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Design WorkshopsApril 2009

Report on patient and carer input to the design process for the New South Glasgow Hospitals

New South Glasgow Hospitals

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ForewordNHS Greater Glasgow and Clyde recognises the valuable role design plays in delivering modern health facilities and in en-hancing patients and public’s experience of our services.

NHS Greater Glasgow and Clyde continues to invest in new buildings and facilities. These include the West of Scotland Can-cer Centre, Gartnavel Royal Hospital and the new Stobhill and Victoria Hospitals.

Each of these developments have set a new benchmark in terms of healthcare de-sign, providing modern state of the art facilities for patients and staff. What these developments have in common is that they have been designed around the needs of patients.

As NHS Greater Glasgow and Clyde’s Design Champion I am delighted that the views of patients, carers and families continue to be at the forefront of the design process for the new children’s and adult hospitals.

This report is part of a continuous process of engagement in the design of the new hospitals and provides a focus on what’s important from a patient, carer and family perspective in terms of healthcare building design.

Only by involving patients in the design process can we truly understand their needs. This report illustrates our commitment to deliver facilities designed around the patient and deliver on their aspirations for a modern healthservice, delivered in world class buildings.

Helen ByrneNHS Design Champion

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Introduction

Background

Methodology

The IDEA Framework Schedule of Design Workshops Recruitment Support for Participation Monitoring and Evaluation

Findings

Common Themes Adult Wards & Single Rooms Children’s Wards & Single Rooms Adolescent Areas Renal Family & Carer Facilities A&E Outpatients Main Entrance Access & Wayfinding Play Areas The Bereavement Pathway External Areas

Conclusions and Next Steps

Contents

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IntroductionThis report describes the feedback from patients, families and carers on 12 key areas for the New South Glasgow Hospitals – both the Adult and the Children’s sites. It has been prepared in order to inform the development of the Design Brief for the new hospitals and to contribute a user perspective to NHS Greater Glasgow and Clyde’s tender documentation.

The report presents the ideas, hopes and aspirations of patients, carers and families for their new hospitals, as gathered through a series of 16 design workshops. It will describe the process undertaken to gather this feedback before detailing user’s recommendations for the design of 12 key areas of the new buildings, amenities and facilities.

This report has been prepared for the Project and Design Teams of the New South Glasgow Hospitals Project and as such it uses terms and language that are appropriate and familiar to them.

However, as the report will also have a public audience some care has been taken to explain the concepts discussed and terminology used.

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BackgroundSince 2004, the legal context for involving patients, carers and the public has been guided by the NHS Reform (Scotland) Act. This Act placed a legal obligation on NHS Boards to involve service users and other stakeholders in “the planning and development of services and those decisions significantly affecting the operation of those services”. The Act makes clear that user views are “to be given the same consideration as clinical or financial issues”.

This does not mean that user’s views are to be uncritically adopted but it does require NHS Greater Glasgow and Clyde to listen to user views, give them due and reasonable consideration and to provide feedback on how these views, aspirations, ideas etc have been adopted or declined. This process has to be proactive, transparent, recorded and open to audit.

The approval of the Outline Business Case in April 2008 marked a significant milestone for the New South Glasgow Hospitals Project and gave the green light to more detailed work on the planning and design of the new buildings for both the adult and children’s hospitals. Since then, a number of engagement structures have been developed to ensure continuous interaction and engagement between patients, families and carers, the New South Glasgow Hospitals Project Team and the planning process.

Through this, and earlier work undertaken by the Community Engagement Team for the Outline Business Case, a number of key areas have been identified by patients, their families and carers as particularly important to the new developments. These key areas are:

• Wardareasandsinglerooms• FamilyandCarerFacilities• PlayAreas• AdolescentAreas• TheBereavementPathway• Outpatientsclinics• A&E

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• Access&Wayfinding• ExternalAreas• Mainentrance

As planning for the New South Glasgow Hospitals Project progressed to the development of a Design Brief, a robust and reliable engagement process was put in place in order to ensure that, at a high level, the Design Brief considered the views of patients, families and carers. This engagement process aimed to begin to specify in more detail the views, hopes and aspirations of patients, families and carers in relation to the physical environment, facilities and amenities of these new developments.

