A sick topic: the humanistic evolution of hospitals

On March 1, 2020, the "Great Construction" program started in Ukraine. Within its framework, it is planned to reconstruct 220 reference hospitals in various regions. "Reconstruction" means repair or completion of reception departments, insulation, as well as "beautiful roofs at the entrances and painting."

While managers argue among themselves, discussing how to allocate and master budgets for the implementation of these "grand plans", we decided to recall how hospitals have evolved in the progressive countries of the world, as well as talk about the latest trends in the context of architectural design and design of health care facilities 'I.

The topic of humanization of the hospital system entered the international discourse as one of the most relevant recently - in the middle of the XNUMXth century. First of all, it was about changing the state policy in general, as well as about changing the attitude of doctors and hospital staff towards patients. But the third position in the list of priorities was firmly occupied by the issue of the quality of the environment.

Paimio is a sanatorium for tuberculosis patients, designed by Alvar Aalto and built in 1929-1933 in Finland. This project became a symbol of the humanistic approach to modernist architecture. Photo: Maija Holma, Alvar Aalto Foundation. Photo source: visit.alvaraalto.fi

Modernist architects perceived the hospital as a "healing machine". They were sure that medicine would very quickly reach the highest level of development, and they designed health care facilities as a conveyor for the rapid provision of qualified care. First of all, scale, reach and speed were important. The patient's comfort, personal, individual qualities and features are not taken for granted, rather, the patient is treated paternalistically, condescendingly, not as a person and subject, but as an object whose thoughts, moods and tastes can be neglected.

Giant maternity homes were built - real factories for the reproduction of new people. And also specialized centers — traumatological and surgical institutes, where dozens or even hundreds of operations were performed every day. The smooth functioning of large-scale clinics required a unified design and equipment, strict rules and vertical subordination.

Decades later, it became obvious that hospitals remain a place where a person, if ill, spends a long time. At the same time, she is in a vulnerable position, under stress, and her rights are often violated. It turned out that an uncomfortable environment not only does not stimulate a person to recover as quickly as possible (no matter how much he would like to leave the government environment as soon as possible), but also, on the contrary, reduces the quality of therapy.

Modernist architects perceived the hospital as a "healing machine"

Florence Nightingale, the founder of statistical medicine and a great ascetic, back in the middle of the XNUMXth century. came to the conclusion that patients' interest in beautiful objects and nature outside the window is a sign of recovery. Florence believed that the monotony and monochromaticity of hospital rooms was as depressing to a patient's brain as monotonous food was to his stomach. "The variety of forms, the radiant colors of the objects surrounding the patients are a real means of their recovery," wrote Nightingale.

Florence Nightingale, the founder of statistical medicine and a great ascetic

When a person gets to the hospital, the mind perceives it as a place where they will be helped to heal. But the patient's body reacts as if he was trapped, in captivity. In psychology and psychiatry, the term "sensory deprivation" is used to describe a syndrome that occurs in the long-term absence of signals from the senses. Sometimes the moral state of a patient in a hospital isolation ward is little different from the moral state of a criminal in solitary confinement.

Today, in the most progressive countries, they try to avoid uniformity in design even when designing prisons - the most striking example of such a humanistic approach in the penitentiary system is the Danish high-security prison Storstrøm, built according to the project of C. F. Møller Architects in 2016-2017. The architects succeeded in combining human-oriented design with specific safety requirements.

Double room in the Paimio sanatorium. Alvar Aalto personally designed interiors, furniture design and silent wash basins. Photo source: es.wikiarquitectura.com

As for hospitals, they have been undergoing a truly revolutionary transformation over the past few decades. First of all, there were changes in private clinics. Private hospitals, competing with each other, must win customers not only by the professionalism of specialists, but also by conditions, raising and raising the bar.


Modern hospitals: buildings that have come out of the shadows

The progress in the movement from an experimental and punitive approach to a humanistic one is most noticeable if we consider the transformation of psychiatric clinics. Isolated from the world of healthy people, prison-hospitals are a thing of the past. Today, the most progressive clinics are more like art galleries or centers for creativity. For example, Hospital L'Adamant, which is moored on the Seine in the center of Paris, is the least like a psychiatric hospital. However, it is intended for creativity with clinic patients and therapy sessions. The architects of the Seine Design bureau designed it as a creative workshop on the water.

