate the overburdened global healthcare system. With High Definition Video Tele-healthcare systems, doctors/nurses will be able to examine and discuss with patients, their cases in person, miles away from surgeries or hospitals. Monitoring sensors can be used to capture and transmit physiological data, e.g. Tele-EEG devices, monitors, etc. There are already early examples of real-time clinical Tele-health such as Tele-mental health, Tele-audiology, and Tele-nursing. A clear understanding of the ageing process, the maturation of the body systems, physiology and senses, together with a true comprehension of related medical issues and salutegonic needs will clearly inform the design of tomorrow’s home. What will the key design features of the future Salutogenic house look like? How can this house evolve into spaces of diagnosis, treatment and healing and general wellbeing?

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Gas Detector

Epilepsy Sensor

Environment Control (BMS)

Medication Reminder / Dispenser

Medication Reminder / Dispenser Gas Detector

Environment Control (BMS)

Temperature Sensor (Hot / Cold)

Sounder Beacon

Pull Cord

Sounder Beacon

Pull Cord

Living Room

Stairs Environment Control (BMS)

Flood Detector

Bathroom

Kitchen

Living Room

Carbon Epilepsy Sensor Monoxide Sensor

Flood Detector

Bathroom Temperature Sensor (Hot / Cold)

Sounder Beacon

Pull Cord

Fall Sensor

Garden

Stairs Carbon Smoke Detector Medication Monoxide Reminder Sensor / Dispenser

Kitchen Front Door

Bedroom

Living Room

Flood Detector

Bathroom

Fall Sensor Panic Button

Garden

Stairs Carbon Monoxide Sensor Smoke Detector

Movement Detector

Chair / Bed Front Door Sensor Occupancy

Bogus Caller Alarm

Pressure Mats Fall Sensor

Front Door

Panic Button

Bedroom Enuresis Sensor

Enuresis Sensor

Video Door Entry

Panic Button

Bedroom

Garden

Smoke Detector

Kitchen

Enuresis Sensor

Chair / Bed Occupancy Sensor

Bogus Caller Alarm

Pressure Mats

Video Door Entry

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Product Design BedPod Government spending cuts will mean most UK Trusts are unable to afford to replace their existing facilities with new hospitals leaving them with old ward layouts and facilities that do not meet recommended standards. The emphasis will therefore be placed on reuse and refurbishment setting another challenge for Trusts their Estates Managers and architects. The BedPod was developed driven by the Design for Patient Dignity Challenge set by the Design Council, on behalf of the Department of Health to improve hospital environments within the existing NHS building stock. Nightingale Associates in collaboration with Billings Jackson Design and manufacturing partner SAS International entered the challenge to address the problems of inpatient accommodation in existing hospitals as well as the wider issue of patient privacy and dignity.

Plug and Play Bed Environment

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The BedPod is a fully integrated, prefabricated, rapidly deployable, modular product which can be used to convert under utilised space within existing ward layouts into bed spaces without the need for major ward or hospital refurbishment. The team worked closely with a number of estate managers and nursing teams to develop the product particularly Kings College Hospital, London. This precisely made factory product gives clients worldwide, a safe, friendly solution applicable to both single and multi-bed configurations.

BedPod in Cruciform Ward arrangement - Paediatric Ward

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BedPod Construction Benefits • • • • • • •

Prefabrication Modular, Plug & play solution Quality controlled product Limited disruption Retrofit of existing wards Minor works programme Releasing under-utilised space

Clinical Benefits • • • • • • • • •

Improved infection control Acoustics Lighting Privacy & dignity Patient centred environment Increased storage Easier access to medical services Flexible choice of components Different clinical application

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Protoype developed for Design Council Exhibition

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Norbury Chair The Norbury chair was developed as part of a Kings Fund Grant to refurbish the Norbury Ward at South Staffordshire Hospital. Working with service users, the design team developed a product that met the specifications required: • • •

Embracing ergonomic form Weighted base Non retractable screws

• • • • • •

Fixed cushion Leather upholstery Over 40 colour combinations Toughened inverted stitch seams Reinforced dovetailed joints Materials from sustainable forestry

These chairs are heavy and robust to ensure user safety, whilst at the same time adding comfort and elegance to the patient environment.