At this point in the planning process this would include considering functionality – that is how well buildings, facilities and public spaces serve their purpose and are useful for staff and patients; access, circulation and wayfinding - the ease of movement around the hospital and character – the look, feel and quality of the buildings as well as other important issues such as light, views and external areas.

The Community Engagement Team held a series of discussion groups with patients, families and carers to focus in on each area and to describe how these areas are used, how people move through them, what people need when in them, how they should feel and how they should function.

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MethodolgyA series of 16 workshops were held. These used the Department of Health IDEA framework and were designed to undertake more detailed work on the key areas identified previously by patients, families and carers.

The IDEA FrameworkThe Community Engagement Team used the IDEA (Inspiring Design Excellence and Achievement) Framework, developed by NHS Estates England, to facilitate focus groups of patients, families and carers to generate their thoughts on the key areas.

The process involves stakeholders considering their experience of using different areas of the hospitals and describing the challenges that need to be addressed in relation to design.

It then looks at precedents (in photographic form) from recent NHS Builds to consider how these challenges have been addressed in other developments and the extent to which their design solutions have succeeded in supporting patients, their families and carers through the patient journey. These precedents act as triggers for reflection and discussion.

The precedents used in these workshops were drawn from the IDEA website, architectural publications and sites of design excellence. However, although promoted as exemplars, users felt that many were unimpressive when considered in the light of their practical experience of hospital care. Some of the precedents used in the workshops are featured in this report by way of illustrating user’s aspirations for the design of their new hospitals.

It was acknowledged that no single precedent represented a solution to all the challenges described by patients, carers and families but nevertheless, some had elements that were thought to be helpful and these have been included.

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Schedule of Design WorkshopsThe first design workshop took place in November 2008. This focussed on the main entrance to the new hospitals and acted as a pilot workshop for the programme. Following positive feedback from participants and the Project Team a schedule of 15 workshops was implemented in February 2009.

These covered the 10 key areas and addressed the specific concerns of different patient groups, geographic communities, age groups and family/support interests. Some groups were specifically for the Adult hospital and some, such as play facilities, for the Children’s. However, other groups were mixed in order to encourage users to share experiences, thus generating new and innovative ideas for the design of the new facilities.

RecruitmentInvitations to join the workshops were sent to the Family and Youth Panels for the New Children’s Hospital and to the Community Engagement Advisory Group, Patient’s Panel (a standing resource of patients and carers who advise the Acute Division) and the Better Access to Health Group for the Adult Hospital. Other groups invited to attend included the Public Partnership Forums, Managed Clinical Networks and the wider mailing lists of voluntary and patient’s organisations held by the Community Engagement Team.

The full schedule of workshops involved over 175 patients, family members and carers. These were aged between 8 and 83 years; had recent experience of using the areas and facilities under discussion; represented a number of the ethnic communities within NHS Greater Glasgow and Clyde; represented people with mobility, sensory and learning difficulties and finally, came from Greater Glasgow, Inverclyde, Renfrewshire,

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Lanarkshire, Ayrshire, East and West Dunbartonshire, East Renfrewshire and Argyll.

Support for ParticipationIn order to facilitate a diverse attendance a number of support measures were put in place.

First, a named contact was clearly identified for the programme in order to provide an easy point of contact for those wishing to seek clarification on the purpose and format of the workshops or to discuss their particular support needs.

Second, the programme included morning, afternoon and evening meetings to provide alternatives for those wishing to participate.

Third, participants were offered support to assist them in attending i.e. transport, childcare, respite etc. It was anticipated that child care could have created a particularly difficult barrier and so crèche facilities were made available for the children’s hospital workshops.

Finally, where there was sufficient demand, an additional session was organised in order to facilitate involvement. In response to feedback from the Family Panel a workshop was held in Lochgilphead.

Monitoring & EvaluationThe pilot workshop was evaluated by participants, the Community Engagement Team and the Project Team in order to ensure that it was ‘fit for purpose’ and that the format could deliver the quantity and quality of information required at this stage in the planning process.

The subsequent process was observed by Architecture and Design Scotland, the Scottish Health Council and the NHSGGC Involving People Committee.

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Common ThemesThere is a considerable degree of agreement in the key interests of patients, families and carers with regard to the design of their new hospitals. There were a number of common themes regarding character (look), functionality (usefulness), infection control (cleanliness), access & way finding (finding and moving around easily) and future-proofing (coping with change) that were repeatedly raised and discussed.