L'Adamant Psychiatric Clinic in Paris. The project of the hospital on the water was developed by the architectural studio Seine Design. Photo: © Sergio Grazia

When designing children's clinics, architects actively experiment with color. Sometimes faith in color therapy remains almost the last chance, a desperate attempt to influence the health of young patients and inspire hope for recovery in children and their parents.

The monochrome of the hospital wards is as depressing to the patient's brain as monotonous food is to his stomach

Friedensreich Gundertwasser's radical experiments with color and form during the design of the oncology hospital in Graz can also be explained by the belief in the healing power of positive emotions. Gundertwasser's approach to architecture coincides with the opinion of the famous Italian architect and designer Achille Castiglioni, who called his main task "to arouse curiosity, bring joy and stir the senses."

Meanwhile, Castiglioni, the inventor of the fun Sella saddle chair (which also turned out to be an excellent exercise machine), developed the revolutionary TR15 letto hospital bed - on wheels and with a transforming back. For the invention of an adaptive bed (which not only provided a new level of comfort for patients, but also allowed them to be quickly and painlessly transported from the ward to the operating room), Castiglioni received one of the highest awards in the world of design in 1979, the Compasso d'Oro.

Hospital bed TR15 letto, created by designer Achille Castiglioni

Maggie's Centers in Great Britain can be considered a physical embodiment of humanistic design and architecture. This is a network of charitable institutions that provide counseling and psychological support to cancer patients, their families and friends, following the ideas of architect and landscape designer Maggie Keswick-Jenks.

Maggie, who selflessly fought the disease for 18 months, felt firsthand how formal and sterile hospital interiors affect the psychological state of the patient, causing him to panic. And since taking over and rebuilding all the hospitals at the same time is an unrealistic task, Maggie developed the concept of separate spaces, places between home and clinic, where patients could distract themselves from their fears and overcome depression.

The first Maggie's center in Edinburgh was opened after the death of the designer in 1996, and now there are 21 institutions, most of which are located in Great Britain. The architects of Maggie's centers in different years have been architects such as Frank Gehry, Kisio Kurokawa, Norman Foster, Zaha Hadid, Rem Koolhaas, etc.

The Maggie Oncology Center of the Royal Oldham Hospital, built according to the project of the dRMM studio. Photo: © Alex de Rijke

Not all buildings of modern hospitals claim to become an accent. The architecture of new clinics harmoniously fits into the style of business centers in megacities or mimics eco-settlement in picturesque protected areas. They are united by a new common feature — modern hospitals do not hide behind high fences and are not evicted to deserted islands. They are proud of them. Not residential neighborhoods or business downtowns, but hospitals and schools will tell the best about the quality of life in a city, a country. And about the quality of people who are in power.


What do patients want?

In 1999, a study was conducted in the USA, asking patients and their family members about what they would like to see modern hospitals. The results were published in the Journal of the Joint Commission on Quality and Patient Safety. The authors of the study found out that it is important for people that the architecture of the building maintains a connection with the outside world: there were no blind fences and barriers, and the windows and terraces opened up views of the garden or park. Interiors should create and maintain a sense of well-being — be homely, relaxing, aesthetic, distracting, but with clear, intuitive navigation.

The PPE Portrait Project is an installation by artist Mary Beth Heffernan at the Wellcome Collection in London. Photo source: wellcomecollection.org

Not only in children's clinics, but also in multi-functional hospitals, the presence of a game room is welcome. Patient confidentiality is very important. And here we are talking not only about separate wards, but also about places where the patient can spend time with relatives. Patients insist that the environment be as inclusive as possible, because when a person is in a dependent state due to illness, any simple actions they are able to perform without assistance emphasize their autonomy. And at the same time, a very important condition is the ability to easily maintain contact with the staff.

Long formal corridors, no or insufficient number of places to wait and rest, confusing long routes, gloomy or boring environment - all these caused people negative feedback.

Interiors should form and maintain a sense of well-being

"Dacha" is a house intended for temporary accommodation of young patients of the Children's Department of the National Cancer Institute and their parents. The interior design was developed by the team of the Sergey Makhno Architects studio. Image source: Sergey Makhno Architects

The trigger is not only the formal environment, but also the formal relationship between patients and staff. The Wellcome Collection, a museum in London whose mission is to discover and demonstrate the connections between medicine, life and art, recently exhibited an exhibition by artist Mary Beth Heffernan. She decided to "turn her face" to the medical staff of infectious disease departments for those infected with Ebola.

