‘People-centric care’ sounds obvious, but we’re stuck in a system

Hospitals, historically.   

When we think about hospitals, we’re likely to imagine disease, pathology, containment, and suffering. A product of the industrial revolution, hospitals as we know them were inspired by the factory model to be functional, sterile, and efficient – supporting a system of care that treats illness instead of the whole person, defines success in terms of bed occupancy, and places the system above the users.   

Historically, we’ve done better. In the 1920s, sanatoriums were built around access to sunlight and fresh air, orienting rooms and balconies to maximise exposure. Bright and clean, these spaces were designed to function as medical tools themselves ¹ Alvar Aalto, the designer of Finland’s Paimio Sanatorium, explained that ‘the main purpose of the building is to function as a medical instrument.’ . This approach saw the design reduce noise, facilitate cleaning, optimise daylight, and prioritise social interactions – showing care for its ecosystem of patients, nurses, doctors, and other workers.   

The toll of the system we have.  

As it is today, hospitalisation demonstrably exacerbates patients’ emotions and increases feelings of depression and anxiety, impacting their ability to cope and adjust¹Alzahrani N. The effect of hospitalization on patients’ emotional and psychological well-being among adult patients: An integrative review. Appl Nurs Res. 2021 Oct;61:151488. doi: 10.1016/j.apnr.2021.151488. Epub 2021 Aug 12. PMID: 34544571. (fig. 2). This stress is also felt by families and carers, who report higher levels of anxiety, social isolation, and fatigue²Rückholdt M, Tofler GH, Randall S, Whitfield V, Washington K, Fethney J, Buckley T. Psychological responses and coping behaviour of visiting family members during and following unplanned hospital admission. J Clin Nurs. 2021 Dec;30(23-24):3528-3538. doi: 10.1111/jocn.15858. Epub 2021 May 24. PMID: 34031927.. Bullying, discrimination, and burnout is rampant for healthcare professionals, and deeply detrimental to mental health, decision-making, and staff retention. 

This toll is even more damaging for First Nations people. The percentage of Aboriginal and Torres Strait Islander people reporting being treated with respect and dignity at the hospital is significantly lower than non-Indigenous patients, while more than half of First Nations healthcare trainees experience or witness bullying ³The Medical Board of Australia, “Medical Training Survey”, Medical Board of Australia, 2023, https://www.medicalboard.gov.au/News/2020-02-10-Media-release-MTS-report.aspx. . Indigenous people are also less likely to present to or stay in hospital⁴Askew, D.A., Foley, W., Kirk, C. et al. “I’m outta here!”: a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital. BMC Health Serv Res 21, 907 (2021). https://doi.org/10.1186/s12913-021-06880-9, risking the need for more elevated care later and indicating a worrying lack of cultural safety in our health system. 

These problems are not individual issues but symptoms of an organisational concern that affects our ability to deliver quality healthcare. They are experiences that reinforce the urgency of our need to rethink what ‘inclusive’ healthcare means in practice and fuel for us to change the conditions that prevent true equality across the healthcare experience.  

Design’s impact.  

Design impacts healthcare because it influences behaviour. Though change requires input industry-wide, a designers’ role is to prioritise people-centric care through the creation of spaces that deeply consider their influence on each users’ personal health and wellbeing.  

These changes to do not mean higher costs, they simply indicate a reorganisation of priority that considers user experience first as a way of informing outcomes. Emphasis on the individual, customisation, and comfort sets people-centric care apart as the next step in healthcare design, impacting behaviour for the better.  

The specific experiences of First Nations people must be met with respect, deep empathy and great behavioural change. Cultural safety is for everyone, and design’s impact can be felt via the creation of spaces that focus on the comfort everyone deserves. Its these shared needs – for shelter, nature, safety, sensory input, and community – that should influence the kinds of spaces our hospitals will become. To serve our diverse, multicultural community well, this approach of recognising and responding to our human commonalities rather than our differences, results in a space that feels intuitive and welcoming for all. 

The people-centric precincts we need.  

Healthcare spaces developed around people-centric care improve lives by dissolving barriers between people, disciplines, facilities, spaces, and cities to create people-centric precincts that foster social and psychological wellbeing alongside physical recovery. A project that embodies this goal is Adelaide’s New Women’s and Children’s Hospital (New WCH), which will be purpose-built for the health and wellbeing of babies, children, young people, women, and their families.

Responding to feedback from patients, staff, and clinicians, the New WCH features a dedicated helipad, an ICU for women, extra beds, and critical care services all on the one floor. These practical additions allow people to arrive, rest and recover in spaces that have been designed to promote wellbeing by being as seamless and gentle as possible. Ultimately, the design allows for age-appropriate paediatric, women’s maternity, neonatal and gynaecological care for our most vulnerable in purpose-built spaces that feel safe.

Ecosystem trumps system.  

Health precincts are multi-disciplinary. Part workplace, research facility, accommodation, sanctuary, café, school and playground, these spaces facilitate a vast spectrum of experience. Taking a people-centric design approach means reframing healthcare as an ecosystem in which patients, professionals, students, families, and the community work together in harmony.  

The built environment is a key character within this ecosystem. When place is understood to impact outcomes as much as people do, emotions and behaviour improve. Connection to nature, daylight, art and symbolic or spiritual objects alongside considered lighting, wayfinding, access, and environmental control alleviate the higher levels of anxiety and fatigue felt by all users.  

Communities of care.  

People-centric design benefits the entire community. By appreciating a place’s cultural heritage, demographics, landscape and culture, a health precinct surpasses the role of landmark. Instead, they can leverage their site and surrounds to become deeply embedded into their communities as places of sanctuary, growth, inclusion, and opportunity.  

Located directly on the banks of the Clarence Valley River in New South Wales, Grafton Base Hospital required a masterplan that allowed it to provide healthcare, professional education, and key worker accommodation. Located in a flood zone, it needed to function independently if it became waterlocked. This meant that the project needed to be self-sufficient as well as highly accessible to the community in a crisis. Ultimately, the design team approached the project in the same way they’d approach the design of an island village.  

Un-stick the system. 

Our healthcare system needs healing itself, and the medicine lies in an empathetic approach that finally places people ahead of a system that no longer serves them – healing holistically instead of simply treating the primary ailment.  

In the built environment, hospitals are some of the most direct examples of design’s impact on communities across generations, so people centric care is an approach that is not only smart, but necessary for a better future. At the end of the day, health is a basic right for every human – and we need human spaces to honour that fact.