The hospitals should be an iconic development portraying a positive image of the NHS, reflecting their importance and communicating respect and concern for the needs of patients, families and carers. The buildings should be able to adjust to change and future developments in healthcare, ensuring the hospitals remain cutting-edge.

Infection control is a primary concern, so much so that several precedents that featured innovative, patient-centred design solutions were rejected by participants on the basis that they would be too difficult to clean and maintain.

Access and way-finding is also a common theme. The design of the buildings needs to consider intuitive way-finding and an appropriate concern for space and independent movement for all users, particularly those with mobility, sensory or learning difficulties.

Key Themes:

• Buildingsandfacilitieshaveacharacterandpresencethatportraysapositive image of the NHS and contributes positively to the local community• Facilitiesarefinishedtoahighstandard,communicatingandreinforcingvalue and respect for patients, carers and families

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• Cleanlinessandmaintenancearekeyconsiderationofthedesignapproach• Accessandwayfindingmeasuresrecognisetheneedsofpeoplewithmobility, sensory, orientation impairments and with literacy or learning difficulties• Accesstoappropriatetoilets,handwashing,andshoweringfacilitiesare considered in designing each aspect of the hospital(s)• Buildingsandfacilitiesarefutureproofed,flexibleandeasilyadaptableto accommodate future demands without damaging the integrity of the site• Spaceplanningaddressestheneedsofdisabledpeopleandtherangeof increasingly large equipment and kit they may need• Facilitiesensureprivacyanddignityforpatientsandcarers• Facilitiesoffertheopportunityforconnectednesstootherpatients• Thedesignmakesfulluseoftechnologyinclinical,patientandpublicareas, providing connectivity to staff and to the outside world• Facilitiesmaximiselightandminimisenoisecreatinganenvironmentthatis calming and reassuring• Buildingsandfacilitieshaveadequatestoragetoensurethecontinued functionality of the design and ease of movement throughout the building• Carersandfamiliesneedtoberecognisedaspartnersincare,integraltothe design process and need to be considered as part of the patient pathway • Carparkingprovisionneedstobeappropriateandcaterfortheneedsof users, including the provision of pick up/ drop off facilities located at main entrances

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Feedback on the key design features of adult wards and single rooms is consistent across the groups that discussed this aspect of the Design Brief. Whilst there are some additional points of interest identified by particular patient groups, such as renal patients whose feedback is discussed later, there are four key factors.

There is a need to provide a space that facilitates treatment and recovery for patients. Such a space would balance the need for privacy whilst providing connectivity with the ward, including excellent line of sight to the ward staff.

The design needs to address patient’s requirements for appropriate and accessible access to toilets, hand washing and showering. This should reflect the particular medical and support needs of individual patients.

The design should consider facilities for distraction/entertainment and consider the needs of patients to socialise.

The issue of nursing practice in single rooms is a complex subject that will require careful consideration. One feature that will require discussion is the needs of those supporting elderly relatives, those with communication or sensory difficulties,complex needs or dementia.

At this stage, it is important that ward design incorporates flexibility and the potential for the provision of facilities for such families and carers.

Key Themes:

• Providespacethatisprivate,quiet,comfortableandhasadequateroomfor

Adult Wards and Single Rooms

What works...This single room design offers patients and staff good visibility into and from the room. The room can be easily screened to afford privacy and dignity. The shower area being located at the rear of the room assists in ensuring good visibility.

The room has good natural light. It caters for the needs of visitors with appropriate, flexible seating. The room has considered storage and entertainment for patients. The space is able to cater for patients who require additional equipment and support and, when required, is able to accommodate the needs of carers.