The PPE Portrait Project demonstrated that patients became less nervous by sticking a photo portrait of a doctor on his protective suit. But the faceless "cosmonauts" caused people to panic. Humanization is an important factor in crisis situations, and designers can contribute even in the field of harmonizing human relations.


Light and color

Bright light can cause damage to the retina in newborns, and the elderly, on the contrary, need more intense lighting. Someone perceives red and orange colors in the interior positively, but in people with mental disorders, they can provoke anxiety attacks.

The white color of the classic hospital interior is not called "sterile" by chance - its choice was determined by high hygiene requirements. White is the most functional, because any dirt, any foreign body is visible against its background. White textiles withstood disinfection at high temperatures. Over time, cleaning technologies moved to a new level, and scientific studies proved that homogeneous white interiors cause sensory starvation in patients.

The multi-colored facade of a children's oncology hospital in the Mexican city of Queretaro, built in 2013 by Sordo Madaleno Arquitectos. Photo: Jaime Navarro

In 1914, doctors in Europe and the USA, primarily surgeons, abandoned white coats in operating rooms, changing them to uniforms in shades of green and blue. White could dazzle a surgeon working in maximum light, increasing the likelihood of an error during surgery. In the USSR, until its collapse, this trend was ignored, adhering to a white dress code. The idiom "people in white coats" in Russian means doctors of any specialization, but in English it means doctors and nurses of psychiatric clinics. The walls of Soviet hospitals were painted in two colors - a white top and dirty green or blue "panels". The reason is banal: green and blue paint, which was also produced for the military industry, was cheap and always available.

Even at the beginning of the XNUMXth century. European modernists rarely, but experimented with color in public buildings, in particular, in medical buildings. For example, Alvar Aalto tried to compensate for the lack of sunlight on the stairwells of the Paimio tubercular boarding house with yellow paint. But this project was an exception to the rules, because boarding houses and sanatoriums fall out of the typology of hospitals and, rather, belong to the resort and rehabilitation sphere.

Choosing the right colors and lighting can be compared to a difficult quest

In 2004, the report "Light and color in hospital design" was published. The study was commissioned by NHS Estates, which in Great Britain until 2005 was responsible for strategy and policy related to the artificial environment of healthcare facilities. The report contains recommendations for the use of light and color design in hospitals to achieve a therapeutic effect.

Choosing the right colors and lighting can be compared to a difficult quest, since children and elderly people with special vision or mental disorders perceive and react differently. The designer must please everyone and at the same time not forget about the functional role of lighting, as well as about energy efficiency.

There are no simple recipes for developing lighting scenarios and color schemes that will satisfy everyone, the authors of the guide "Light and color in hospital design" warn. Before designing, it is a good idea to conduct a survey of medical staff who will work in the new space, as well as study the tastes of patients or local residents who will visit the new hospital.

Samut Sakhon Children's Hospital in Thailand, designed by the architects of the Integrated Field studio according to the concept of "play heals". Photo: Ketsiree Wongwan

Among the general recommendations are the following: do not use the color blue in cardiology departments, as it complicates diagnosis. For the same reason, yellow should be avoided in maternity wards - it can prevent the detection of jaundice in newborns. And in psychiatric and dermatological clinics, it is better to abandon the use of "active" colors - orange and red. Signs and navigation plates should integrate into the general color scheme, be in prominent places and be well lit.


Oleksandr Danilov

Lighting design consultant

Oleksandr Danilov

PRAGMATIKA.MEDIA: How often do customers or contractors turn to lighting specialists when designing or carrying out repairs in Ukrainian hospitals?

Oleksandr Danilov: Situations differ in the public and private sectors. Private clinics are developing quite actively in this regard and take an example from Western countries. I recently saw a very competent project developed with the involvement of a lighting specialist. There are several such professionals in Ukraine. It is important for private clinics to attract customers, so the comfort criterion is very important for them. There is an understanding that a favorable psycho-emotional state of a person speeds up recovery.

Various light scenarios have been developed for the wards, treatment and public spaces of Samut Sakhon Children's Hospital of Thailand. Photo: Ketsiree Wongwan

In the public sector, everything is much sadder. Often, lighting design decisions are made only at the level of workmanship or electricity. As a result, the environment we are used to in most polyclinics and hospitals is half-dark, gloomy spaces. The last time I was with my child in a children's clinic, I saw exactly this.

