Researching 'Super Bed Wards'

Reachable from any position. The proj­ect also makes specific proposals for interior design and furnishings, for example this trolley, which patients should be able to use whether they are seated, standing or lying down.Illustration: ’Fremtidens sengestue’

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A pilot project at Herlev Hospital, Denmark, seeks to determine the best design of the in-patient hospital ward of the future. The specific occasion is a large upcoming expansion of the hospital and, in a larger perspective, the construction of new super hospitals all over Denmark. The project, which involves the use of a new observation method, aims to ensure that future patients receive the best possible care and have optimum quality of life.

By Trine Vu

On a chair in the corner of a ward in the paediatric section of Herlev Hospital near the Danish capital of Copenhagen, an architecture student is making notes of everything she sees. Every ten minutes she snaps a photo, and in addition she drafts the room and the movements in it. After eight hours she is relieved by another student, and another eight hours later the last observer of the day checks in to record procedures and changes in the room.

Some of the notes from an early morning shift: “05:50: Sleep sounds. Room is dark. 06:00: Radio on again. Cars moving outside. 06:15: Blood pressure and temperature checked for both patients.”

These 24-hour observations are taking place in four wards in four different sections of Herlev Hospital. They are part of the pilot project Fremtidens sengestue (The bed ward of the future), which involves the Royal Danish Academy of Fine Arts, School of Architecture, Henning Larsen Architects and Herlev Hospital.

24-hours observations in bed wards. In eight-hour shifts architecture students sit in a corner of the room, making notes of everything they see. Every ten minutes they take a photo, and in addition they make drafts of the room and the movements in it and write down notes about moods and ambiences.  Photo: ’Fremtidens sengestue’

Everybody Has an Opinion About the Bed Ward

The project coordinator is Merete Ahnfeldt-Mollerup, who is an architect and an associate professor at the Royal Danish Academy of Fine Arts, School of Architecture. She explains that in the long term, the project will relate to health care architecture in a broad sense, but currently the focus is on the hospital bed ward. A quality report commissioned by the previous government in connection with a reform of the Danish healthcare sector states that the intention for the ‘super hospitals’ of the future is that all bed wards should be single occupancy, and that they should all be identical.
“The bed ward is a good case study because it is something that healthcare staff, patients and relatives all relate to on a daily basis. With an approach that involves 24-hour observations, among other elements, we are therefore trying to identify what it takes to make a bed ward that gives the patients the best possible care and quality of life,” Merete Ahnfeldt-Mollerup explains.

In the project, the client and project manager for the expansion of Herlev Hospital, architect Anette Madsen, serves as the liaison between the clinical staff, architects, researchers and students. She says,
“We cooperate with the clinical staff because it’s essential to base our work on the real-life conditions that they face. When we ask people about their work procedures their responses sometimes differ from our observations. These 24-hour observations provide completely basic records of the way things actually work, which lets us identify issues that we can then seek to address.”

Children Playing in the Hallways

One of the issues that were uncovered by the observations in the pilot project is the function of single-bed wards in paediatric versus adult sections. The purpose of offering all patients single-bed accommodation is to make the hospital as flexible as possible, since no one knows what the future will bring. The location of the paediatric section on the day when the hospital opens may have to be used for an adult section ten years down the road. However, that approach to flexibility makes it difficult to target the design to the needs of specific patient groups.
“Observation records from the paediatric section show that some children actually don’t spend much time in the ward or in their beds but instead play in the hallways and in other rooms, and that points to a challenge in relation to designing single-bed wards for children,” says Anette Madsen.

Merete Ahnfeldt-Mollerup explains,
“One of the findings in our studies and interviews especially with the healthcare staff is that being sick means many different things. There’s a big difference between the elderly, feeble patient who has frequent but short hospitalisations and for whom a single-bed ward can help prevent hospital infections to children who have lengthy hospital stays, and who may for example go to school in the morning. But both groups have to be able to thrive in the hospital. A hospital is an incredibly complex organism with many different people, so there are many things to consider in the design of a hospital.”

Sick or Well

The main function of the bed wards of the future should be to help patients feel safe and perceive their surroundings as pleasant, says Anette Madsen. Additionally, they should promote the patients’ ability to be active and take part in their own care. Single-bed wards have a positive effect on many of the factors that influence patients’ healing such as the risk of infection, errors in medication and the quality of the patient’s sleep.

Observations in the pilot project reveal, however, that we experience our surroundings very differently when we are sick compared with when we are well. Therefore, one of the issues that the researchers have addressed in the project is our assumptions about what it means to be sick.
“What might seem intimidating when we are well may have the opposite effect when we are sick. And vice versa. For example, the bed panel with the many devices and tubes may seem scary to us when we are well. But someone who is sick may perceive the panel as reassuring because it signals that one is being cared for,” Anette Madsen explains.

Merete Ahnfeldt-Mollerup mentions another example of a detail that only becomes clear once one adopts the patient’s point of view:
“When one is sick, one literally looks at the world in a different way. For example, if you’re bedridden for a long time, you’ll spend a lot of time staring into the ceiling, so therefore, as a very basic point, it’s important to include the ceiling as part of the design of a bed ward,” Merete Ahnfeldt-Mollerup points out.

She views the pilot project with the bed ward as stage one in a larger exploration of how to make the best use of hospitals in the future. As part of the project the researchers also develop prototypes of equipment, furnishings and interior design solutions.

Records. It is important to understand who actually uses the room and when in order to determine the best design. Patients, healthcare staff and visiting relatives all have different needs and perceptions of a ward. Photo: ’Fremtidens sengestue’

Boredom Brings out the Details

“07:40: Patient #1 goes to the toilet. The patient seems delighted to be able to take in the sunrise and the life in the city. (He mentions that there was a power failure last Monday, and that he could see the one building that still had power …).”

Merete Ahnfeldt-Mollerup has been involved in developing the method of the 24-hour observations that is being tested in the project. It marks a new approach to evidence-based design, and she explains that in the case with the bed ward study the traditional approach would be to study a thousand bed wards all over the world in order to compare the different models, while the new method instead studies a single ward.
“We take an in-depth look at just one ward because it is important to see how the patient interacts with the healthcare staff and with his or her visitors and to observe what actually goes on in the bed ward,” says Merete Ahnfeldt-Mollerup. She explains that one aspect of the method is that the observations take long enough for the observers to get bored – and when they are bored they notice important details, such as cables lying about.

Merete Ahnfeldt-Mollerup hopes that the method applied in the project will prove its worth, so that in the future it can be conveyed to consultants working with demanding tasks such as the design of hospitals, schools etc.
“In the long term we hope that this sort of approach can lead to the development of a theory of our perception of our physical surroundings, because the method is really good at recording our perceptions of rooms and the quality of life they enable,” says Merete Ahnfeldt-Mollerup.