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clinical activity, equipment and mobility aids• Providesafety,reassuranceandconnectivitybyensuringvisibilityandalineof sight to staff• Havegoodcommunicationswithstaffandtheoutsideworld• Provideaccessible,appropriatefacilitiesfortoilets,handwashingand showering • Warddesignshouldconsidertheneedsofthosepatientswithcomplexneeds and the associated demands of bulky equipment, additional space for manoeuvrability and the need for carer support. Design solutions could consider the provision of designated rooms with additional space, carer facilities and integrated lifting equipment to assist movement• Providepatientswithadegreeofcontrolovertheirenvironment• Roomsshouldbepleasant,lightandairywithviewsoftheoutsideworld• Roomsshouldbedesignedtoaccommodatetechnologyincluding communications and entertainment• Considertheroleoffamiliesandcarersaspartnersinthecareofthepatient• Thedesignshouldconsiderhowspaceinthewardcanbeutilisedtoprovide opportunities for patients to socialise• Availabilityofspaceateachwardlevelforcommunicatingwithcarers/families in private/ providing a quiet space to deal with upsetting news

Adult Wards and Single Rooms

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Children’s wards and single rooms need to strike a balance between the need for privacy and connectivity to the ward, including an excellent line of sight to the ward staff. A particular interest is in the provision of age and size appropriate facilities for toilets, hand washing and showering.

The specific requirements of disabled or complex needs patients are of particular concern with a clear preference for the integration of hoists and lifting equipment to assist movement.

Provision for distraction/entertainment should consider access to facilities such as television/PCs but also provide appropriate, accessible space for play and socialisation.

The needs of families and carers, as partners in the care of children and young people, should be met through the provision of facilities that sustain families through, what can be a protracted, demanding and stressful experience. This includes space to sleep, toilets, showers, somewhere to wash their clothes and somewhere to make a cup of tea or a snack. These would help families to manage the demands of a hospital stay.

Key Themes:

• Providespacethatisprivate,quiet,comfortableandhasadequateroomfor clinical activity, equipment and mobility aids• Providesafety,reassuranceandconnectivitybyensuringvisibilityandalineof sight to staff

Children’s Wards and Single Rooms

What works...The design has considered the needs of families and carers by providing a spacious seating/ sleeping area. The space around the bed is able to accommodate additional equipment and mobility aids if required.

The room is bright and airy without being overpowering in the use of colour. and is complemented by the use of art work. The room makes good use of natural light and offers connectivity to the outside world with large windows. The room has ready access to washing, bathing and toilet facilities and a built in entertainment system.

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• Warddesignrecognisestherangeofpatient’sages,experiencesandabilities• Havegoodcommunicationswithstaffandtheoutsideworld• Provideaccessible,appropriatefacilitiesfortoilets,handwashingand showering • Providepatientswithadegreeofcontrolovertheirenvironmentandan opportunity to personalise their room• Thedesignshouldconsiderhowspaceinthewardcanbeutilisedtoprovide opportunities for patients of all ages and abilities to play, meet and socialise• Roomsshouldbepleasant,lightandairywithviewsoftheoutsideworld• Roomsshouldbedesignedtoaccommodatetechnologyincluding communications and entertainment• Warddesignshouldprovidepatientswitheasyaccesstostaff,bewelcoming and reassuring• Wardsshouldconsiderhowtheneedsoffamiliesandcarerscanbe accommodated into the design and layout• Warddesignshouldconsidertheneedsofthosepatientswithcomplexneeds and the associated demands of bulky equipment, additional space for manoeuvrability and the need for carer support. Design solutions could consider the provision of designated rooms with additional space, carer facilities and integrated lifting equipment to assist movement• Availabilityofspaceateachwardlevelforcommunicatingwithcarers/families in private/ providing a quiet space to deal with upsetting news

Children’s Wards and Single Rooms

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The key issues identified by young people and their families reflect a desire for increased independence and treatment that recognises ‘young adult’ status. Privacy is an important consideration as is the provision of age-appropriate activities such as internet access that facilitates connectivity with school, friends and the outside world. Separation from younger children is a key concern.

Age-appropriate facilities should be provided throughout the treatment, waiting and support areas of the hospital – not simply in the wards and single rooms.

Young people require a degree of control over their environment and the opportunity to personalise their room through space – such as a notice or white board - for posters, cards, pictures etc.

There is a need for appropriate and comfortable family and carer facilities. Many young patients rely on their families for personal care, communication and support. Family facilities need to provide space to sleep, toilets, showers, somewhere to wash clothes and somewhere to make a cup of tea or a snack.

Key Themes:

• Allowforindependence• Provideseparationfromyoungerchildren• Provideyoungpeoplewithadegreeofcontrolovertheirenvironmentandan opportunity to personalise their room• Provideaccessible,appropriatefacilitiesfortoilets,handwashingand showering

Adolescent Areas

What works...