When making a decision, they are often guided by the cost of lamps, and not by their quality and safety for people's health. Lighting calculations are also neglected, which leads to errors. Bad light depresses not only patients. Doctors spend their entire working day in polyclinics and suffer even more than patients from the negative effects of poor lighting and an uncomfortable environment in general.

Doctors suffer even more than patients from the negative effects of poor lighting

Various light scenarios have been developed for the wards, treatment and public spaces of Samut Sakhon Children's Hospital of Thailand. Photo: Ketsiree Wongwan

PM: To what extent do the existing state building regulations for health care facilities in Ukraine require changes in the part related to lighting?

O. D.: One of the most important parameters, the color index, was forgotten in the state building regulations regarding lighting in medical institutions. It depends on how we see the colors of the surrounding objects under this artificial lighting. Lighting with the help of cheap lamps with a low CRI (color rendering index) "eats" the color of objects, distorts the color of the skin in particular.

However, for a doctor, the patient's skin color is an important marker. At the same time, the parameters of the color index are prescribed in the DBN for the lighting of warehouses, parking lots, etc. And here a question arises for the developers of the norms: did they simply forget about these criteria, or did they deliberately ignore them?


The simplest cardio exerciser

Modern design strategies for healthcare facilities are aimed at stimulating physical and mental activity. This can be expressed in the creation of rooms for yoga or physical education. But sometimes it is enough ... stairs.

It is logical that even a low-rise hospital building should be equipped with an elevator. If there are several such elevators, even visitors who do not have mobility problems prefer to use them instead of stairs. The authors of the Active Design Guidelines suggest maintaining a balance when designing hospitals by limiting the number of elevators.

Campo Largo Hospital in Brazil, built by Manoel Coelho Arquitetura e Design. Photo: Nelson Kon

But the stairs must be made as visible, comfortable and attractive as possible. Today, the function of stairs is not just a vertical route from top to bottom and vice versa. Stairs are seen as a place for meetings and communications, as well as an ideal cardio exerciser. In culture and art, stairs are shrouded in many metaphorical and symbolic connotations. The American architect David Rockwell called the staircase "the most emotionally malleable physical element", and often the central staircase is the main accent and the core of the entire interior space of the building.

On stairwells, you can not only place chairs in which elderly people can rest, but also place works of art: installations, sculptures, paintings. This little trick encourages people to use the stairs more often.


Distracting from sad thoughts

In many cities of the USA and Europe, the Percent for Art rule applies to developers, according to which an amount for the development of public art is supposed to be included in the construction budget. This explains the fact that new hospitals often look like art galleries. Art objects can distract patients and their relatives from sad and anxious thoughts during forced waiting or hospitalization and generally reduce general nervousness.

Objects of art can distract patients and their relatives from sad thoughts

The authors of the report "Light and color in hospital design" cite an example where the walls in the manipulation room were decorated with aerial photographs of the area where the hospital is located. These photos were very distracting to the patients, who began to look at them with interest to find out what their house or other familiar object looks like from a bird's eye view. In this, adult patients are not too different from children, whose attention is distracted by a toy while the nurse prepares to give an injection.

The decoration of the walls in the corridors and offices of the municipal and national hospitals of Ukraine consists mainly of visual propaganda and posters explaining the danger of infection with one or another infection, images of organs affected by the disease. This is the legacy of the cultural enlightenment of the beginning of the XNUMXth century, when the poorly educated population had no access to information. How relevant are such posters today?

The architecture of the Campo Largo hospital is designed to help patients stay in touch with the outside world. Photo: Nelson Kon

We wrote in detail about the growing role of gardens and parks in medicine and how hospitals in Great Britain compete with each other to be recognized as the smartest, most beautiful and most useful garden in the article "From a "punitive" landscape to a therapeutic one» in the 16th volume of PRAGMATIKA.MEDIA. We should add that winter gardens and greenhouses can be seen increasingly in the halls and atriums of large clinics.


Fast construction

The construction of a hospital for people infected with the coronavirus in Wuhan in a ten-day period became possible thanks to the fact that extreme and adaptive architecture today relies on new technologies - parametric design and modular construction.

Puyo modular hospital in Ecuador, built according to the project of the Spanish architecture studio PMMT. Photo source: pmmtarquitectura.es

NATO's fully autonomous field military hospitals can be deployed in a few hours, even in the desert. Building a modular hospital will take longer, but it can last for months or even years.