Norbury Chairs manufactured by Knightsbridge

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Bedside Locker billings jackson design collaboration Developed as a direct response to issues raised by patients, nurses and doctors during both the Peterborough and North Bristol PFI inpatient accommodation user group meetings. seven key issues identified; • • • • • • •

Falls Mis-medication Infection control Nutrition Ergonomics Lost property Personal space

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Sustainability BREEAM and LEED Nightingale Associates played a key role in assisting the BRE and Department of Health as part of the steering group to develop NHS Environmental Assessment Tool (NEAT) and its replacement BREEAM (Building Research Establishment Environmental Assessment Method) Healthcare. We are still involved with its updates. We also have three trained assessors for BREEAM Healthcare, Education and International projects based in the Rochdale, Harwell and Cardiff studios.

Photo Credit: E Minty-Berger

Photo Credit: Joel Mabel

Photo Credit: JE Minty-Berger

A number of our staff in all our studios have undertaken an introduction course in LEED (Leadership in Energy and Environmental Design) to help us integrate with IBI Group, work in the USA and Canada and provide an alternative assessment method for our international work.

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Designing Out Waste Nightingale Associates was one of the first architectural practices in the UK to sign up to the Designing out Waste and WRAP (Waste & Resources Action Programme) Halving Waste to Landfill commitment. This commitment is now backed by many UK contractors, designers, manufacturers, suppliers and professional bodies. Design principles: 1. 2.

Reuse and recovery of materials and components Off site construction/manufacture

WRAP workshops were undertaken for New South Glasgow Hospital

Materials optimisation Waste efficient procurement 5. Deconstruction and flexibility 3. 4.

The practice is actively designing to reduce waste and increase the use of recycled materials, undertaking workshops on a number of schemes including Morriston Hospital in Wales, North Middlesex Hospital and New South Glasgow Hospital.

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Adaptability and Flexibility To improve the adaptability and flexibility of our buildings, Nightingale has signed a collaboration agreement with Loughborough University to help develop an Adaptable Futures Toolkit for use in design. The toolkit will seek to encourage designers to think about issues of adaptability throughout the design process and help facilitate conversations with clients and other stakeholders.

This follows a four-year study by the Adaptable Futures Group at the university on design for adaptability. This study included identifying existing good practice on adaptability and generating new insights into how buildings can be designed to accommodate change.

The Six Degrees of Designing for Adaptability

Nightinga le THiNK

Visit www.adaptablefutures.com to find out more about the project, the toolkit and case studies. The website also links to AF talks given at the Nightingale Sustainability conference (2011). Adaptability workshops have been carried out with the university in each of our main sectors of healthcare, education and science projects. It is hoped that this initiative will help encourage more adaptability/flexibility THiNKing on projects.

Adaptability Hierarchy

Robert Schmidt III, Loughborough University, said: “We have had a number of collaborators throughout the life of the project and THiNK’s enthusiasm, advocacy and understanding of adaptability (and more generally sustainability) has made them a top-tier collaborator.”

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Building Performance Modelling

Geometry model with full solar analysis

Standards and regulations in sustainability and environmental design are increasing and improved modelling tools and total life cycle approaches are likely to be pivotal in ensuring these are met. According to the Royal Institute of British Architects â&#x20AC;&#x153;the greatest challenge currently facing the construction industry is building low carbon buildingsâ&#x20AC;? (November, 2011). The 2016 and 2019 zero carbon targets for non-domestic buildings are a particular challenge. For many years, THiNK has collaborated with a modelling developer, pushing for a building performance modelling

tool for use in early design stages, to help improve building energy and environmental performance. This tool can develop in its complexity, allowing architects and engineers to test legislative compliance, engineering, environmental and visual impacts, as well as aspects such as solar shading. This tool could help ensure design decisions are better informed throughout the whole design process and subsequently for changes post completion. Recently such tools have been created and Nightingale is looking into the pros and cons of each. Example images from EDSL â&#x20AC;&#x201C; Tas Architectural Model

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Sustainable Case Studies We are winning bids for projects which require sustainability credentials and the sustainability performance of our projects is increasing, examples include: Gateway Sixth Form College, Leicester, UK Sustainability and energy conservation were high on the clients’ agenda and they were provided with a building that has a carbon footprint of less than half of a similar new-build college and an Energy Performance Certificate (EPC) score of 28. The building has received a Gold Green Apple Award.