This space has considered the needs of young people who may require to stay for a substantive period of time with excellent and varied storage facilities. The space provides opportunities for patients to personalise the space assisting in creating a familiar and comforting environment. The space has good access to entertainment and distraction and offers privacy for patients if required/ desired.

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• Haveadequatespaceforadolescents,especiallythosewhousewheelchairs and other bulky equipment• Thedesignshouldconsiderhowspaceinthewardcanbeutilisedtoprovide opportunities for young people to meet and socialise• Roomsshouldbepleasant,lightandairywithviewsoftheoutsideworld• Roomsshouldbedesignedtoaccommodatetechnologyincluding communications and entertainment• Warddesignshouldoffereasyaccesstostaffforpatients,bewelcomingand reassuring• Wardsshouldconsiderhowtheneedsoffamiliesandcarerscanbe accommodated into the design and layout• Allowforsocialisationbutalsohavequietspaceforreflectionorschoolwork• Providesafety,reassuranceandconnectivitybyensuringvisibilityandalineof sight to staff

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What works...

Renal FacilitiesPatients and carers from renal services identified a number of areas in which their experience of treatment differs from that of other out, day and in patients.

Furthermore, owing to the range of treatment modalities (types of treatments), the experience within a group of renal patients can also differ significantly. As a result, renal facilities involve a level of specification that may not be required of more general wards and treatment areas.

The design of renal facilities should acknowledge the lengthy periods spent in treatment areas and address the needs arising from this. Treatment areas require privacy, to allow for invasive or intimate clinical treatment, and social interaction, to help patients manage their prolonged and largely uneventful treatment episodes.

Whether treatment is provided as an in or out-patient, there is a need to attend to patient’s requirements in terms of storage, waiting, interview and washing facilities. A particular issue is the provision of adequate washing facilities for cleaning items of clinical equipment and assisting with treatment. These should be separate from patient’s toilets and showering facilities.

Families and carers needs are similar to those of in-patients but for out-patients, where lengthy waits while patients undergo dialysis are the norm, easy access to shared, public amenities is required.

Key Themes:

• Designneedstorecognisetheparticularneedsofrenalpatientsandtheir overall patient experience

This dialysis bay has good space to enable staff to work and patients to retain a sense of distance without being too far removed from other patients if they wish to socialise. The provision of a built in screen allows for patients who prefer to dialy-sise in private.

The space provides storage for patient’s personal effects, providing reassurance. The space has calming colours and good natural light, the provision of blinds enables patients to control their own environment.

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• Providesanadequatespacetofacilitateclinicalactivityandallowforprivacy• Providesspacethatstrikesabalancebetweentheneedforprivacyandthe desire to maintain social interaction during lengthy treatments• Providesappropriate,accessiblewashingfacilitiesforclinicalneeds• Providesaccessiblefacilitiesforpatientse.g.storage,waiting, entertainment/distraction i.e. TV, telephone, Wi-Fi appropriate to the space• Providesspaceforprivateinterviewsandmeetingswithstaff• Providesappropriate,accessibletoilets,handwashingandshoweringfacilities• Providesacalming,restfulatmospherewithnaturallightandviewsofthe outside world• Givespatientsadegreeofcontrolovertheirenvironment• Provideseasyaccesstopublicfacilitiesforfamiliesandcarers

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What works...

Family and Carer Facilities

This area provides 24 hour access to refreshments and sustenance for parents and carers. The space is bright and airy with good natural light and is easily maintained. The seating and dining area is appropriate with high quality furnishings and finishes. The layout and refreshments available provides a functional and appropriate space that meets the needs of families and carers.

Family and carer facilities are an issue of considerable concern to users of the adult and children’s hospitals. There is a clear distinction between the roles of ‘visitor’ and ‘partner in care’. For visitors, there is a need to consider access, wayfinding, amenities for refreshments, toilets and appropriate shopping and support facilities.

The vast majority of the aspirations for family and carer facilities relate to the Children’s Hospital. This is due to historical expectation that family members will stay with a young patient in hospital. The design of the new hospital should enhance families experience and thus, their ability to contribute positively to their child’s care and support.