The Puyo Multidisciplinary Hospital in Ecuador was built in a matter of months due to the dengue epidemic. Designing modular buildings reminiscent of giant agricultural hospitals, the architects of the Spanish studio PMMT used the experience of creating progressive modern clinics. Hospital buildings erected by the dry construction method (prefabricated plasterboard panels on a metal frame) have a sufficient margin of strength, they are not only functional, but also comfortable, and can be used for a long time. The clinic has been operating since 2013 and has since won many awards for engineering solutions, architecture and design.

Extreme and adaptive architecture today rely on new technologies

MedModular is the first "smart chamber in a box". Image source: admares.com

MedModular is the first "smart chamber in a box". Image source: admares.com

In 2018, EIR Healthcare, in partnership with ADMARES, patented the world's first "high-tech hospital ward in a box", MedModular. Such a ward in a container can be used as a separate unit, placed on a wheeled base or integrated into the general modular construction of the hospital. In 2019, it became possible to purchase MedModular chambers through Amazon for $285. The first batch was quickly sold out.


Look into tomorrow

A separate institute in California (USA) — the Academy of Neuroscience for Architecture — is engaged in collecting and processing information on research into the impact of architecture and design on the human body and psyche. ANFA claims to be supporters of evidence-based science, so any hypothesis about human reactions to the artificial environment must be tested in practice.

Science confirms: the artificial environment affects human biology

Research in itself can be a creative and artistic event. At Milan Design Week 2019, scientists from the interdisciplinary practice International Arts + Mind Lab, in collaboration with the tech giant Google, held a neuro-aesthetic exhibition "Space for Life" to demonstrate to visitors the impact of design on human biology.

The architects of the Reddymade Architecture and Design bureau and the designers of the Danish furniture brand Muuto designed three rooms that differed from each other in terms of atmosphere: lighting, color, textures, aromas and sounds. The goal was to program a mood change in visitors. Guests wore wristbands with sensors that measured pulse and temperature. A computer program processed the data and issued a resume — which environment was more comfortable for one or another person.

"Living room" from the exhibition A Space for Being, presented as part of Milan Design Week in 2019. Photo: Maremosso. Image source: artsandmindlab.org

"Today confirms what architects and designers have always known intuitively: the artificial environment affects our biology. Thanks to new non-invasive brain research technologies in the last two decades, we have collected more data than ever before. We must take them into account when building new hospitals, schools, workplaces, and homes,” writes Susan Megzemen, director of the International Arts+Mind Lab, in a blog post for ANFA.


Is the new building of "Okhmatdyt" a symbol of progress?

This year, they plan to open the second stage of the new building of the "Okhmatdyt" children's hospital in Kyiv. In addition, as promised by the former Prime Minister of Ukraine, Oleksiy Honcharuk, the building will be commissioned in March. The first block was opened in April 2018. In general, the new medical and diagnostic complex will unite 10 modern surgical departments, 5 oncological departments, as well as hematology and diagnostic departments.

The large-scale project started back in 2011, but due to funding interruptions, work at the facility was constantly stalled. There were fears that the project would suffer the sad fate of the "Hospital of the Future" project. We will remind you that the mega project of the wife of the ex-president of Ukraine, Viktor Yushchenko, Kateryna, was frozen after a loud PR campaign, and millions of dollars in charitable aid simply dissolved.

The building of the new medical and diagnostic building of the "Okhmatdit" hospital in Kyiv has been under construction since 2011 and has already been redesigned several times. Photo source: ohmatdyt.com.ua

However, the second phase of the Okhmatdit clinic has already been physically completed. At the start of the project, it was said that the new building would symbolize not only progress in Ukrainian health care, but also in architecture. But the irony is that the name of the architect of this symbol remains unknown to the general public. The development of the construction project was carried out by Ukrprofmed LLC, which later became a participant in a criminal case of embezzlement of budget funds. Neither an architectural competition, nor at least a presentation of an architectural project was held.

It was assumed that the new building of "Okhmatdyt" would demonstrate the progress of the Ukrainian health care system

Over the course of 9 years, the building was redesigned several times, the estimate was revised again and again, contractors were changed, and each stage was accompanied by loud scandals, arrests and court proceedings. Currently, the cost of project implementation has already exceeded UAH 5 billion. Given the multiple redesigns, it is naive to expect that the interiors of the new building will demonstrate a new standard in design. But judging by what the first block is like, the halls, corridors, and even the MRI rooms were tried to be refreshed by painting the walls.


