Originally published in CHAE Magazine
Written by Gu Lin
“The patient-and family-focused design empowers patients, fosters a positive work environment, is community-centric, and flexible enough to adapt to support emerging thinking, practices, and technology, while allowing for adaptation to suit the city’s growing healthcare needs.”
Promoting Transformative Design Solutions
Chris McQuillan has been in the healthcare design industry for more than 20 years and accumulated vast /rich experience in healthcare, behavioral health, bio-medical research, facility and function planning, and project feasibility study. Chris joined B+H Architects – a global, award-winning architecture, interior design, planning, landscape architecture and strategic consulting firm – in 2012 and has since led his teams to deliver a range of transformative healthcare solutions that positively impact people, the community and the environment. To date, B+H has delivered over 90 healthcare projects across 31 countries and over 1 million square meters of new and renovated healthcare work. B+H’s 50 years of healthcare design expertise has seen the firm win more than 120 awards over the past 20 years.
Chris identifies with B+H’s design concept. He believes that high-quality design for healthcare service originates from the know-how of providing support to others and the close cooperation with users, medical staff, patients as well as other stakeholders to create the medical facilities that improve wellness and healing.
“Back to the days in college, I was obsessed with technology. I majored in engineering and architectural design, and the time of my graduation coincided with the period of the economic downturn in Canada. My first job happened to be an architect in healthcare sector. Gradually, I found that medical building was different from other public buildings, as the former was built to cure the patients, while contributing to the society. I felt very happy and fulfilling at work. That’s when I decided to embark on a lifelong career in healthcare design.”
Integrating Human Behavioral Science and Healthcare Design
Besides healthcare design, Chris has also worked as a part-time theater designer for two years in order to understand people’s subconscious response to sensual stimulation. This experience had a great impact on how Chris designs healing healthcare space and deepened his understanding of the relationship between human behavioral science and healthcare design.
Chris has also worked on mental health facilities as well as community hospitals with mental health treatment components in their program. Although mental illness has already become a common disease worldwide, social acceptance of it remains low. Therefore, patients with minor mental illnesses such as depression and anxiety would conscientiously avoid treatment. Up to now, traditional ways of isolation are still being used for patients with mental illnesses or epidemics. Take U.S. as an example, its rehab centers and sanitariums are usually built on remote and isolated mountains. Chris believes that such an outdated approach/model is not conducive to the healing process because it isolates the patients with the society. On the contrary, he argues that creating a controllable environment with regular exposure to the outside world that allows these patients to live in a normal environment will not only help them restore self-control, but also provide more flexibility and help them re-integrate into the society. Safety for both patients and caregivers are very important. Therefore, design details in these healthcare settings shall be given full attention since mental illnesses are often accompanied with self-harm. Chris emphasizes that there are three important things in designing mental health centers: first, giving people dignity; second, building a normal space; third, assuring safety.
Apart from mental health centers, Chris has also been involved in the design of a number of cancer centers which are slightly different. Unlike patients with mental illnesses, cancer patients, although linked with negative implications, are not marginalized. The treatment of cancer is a long run and sometimes reoccurring long runs. Patients may need to be hospitalized again and again when he or she relapsed from home after chemotherapy or surgery. Therefore, cancer centers are usually designed like an out-patient space. Cancer patients are usually unwilling to communicate with others due to physical suffering and pressure. Hence, comfort, convenience, effectiveness, education function, family support and warm community environment should be taken into consideration during the design process. For example, patients are in deep fears when facing chemotherapy devices in the operation room alone. Therefore, a delicate arrangement of lighting and furnishing will help them overcome fear, rebuild their lives and recover.
Healthcare Design Goals
A key objective in any healthcare project is to improve patient outcomes through patient-centered design. Healthcare design, however, is rather complicated with many strict rules and involves medical devices, doctors and caregivers. The cost of labour and material resources is also a mounting pressure for healthcare design. Therefore, healthcare design prioritizes efficiency and hopes that a hospital can operate like a giant machine which could reach all the expected goals in a short time. For example, when performing joint replacement surgery, a hospital may only focus on the success of replacement instead of curing that patient. And the patient may relapse and come back for further treatment. Therefore, patient-centered treatment requires a holistic approach that considers all elements such as the patient’s age, mental activity and family influence. Then, evidence-based design and lean design are carried out with the goal of reducing the time in the hospital (via measures such as infection control, contamination, etc.) and improving health outcomes quicker. The philosophy of patient-centered is not to weaken or even neglect the interests of doctors and staff, who are all participants in the medical activities for healing patients. Rather, patient centered design supports and enhances the work of the clinicians, nurses and staff by contributing to overall patient wellness through the healing environment.
To demonstrate patient centric design philosophy, Chris talked about one of his recent project that he is very proud of, the Milton District Hospital (MDH). Located in Milton, Toronto, Canada, the hospital remained relatively unchanged since its last expansion, over 20 years ago. The increase in its population and the diversity of its inhabitants were important catalysts for the redevelopment and expansion of the project. Chris discussed: “By putting people first – patients and their families, as well as the staff at MDH – our design prioritizes healing and supportive environments that address the ‘whole’ person where physical, mental and spiritual well-being are interdependent. The hospital’s design revolves around spaces that maintain privacy and dignity; are safe, warm and positive; are light-filled with both interior and exterior views that reduce stress and promote healing; that support healthy lives and enable patients’ education; and provide easy accessibility to resources. Capping off this human-centred approach are lean, evidence-based design principles and Halton Healthcare Service Corporation (HHS) standards to help the hospital maximize its resources and realize economies of scale.”
Moreover, Visual references that embody the natural environment and agrarian history of Milton are used throughout the facility, such as 45 murals featuring original photography of the local landscape and trees and plants native to Southern Ontario. The murals are enlarged to scale to provide patients and visitors with a sense of calm and respite as they navigate through the hospital’s various departments.
Locally-quarried limestone and water features reference the neighbouring Niagara escarpment. Multi-coloured terrazzo evocative of Milton’s agricultural landscapes. Enhancing the human experience and inspired by nature, exterior and interior elements include artistic details that promote the psychological and physical health and well-being of all its users.
The new MDH expansion provides a sense of place for the community of Milton, now and into the future. Its patient- and family-focused design empowers patients, fosters a positive work environment, is community-centric, and flexible enough to adapt to support emerging thinking, practices, and technology, while allowing for adaptation to suit the town’s growing healthcare needs.” Chris added.
In response to the medical resources of China and Canada, Chris continued: “Similar to the conditions in China, Canada is also in shortage of capacity in hospital-based medical services. The cost of medical care is high, particularly the cost of wages for caregivers and for drugs – and this is most true when the care is delivered in a hospital (versus in other settings or within the community). In addition the capacity that currently exists is diminished by patients with chronic medical conditions (illnesses, injuries and the like) which require treatment – but not at an intensity or level of an acute care hospital. We call these patients “Alternate Level of Care” (ALC) and they account for 20% of patients in our acute care hospitals today. Many of these ‘ALC’ patients are elderly – so there is a relationship between aging and the strategy needed for the healthcare system. There is simply not enough capacity outside of the hospital, e,g, delivered at home, in the community or in institutions designed for these patients (complex continuing care (CCC), rehabilitation or long-term care) to free-up the acute system to address the acute care need. Therefore, we are working on new types of healthcare facilities to make our system more sustainable and diversified. It is an imminent need. In a manner of speaking, it is not a ‘hospital design’ problem – it is a problem of designing lower-cost alternatives that better target the patient/ family need AND convincing these users to have confidence in the alternatives.”