Ward design should address the needs of family and carers by providing a comfortable space to sleep, toilets, showering facilities, somewhere to wash their clothes and access to a basic pantry to prepare tea/coffee, snacks etc. The provision of such amenities could overlap with patient’s facilities, such as through access to en-suite toilets, but if separate should be sufficiently close to prevent lengthy absences from the bed side.

Whilst bedside accommodation has not traditionally been associated with adult wards, some users, principally those supporting elderly relatives, those with communication or sensory difficulties, complex needs or dementia may require to stay.

This is a complex issue that will require careful consideration – particularly in relation to nursing practice for single rooms. However, at this stage, it is important that ward design is flexible and considers the provision of facilities for families and carers.

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Family and Carer FacilitiesFamilies and carers from both adult and children’s services value the provision of appropriately situated, high quality facilities offering easy access to support, information and advice. This is a particular concern for those who are unfamiliar with either the hospital campus, the Glasgow area or who have limited experience of acute care.

Where families and carers are not accommodated within wards and single rooms there is a need to consider alternative accommodation arrangements and whether dedicated facilities can be identified.

Key Themes:

• Providefacilitiesthatrecognisetheroleoffamiliesandcarersaspartnersin the care of the patient• Providefacilitiesthatsustainfamiliesandcarersthoughlengthystays• Offeraccesstosupportservicesforawiderangeofconsiderationse.g. geography, other siblings, extended families, level of ability• Providehighquality,convenientlylocatedsupportfacilitiesthatoffer information, resources and respite• Maintainconnectednesswiththeoutsideworld• Provideabalancebetweenspaceforthepatient,clinicalactivityandcarer

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Accident and EmergencyThe design of Accident & Emergency departments was of particular interest to patients, families and carers as a result of their reliance on them at difficult and stressful times. Access, waiting and patient flows should strive to maximise safety and security and provide a reassuring and calming atmosphere. Treatment, waiting and reception areas should be designed to maximise privacy and dignity.

As people arriving at A&E will be in pain, distressed, in a hurry or dis-orientated in some other way, particular attention should be paid to access and way finding including clearly distinguished entrances with appropriate parking, drop-off and public transport access. Once patients and carers have arrived, immediate access to staff, mobility aids and practical assistance if required is important.

A&E should provide appropriate waiting areas. The needs of carers and families (including children) should be catered for with facilities including accessible toilets, drinking water, support information, payphone, distraction etc. A quiet room should be available to assist in meeting the needs of families and carers dealing with traumatic news and bereavement.

Key Themes:

• Entranceneedstobeobvious,accessible,easytofindanddistinguishable from other areas of the hospital• Haveimmediateaccesstostaffattheentrance• Haveeasilyaccessedpracticalaids&equipmentsuchaswheelchairsavailable at the entrance

What works...

Arrival at the emergency department is important. The Accident and Emergency entrance is clearly signposted, identifiable and distinct from other areas of the hospital. Covered seating and waiting areas are provided outside.

There is a dedicated drop off/ pick up area directly outside the entrance to the department.

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Accident and Emergency• Securitymeasuresshouldbehighlyvisible• Treatmentareasaredesignedaroundtheneedtoprovideappropriate treatment but should provide privacy and protect the dignity of patients• Treatmentareasallowroomforbothclinicalactivityandaccessfordisabled people, carers etc• Considerstheneedsoffamiliesandcarersindealingwithtraumaticnewsand bereavement• Patientsshouldbestreamedintothemostappropriateareasbasedon clinical need, with separate access for the most critically ill/ injured patients in order to maintain privacy and avoid distress to other patients• Waitingareasareappropriatetotheparticularareasandaredesignedto maximise safety, security and provide a reassuring and calming atmosphere.• Waitingareasprovideaccesstoappropriatetoiletandwashingfacilitiesand where appropriate facilities for carers and families (including children)• Waitingandreceptionareasaredesignedtomaximiseprivacyanddignity• Waitingareasofferabalancebetweenpeace&quietanddistraction• Patientflowallowsrapidmovementintothemostappropriateclinicalarea whilst maintaining patient privacy and dignity

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The design of outpatient areas needs to consider patient flows and movement from one treatment area to another. The design should assist patients to move through the space and be planned logically in order to maximise co-location of facilities but also reduce distances travelled.

Helping patients to move between clinics and treatment areas will aid independent movement and reduce the need for porters and wheelchairs. Entrances should be clearly visible and easy to find.