New "Dacha" for children with cancer

The opening of a new medical and diagnostic complex of the Central Children's Clinic of Ukraine will not solve the problem of accommodating patients from other cities. Charitable foundations solve this task. As it usually happens, public organizations, in contrast to the inflexible state system, demonstrate great openness and readiness to follow world trends. Oncology courses are quite long, treatment is mostly carried out on an outpatient basis or in a day hospital, and the payment of rent for housing in Kyiv is a heavy burden on the patients' families.

"Dacha" in Kyiv. Design: Sergey Makhno Architects. Image source: Sergey Makhno Architects

To solve this problem, the "Zaporuka" charitable foundation launched the "Dacha" project 10 years ago. For the last 10 years, the administration has been renting private houses where families live in the format of a temporary community with funds received in the form of donations. At the same time, the foundation is constructing a two-story building in the Solomyansk district — a house designed for temporary accommodation of young patients of the children's department of the National Cancer Institute and their parents. Recently, the team of the architectural studio Sergey Makhno Architects finished designing the interiors of the new "Dacha".


Viktor Zakharchenko


Viktor Zakharchenko

PRAGMATIKA.MEDIA: When working on the interiors for "Dacha", did you rely on examples of world practices?

Viktor Zakharchenko: If they leaned, then very little. Our project is unique in its essence — it is not a medical facility or a hotel. This is a temporary home for children undergoing treatment at the Cancer Institute and their families. It was quite difficult to find an analogue.

But, of course, we studied in detail the projects of American clinics in order to have a general idea of ​​the planning and requirements for this type of facility. And adapted them to our unique concept.

PM: Judging by the visualizations, your project is different from the usual "design for children" in our society. There is no riot of bright colors in these interiors, on the contrary, they are quite restrained and quiet. Why?

V.Z.: After courses in chemistry or radiology, children are very receptive to color. Their eyes are sensitive, so bright colors can provoke various reactions, up to nausea. The task was to create a quiet color scheme, while not forgetting that the spaces are intended primarily for children. It turned out that the form is childish, and the color palette is rather adult.

The architects faced the task of making the interiors of the "Dacha" as informal as possible

PM: To what extent is the planning, interior and furniture inclusive, oriented to the specific needs of future residents?

V.Z.: If we talk about standards, then our national standards are outdated. And those related to the design of public buildings and structures, and medical institutions as well. It was unrealistic to rely on them. We used general provisions, but it is impossible to answer in detail. In addition, we faced the main task: to make this place unlike a hospital.

We had to create a home comfort both for the children who will be rehabilitated here, and for their parents who will live with them here. It was necessary to take into account all conditions for children with limited mobility. For those in wheelchairs, we have provided special showers, wash basins and toilets with handrails. And, of course, they designed an elevator to go up to the second floor.

Each bedroom of the new "Dacha" has its own name and thematic design. Image source: Sergey Makhno Architects

PM: What interior solutions are not focused on functionality, but on evoking positive emotions and a sense of calm?

V.Z.: We have two zones: for children from 0 to 5-6 years and for teenagers. Children of the first group prefer to always play together — that's a fact, they always band together. And older children often require seclusion. They have a transitional age, the process of personality formation is underway. Therefore, my initiative was to provide areas for solitude - "cells" for reading or resting. So that you can hide from the outside world, but still be a part of society, without leaving the game area.

You can sit in one of the "cells" with a book or a phone/tablet, but if something interesting happens in the room or an interlocutor appears, you can enter into a dialogue with him. It was important. And the space for small children is programmed from the beginning for communication and interaction. For them, there is a mini-stage, a mini-theatre with podiums that can be used to organize a performance or performance, or simply as a place for games.

Each bedroom has its own name: there is "Rock Star", "Jungle", "Crippled Babies". Each has its own unique atmosphere created by design details and drawings on the walls. The furniture is functionally almost the same, but each room has its own individual gaming subtext. A child, getting to know someone new at the Dacha, to the question "Where do you live?" can answer that he lives in the jungle or in the room of a rock star. Such a playful subtext allows you to get rid of the numbering used in hospitals. Ward number 102 or 103 is not our story.