As part of the sustainability strategy, photovoltaic glass is installed above the main entrance and the biomass boiler within the energy centre has been made clearly visible through large glazed panels located in a prominent position at the front of the building. Gateway College is actively in support of Leicester City Council’s environmental philosophy as Britain’s first “Environmental City” and the new building responds to the City’s ambitions. We have successfully achieved our aspirations for a sustainable building that also delivers our educational vision.

Sports Hall Art & English

Business and Social Science

Library / Learning Resource Centre

Health & Social Care, Mathematics, Science and Sport

The Street

Plant Room Servery / Kitchen Skills Development Services

Ground Floor Plan

Theatre

Main Entrance

Entrance

Energy Centre

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Castle School, Newbury, UK One of the first projects by Nightingale to achieve a BREEAM ‘Excellent’ Post Occupancy Certificate. It was assessed by one of our in-house assessors.

knowledge, he was able to provide valuable advice on numerous occasions, which helped us to achieve the requirements”.

The Project Architect said: “Using an in-house BREEAM assessor was of great assistance as we were able to communicate quickly and effectively, and with his detailed

As part of the BREEAM assessment the building achieved the maximum credits for its Site Waste Management Plan.

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Rutherford Appleton Laboritory Harwell Science & Innovation Campus, Oxfordshire, UK The Rutherford Appleton Laboratory is a leading global centre for science and innovation. The building design incorporates a number of energy saving and sustainable features including: a ground-coupled ventilation system (earth tube) which exploits constant ground temperature to reduce heating and cooling loads, the use of ground granulated blast-furnace slag (by-product of power

stations) as a cement replacement in the concrete mix, to reduce embodied energy and exposed concrete structure and openable windows in the office and café areas to reduce the amount of air-conditioning required (air-conditioning is limited to the laboratory areas only). The building achieved a BREEAM (Bespoke) ‘Very Good’ (design stage)

Air handling units

Vertical air shaft

Earth Tubes (underground)

Air inlets (above ground)

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Ysbyty Aneurin Bevan, Local General Hospital Ebbw Vale, South Wales, UK This was the first 100% single bedroom NHS hospital. The building achieved a NHS Environmental Assessment Tool (NEAT) ‘Excellent’ score, Energy Performance Certificate (EPC) 20 ‘A’ score. Sustainability design principles included: the use of cut and fill to ensure no excess material was removed from the site, a biomass

boiler for all heating and hot water, a mixed mode ventilation system which uses natural ventilation where possible, maximising natural day lighting and views to either landscaped courtyards or across the valley to common rooms and bedrooms and using materials that can be recycled where possible.

Ground Floor Entrance

Therapies

Mental Health Floor Plan Ground

Urgent Care

Outpatients

Support

Diagnostics

Birthing

Ysbyty Aneurin Bevan Ebbw Vale, Blaenau Gwent

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Thought Leadership Academic Collaboration

Manufacturer Collaboration

Sharing ideas and collaboration is essential to innovation. As such, THiNK has a successful track record of assisting research institutions and universities.

THiNK is working with a plethora of international industry partners, advising and collaborating in the development of new products and materials.

