International Healthcare Design Reflects Culture, Faith, Tradition
In the United States, most healthcare design projects are driven by very concrete metrics: schedule, cost, code, and pro-forma, to name a few. Often the program is in place before the first user group meeting, with very little wiggle room for study, interviews, or meaningful research.
But what if these criteria mattered less than observance and integration of the local culture and traditions of the area?
Designing healthcare facilities in some other regions of the world requires that these concerns be put first, and four designers who have experience dealing with these challenges shared how the unique cultures of the places where they worked inspired the design of the spaces they created.
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Barbara Huelat’s international design work took her to King Faisal Specialist Hospital & Research Centre in Saudi Arabia, where her firm, Huelat Parimucha Healing Design (Alexandria, Va.) completed a children’s cancer hospital, a critical care inpatient unit, an ambulatory care clinic, and an interiors master plan.
While her firm was hired to bring a “western” look to the facility, she found that cultural issues created interesting design challenges.
Privacy is greatly valued in this culture and designed into hospital spaces. For example, the use of high-back chairs in congregate areas is preferred over lower ones, as they provide visual privacy.
While the people of Saudi Arabia strongly value their culture and their views of the desert, the orientation of a building and its relationship to windows and sun are important, as well. In the United States, exterior views and visual access to the outside are highly valued, whereas the Saudis must place windows strategically and more sparingly in the desert environment as heat, sunlight, and sand storms can be a threat.
The Saudi people are deeply spiritual, and reverence of the Islamic faith is completely integrated into all activities of daily living. The hospital includes prayer rooms and mosques to accommodate spiritual needs.
Interior spaces are notable for their absence of art and music. Decorations may be patterned or geometric in nature but can’t contain anything figurative, per the Islamic faith. Darker jewel tone colors are preferred for interiors, to provide contrast with the light and brightness of the desert.
Karen Muraoka, principal, Karen Muraoka Interior Design LLC (Honolulu, Hawaii) offers insight into a 400-bed acute care project in Japan—the family-centered Kameda Medical Center. The 50-acre campus includes an entire “city” of support to the hospital: a nursing school, beauty shop, pet hotel, on-site parking deck (which is unusual in Japan), dry cleaner, aromatherapy center, restaurants, and staff housing. In addition to this, the hospital itself includes five dining facilities.
The family focus and culture of the center is gentle, humble, and courteous: Patients and families are treated like a guest in the Kameda home. The hospital is open 24/7 to family members and visitors, as they are important to patient care and morale.
Much of the clinical design is influenced by staff visits to other facilities where more contemporary systems are in place for staff and operations. A typical four-bed patient room is employed to address nursing shortages and emotional health, with the arrangement allowing for social interaction and a positive distraction during a longer stay.
Jean Hansen, of HDR, shared the creation of the Cleveland Clinic Abu Dhabi hospital, a project currently pursuing LEED certification. The design uses concept elements of a traditional Abu Dhabi souk, or central plaza and marketplace for the gallery, an area that includes places for interaction or services. The wadi, or desert canyon, connects the clinic and diagnostic and treatment areas. The hospital is designed around privacy and modesty, family involvement, and improved patient outcomes.
Cultural influences are noticeable as the male and female family waiting and prayer rooms are separate from one another. Family support and sharing a meal is important in this culture. The patient floors have food preparation areas and a dining table so the family may prepare meals together. Additionally, there are family sleeping areas within the patient room and tea rooms on each floor, accommodating the culture of the region and allowing the hospital to feel like a temporary “home.”
Patient rooms are planned to respect privacy rather than ease of nurse supervision: the patient bathroom is inboard to help block the views of staff and others and room entry is similar to the hospitality model where one enters a room through a vestibule.
Jane Rohde, principal for JSR Associates Inc. (Ellicott City, Md.), designed a senior-living resident age care community in Hangzhou, China. Her client, China Senior Care, invested in benchmarking, evidence-based design, continual quality improvement, and sustainability. In 2010, JSR Associates was commissioned to bring western knowledge to its residential healthcare.
;s experience also echoes cultural differences that created unique design parameters for this project. For example, almost all commercial buildings are designed with the core and shell first, and then a separate interiors team provides the interior fit-out. Completing the functional programming at the beginning of the design process is not standard in China, but the western side of the China Senior Care team has embraced and integrated the programming process in planning.
As an outside consultant, Rohde is also required to use the expertise of a Local Design Institute (LDI), a government-approved architectural firm. The LDI brings the local regulatory experience and standards to the project, directing the inclusion of such requirements as a bomb shelter.
A small living unit for patients is embraced, to achieve resident-centered care. From a Chinese perspective, the resident units are very large; however, the apartment dwelling size would be comparable to small apartments in New York City.
There is a great love of nature and light in China, and all residents have access to a working garden and a sunroom. The government requires a certain amount of exposure to daylight each day, and there is a strong emphasis on having access to and spending time outdoors. Although the center gardens are designed from a western perspective, they include traditional Chinese planting, walking paths, walking “stones” used for reflexology, areas for Tai Chi, and a labyrinth. Outdoor areas are gated for safety.
While the designers on all these facilities around the world acknowledged on a basic level that their projects were western in concept, the nuances and particulars of the interior design across the countries added dimensions to these facilities that are challenging, rich, and intricate.
Alison LeVino Jones, AAHID, ASID, EDAC, IIDA, LEED AP, is president of LeVino Jones Medical Interiors Inc., and can be reached at email@example.com. Sandy Boyette, AAHID, NCIDQ, is project manager at LeVino Jones Medical Interiors and can be reached at firstname.lastname@example.org. The designers who took part in this article discussed the topic of international healthcare interior design at the 2012 HEALTHCARE DESIGN Conference in Phoenix.