In general, the building has two types of zoning: first and second floor. Additionally, the second floor is divided into spaces for teenagers and preschoolers. The first floor is mainly for adults. There are office spaces for the staff, for doctors, common areas of the kitchen and dining room, and there is also a relaxation area for adults, where you can just lie down, read books from the home library, and talk to someone while sitting at a table. And children at this time can play on the second floor under the supervision of, say, one adult. For safety purposes, the stairs can be closed.

PM: The projects of Sergey Makhno Architects are always distinguished by careful work with light, the use of original design objects. Were any similar solutions managed to be included in this project?

V.Z.: Unfortunately, our subject design and the functional purpose of the object (children's center) are incompatible. Ceramics break easily, it cannot be integrated into children's interior. There is no place for decor, any non-functional, excessive details. In this aspect, we decided to show minimalism.



Natalia Onipko

President of the "Zaporuka" Charitable Foundation

Natalia Onipko

PRAGMATIKA.MEDIA: Why it is important for young patients and their families to create conditions that differ from the unfavorable hospital environment or faceless rented apartments?

Natalia Onipko: Treatment of cancer in children can last for months or even years. Children undergoing cancer treatment need a home. A sense of comfort and security is needed. And when babies go to the hospital for procedures in the morning or are hospitalized for several days for chemotherapy, they know that they will soon return "home". It is important for them to hear from their parents that soon they will again be in the playroom surrounded by their favorite toys, they will again be waiting for visiting volunteers, and the smell of fresh baked goods will be heard from the kitchen.

Children undergoing cancer treatment need a sense of comfort and security

PM: What does your experience show, to what extent the living environment affects the well-being of children and parents?

N.O.: The rented "Dacha" has existed for 10 years and during this time has become a home for more than 1 families. Children living here have better tests and recover faster. Parents gather for tea every day, and their communication becomes a kind of self-help group, among "their" they find understanding and support.

PM: How did you want to see the interiors of the new "Dacha"? What was emphasized when discussing them with the designers?

N.O.: We imagined the new "Dacha" to be warm, cozy and modern. This is what they emphasized when talking to designers. We want to create conditions so that the family can live here as normal as possible - like at home.

Awaiting the completion of construction of "Dacha". Photo source: Zaporuka Charitable Foundation

PM: To what extent does the work of architects and designers meet your expectations?

N.O.: We are delighted! Now we can't wait to bring the project to life. For this, we need your support: every donation on our website www.zaporuka.org.ua, every sms to the number 88077 containing a contribution of UAH 10, brings us closer to the big goal.


System errors

In August 2019, the Ministry of Regional Development, Construction and Housing and Communal Services of Ukraine announced plans to significantly edit the state building regulations "Health care facilities. Buildings and structures" and align them with modern European standards. It was planned to increase comfort for patients: to provide for the presence of a bathroom in each ward, a ward for the child and parents to stay together, as well as to review the requirements for public places in hospitals. It is not yet clear whether the topic of reforming the hospital environment will be the focus of attention of the new minister of development of communities and territories of Ukraine, to whom the sphere of construction was subordinated.

Despite rare exceptions, the influence of architecture and design on the condition of patients, which was obvious to Florence Nightingale and a scientifically proven fact for European architects, is not so obvious today for Ukrainian officials in charge of medicine. Progressive trends are often not discussed. The excuse for not putting the issue of increasing comfort on the agenda is the acute lack of funds.

But in reality, most of the measures to improve the hospital environment are not that expensive. For example, even under conditions of limited budgets, the choice of paint or spectrum of lighting points can be entrusted to professionals. Such consultations will not create a burden on the project budget, and in special cases, when it comes to children's municipal clinics, many architectural bureaus and designers will agree to consult on a charitable basis.

Assuta Medical Center is a hospital in Tel Aviv, built according to the project of the Canadian architectural bureau Zeidler Partnership Architects. Photo: Tom Urban. Image source: v2com-newswire.com

Undoubtedly, the architectural appearance of hospitals, as well as the design of wards, halls and offices, are lower on the list of priorities than the problems of shortage of personnel and equipment. But if Ukrainians (doctors and patients) remain prisoners of the paradigm "Not to fat, but to live!" and victims of learned helplessness, the public hospitals of our cities can maintain their limbic appearance for decades.