Warwick University

Cardiff University

ICI

Bushboard

Canterbury University

Imperial College, London

AkzoNobel

Gyproc

Newport University

Glyndwr University

Phillips

Zolatone

De Montford University

Durham University

Corus

Dulux

Hamlyn Centre

Southampton University

Static Systems

Polyflor

Lund

Newport University

Besam

iGuzzini

Salford University

University College London

Venesta

British Gypsum

University of Oxford

Ravensbourne College

St Gobain

Tarett

Cambridge University

Yale

Crown

SAS International

Maru

The Kingâ&#x20AC;&#x2122;s Fund,

Silent Gliss

Altro

Bradford University

Architects for Health

Ecophon

Knightsbridge

Royal College of Art

Macmillan Cancer Support

Oculus / Ovei

Oxford Brookes University

Loughborough University

Sheffield University

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Design Charettes Nightingale THiNK regularly organises design charrettes for staff across all the studios. A design charrette is a short but intensive design exercise that can promote creative thinking. Charrettes are a fun team building activity, providing a platform to share ideas across all levels.

Small teams are given a design brief and a deadline to come up innovative solutions. Examples that have been carried out include a temporary school for Burmese refugee children, converting a shipping container into a hospital and a design for a fold down hospital bed.

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Design Guidance Members of the THiNK team are actively involved in the formulation of guidance through commissioned reports and reviewing documents such as Hospital Technical Memoranda (HTM) and Hospital Building Notes (HBNs). Key topics include; sustainability and environmental design, acoustics, designing for disability and mental health. THiNK has also been commissioned to produce research reports on building materials and elements, and building element failures.

Ysbyty Alltwen, Porthmadog, Wales

Case Study – ETFE roof coverings THiNK compared ETFE cushion coverings with conventional glass solutions for an atria roof on our King’s Hospital Jubilee Wing. As well as for King’s, ETFE has since been used for another two of our hospitals, the Coventry New Hospitals Project and Ysbyty Alltwen, Wales.

Coventry ETFE solution over a waiting area

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Thought Leadership: New Concepts hPod Delivering the optimum environment to engage the senses and enhance well-being and performance Drawing on over a decade of research into sense-sensitive design and deploying that information to unique effect, the hPod will present the world with a groundbreaking development in wellbeing. The Future The pods were originally designed for the healthcare market, to deliver the optimal healing environment for the patient through light, smell, sound and vision. What makes the pod unique is the manner in which it makes use of the latest medical findings, combines these with the possibilities offered by cutting edge technology and allows the creation of individually prescribed healing environments. Patients can be equipped with a smart card storing their hPod prescription. When they enter the pod, light settings, temperature, smell and audio and visual stimulus will adjust to create their ideal surroundings

As well as promising to revolutionise healthcare design, the hPod will have applications in a wide variety of sectors such as hospitality, retail, sport, leisure and work place. Further work is being undertaken to investigate its use to influence the nature of the learning environment improving both staff and pupils wellbeing, development and learning experience. The pods also offer opportunities within the air travel sector providing soothing environments to calm travellers and combat the effects of jet lag. The hPod will feature up to 16 healing environments, within the following categories: • • • • • • •

Calming Energising Headache/migraine Seasonal Affective Disorder Jetlag Breastfeeding Bipolar depression

• • • • • • • •

Neonatal Oncology Labour MRI/CAT Cardiac Intensive therapy Phlebotomy Burns

Photo Credit: Jason Kuffer

Photo Credit: Moni Sertel

Nightinga le THiNK 51

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A multi-disciplinary Professional Services Firm URBAN LAND Land Use Planning; Urban Design; Landscape Architecture; Public Outreach; Real Estate Research / Economic / Financial Analysis; Municipal Engineering; Land Engineering; Surveying and Mapping; Water Resources Management.

FACILITIES Architecture; Mechanical and Electrical Engineering; Functional Programming; Interior Design.

TRANSPORTATION Transportation Planning; Traffic Engineering; Transit Planning and Design; Highway Design; Bridge Engineering; Electrical Engineering; Environmental Assessment; Construction Administration.

INTELLIGENT SYSTEMS

www.ibigroup.com

Systems Engineering; Software; Communications Systems Engineering; Program Management; Operations and Maintenance; Industrial / Process Engineering.

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IBI Group is a multi-disciplinary organization offering professional services in four areas of practice Urban Land | Facilities | Transportation | Intelligent Systems

September 2012