By Christopher UptonThe design of a medical facility dedicated to the care of children requires a rethinking of the commonly accepted minimum standards of healthcare design. This re-evaluation is necessary largely because when a child is in the healthcare environment — especially a critical care environment — the “patient” is often the entire family.
This physical and psychological extension of the patient can be either a great asset or a great hindrance to caregivers. If accommodations in the physical environment are made for this extension of patient care to the family unit, it greatly improves the ability of caregivers to promote a healing environment. If there are no accommodations for the extended “patient,” the presence of a visitor may become an obstacle rather than a benefit to the patient and to caregivers.
With this in mind, a properly designed children’s environment must not only meet the basic healthcare needs of the child, it should additionally address the social, developmental, psychological and emotional needs and wants of the child, as well as of that child’s family.
Yet, design professionals must ensure these concepts don’t become cliché. Splashes of color and playful wall graphics alone are not enough to alleviate a child’s anxiety in a hospital setting. Patient room amenities that cater to the family, such as comfortable chairs that convert into beds, are far more effective at helping to further the goal of improving patient outcomes when accompanied by other insightful and empathetic designs.For example, design teams will often create larger patient rooms that provide a “family zone” to accommodate a parent or sibling that is working, eating or sleeping. Storage areas and display shelves in each room contain family belongings and allow for the exhibit of a child patient’s favorite toys (as approved by the infection control and risk management staff). This begins to personalize the space making it more familiar and comfortable to the child/family.
On a unit level, design professionals need to explore any means or opportunity to introduce family focused areas and play environments to encourage interaction as a family unit. For younger children especially, playtime is not an occasional activity — it is their vocation. All day, every day a child clocks in and begins a hard day of play.
Because so many things in a hospital environment are unfamiliar and frightening to children, it is important these areas offer a comfortable, safe retreat from the intimidating hospital environment, and that family and caregivers can share the space with the child. It is also important that no treatments occur in this area; it must remain the child’s sanctuary from pain. The design team should also ensure that the solutions presented relate to the child’s visual and physical perspectives, and not simply be a scaled-down version of an adult-oriented space.
As important as play space is, this is another design element that shouldn’t settle for a standard, sometimes tired, approach, such as placing the ubiquitous “playroom” in pediatric facilities. Studies show that in facilities containing specific playrooms for children and separate support facilities for the family, both child and adolescent patients gravitate to family support areas instead of playrooms. Rather than seeking preprogrammed play opportunities, children prefer the familial environments because they are more reminiscent of home life.
Many other components of pediatric healthcare design can heighten the family-as-patient theme. For one, waiting areas that once typically consisted of rows of plastic shell chairs in bus-station formation now seek to provide sufficient comfort, access and privacy for a range of family and friends — whether the wait is for reasons traumatic or mundane.
Ultimately, design professionals need to keep in mind that the patient and family at a pediatric care facility would rather not be there. The goal should be to create a place that gives child patients and family members alike the sense that, as bad as things may be, this is exactly where they need to be for the good of the child and the family as a whole.
Christopher Upton, AIA, FAAMA, has served as both a designer and an administrator for children’s hospitals. He is project director with TAYLOR, a California-based healthcare design firm whose mission is "Promoting Wellness through Architecture."