Julia Dvorakovska:

"Private clinics have been in trend for a long time, while state clinics are catching up"

What prevents the progressive use of hospital design experience in practice in Ukrainian realities? How big is the gap between European construction standards and Ukrainian ones and can it be considered an insurmountable obstacle for innovation? The questions of PRAGMATIKA.MEDIA were answered by Yuriy Dvorakovska, managing partner of CBMforum — a company specializing in technical and engineering consulting of construction objects, in particular in the field of health care.

PRAGMATIKA.MEDIA: Humanization of the healthcare environment has been an actual global trend since the middle of the XNUMXth century. Can we say that today it is supported in Ukraine both in the field of private and state medicine?

Julia Dvorakovska: It can be said that this trend in Ukraine is progressing in parallel with the development of private medicine. Until 2009–2010, even in the construction projects of medical institutions of increased comfort, functionality and brevity prevailed, as well as the complete absence of any individual style in the interiors. But already in 2012–2015, it became the norm to involve professional designers in the development of interiors of private clinics. Prior to this, customers were more often guided by personal taste, as well as photos of wards and halls of advanced European clinics.

Julia Dvorakovska

The trend of humanization was introduced into state medicine by the public movement. That is, "from below", not "from above". Public organizations, activists, and then charitable foundations tried their best to draw attention to the fact that the patient needs the comfort and aesthetics of the hospital environment as much as its functionality.

There are many examples of such grassroots initiatives. Around 2010, the family of my friends had to spend a lot of time in the "Okhmatdit" clinic with a newborn baby. Friends of the family repaired the room at their own expense: they changed the windows, bought comfortable furniture, equipped the room with a refrigerator, kettle, TV, and microwave oven.

Later, in 2015, the trend of humanization was discussed in the offices of government representatives and heads of state medical institutions. But each manager / chief doctor tried to implement it to the extent of his capabilities and personal ideas. In my opinion, a good example is the activity of Andrii Semivolos as the head of the Kyiv City Children's Diagnostic Center.

First by the efforts of the team, and then by involving professional companies on the terms of volunteerism and charity, he completely changed the interior space of the center. Clear navigation, elements of visual communication, comfortable waiting areas, compliance with all norms of inclusivity, an electronic queue are only a part of all the innovations that the center's team managed to implement in 2016-2018.

PM: To what extent is the importance of modern design and its criteria, such as universality and inclusiveness, obvious to the owners and construction customers?

Yu. D.: Nowadays, the importance of modern design is obvious to all customers of private medical facilities. Universality has been inherited, and inclusiveness is implemented thanks to the adoption of new building codes.

It should be noted that an internal control mechanism exists and works well in private medicine — all medical institutions, without exception, must obtain a license for medical activity. And for this, it is necessary to provide the opinion of the sanitary-pedem station. It was SES that remained the outpost that actually performs the function of control. You must present the inspector with ready-made premises, repaired in accordance with all current regulations. Otherwise, conclusions cannot be obtained.

Versatility is inherited, and inclusiveness is implemented thanks to the adoption of new building codes

PM: Are modern European recommendations for the design of medical facilities consistent with our DBN and sanitary standards? Maybe some techniques and approaches cannot be implemented in our conditions, because they contradict the law?

Yu. D.: Our deep dive into this issue has shown that the inconsistency of European design and our standards is a myth supported by designers who do not want to develop. Our and European standards have a single functional base. Ukrainian regulations are prescribed slightly "with a margin" - and this often entails an increase in project budgets and more difficulties for investors.

Unlike European ones, our norms have not changed for a long time and do not correspond to new technologies, pace and lifestyle. But at the same time, our legislative base is very large. We can always find a compromise for each solution that the customer wants to implement, based on the recommendations of colleagues from European countries.

Until now, in our practice, there were no techniques and approaches that we could not implement. At the same time, all our projects have passed a comprehensive construction examination. We cooperated with technologists from Israel and the Netherlands, and after the projects passed the state expertise, they carried out a re-analysis and issued an expert opinion on whether the project meets the concept. In addition to our experience, I can give an example of the new "Oberig" clinic, which was also created according to the concept and in cooperation with Spanish designers.

PM: Your forecast: will Ukrainian state medical institutions in terms of comfort at least reach the level of an average private clinic and how will this happen?

Yu. D.: I am absolutely sure that state institutions will slowly but surely improve their level of comfort. Consumers of services have changed a lot, the tolerance for discomfort drops to zero. We all already know that hospitals can be different. And since the requirements have increased, the entire medical field must also meet them.