Waiting areas are an important part of the patient journey and appropriate waiting space needs to be provided at each treatment point, providing a calming and reassuring atmosphere whilst protecting patient privacy and dignity.

Treatment areas should be appropriately separated from public areas to ensure privacy and confidentiality.

Treatment areas should have a number of functionally different spaces, providing appropriate space for clinical examination and treatment, hand washing, interview and paperwork whilst accommodating the needs of carers.

Accessible toilet, hand washing and showering facilities (where appropriate) should be available and planned as part of the patient journey,

Key Themes:

• Entrancesareeasytofindandaccessible• Provideeasyaccesstoandidentificationofamemberofstaff

Outpatient Areas

What works...

An important element of the outpatient journey is the waiting area. This example provides an interesting and stimulating environment with independent bespoke spaces providing ready access to information and catering for a range of users including children. The area is finished to a high standard with good use of both natural and artificial lighting.

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• Buildingsorientpatientstowardsclinicsandwaitingareas,facilitating independent movement around the site• Patientflowsshouldbelogicallyplannedandco-locationmaximisedto minimise distance• Waitingareasareaccessible,haveadequatepatientfacilitiesandappropriate toilets, hand washing, showering and bathing facilities • Waitingareasareavailableateachtreatmentpointaspartofthepatient pathway• Waitingfacilitiesbalanceadequatespaceforindividualswithadegreeof privacy• Provideseparationbetweenpublic(waiting)andprivate(treatment)areas• Treatmentareasofferprivacy• Treatmentareasprovideadequatespaceforclinicalactivityandface-to-face interaction with patients and their carers• Treatmentareashaveappropriatetoilets,handwashing,showeringand bathing facilities

Outpatient Areas

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Main EntranceThe main entrance is an important feature as it sets the tone for patients’ initial experience of the hospital. As such, the main entrance to the hospital buildings needs to be easy to locate and logically positioned. The entrance should be obvious with good external signage and wayfinding.

The entrance should be located close to car parking and public transport routes, including appropriate pick up/ drop off areas. The needs of pedestrians need to be considered and pedestrian and vehicle routes should be separated to allow for easy movement to and from the building

The main entrance doors should be fully automated with ready access to seating and waiting facilities for patients who require to wait for assistance. This should include ready access to mobility aids i.e. wheelchairs.

Upon entering the building there should be an immediately visible and obvious reception desk to provide assistance and reassurance to patients and families. The entrance needs to provide a calming and reassuring atmosphere whilst recognising that individuals may require stimulation and distraction.

There should be access to amenities for patients and carers including comfortable waiting facilities and access to appropriate shopping and support facilities. To assist rapid movement into the main areas of the hospital the design needs to provide a logical, easy to follow layout with accessible signage and way-finding.

What works...

The entrance is clearly visible and well signposted. There is good access for pedestrians, public transport, cyclists and vehicle users with the provision of a dedicated drop off/ pick up area. The space is uncluttered and free from obstacles assisting easy movement to and from the building. There is good use of landscaping including an external waiting space for patients and carers.

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Main EntranceKey Themes:

• Mainentrancehighlyvisible,obviouswithgoodexternalsignage• Locatedclosetocarparkandpublictransport• Providegoodpedestrianroutesanddrop-offpoints• Ensuresseparationofpedestrian/vehicleaccess• Easilyaccessede.g.automaticdoors,levelaccessetc.• Immediateandobviousreceptiondesk• Providesaneasytofollow(intuitive)layoutwithappropriateandaccessible signage• Providesacomfortablespacetosit/wait• Providesarangeofappropriateshopsandfacilities• Characterprovidesabalancebetweenastimulatingandcalmingenvironment

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Ease of access and the ability to move straightforwardly and purposefully around the hospital site are essential to the patient journey.

The design of the buildings needs to consider clear, understandable layouts with circulation routes that explain themselves to users without reliance on sign posting. Signage should consider the different reading and comprehension abilities of users, and not rely solely on written signs to provide information for patients and visitors.

Clarity of route should be a primary design feature. Circulation routes around the buildings need to be obvious, understandable and connected to internal landmarks. Where possible, these should be short and direct.

The difference in patients mobility, many of whom are elderly, to travel around long corridors should be considered with practical aids such as seating or handrails provided at regular intervals. Circulation routes should be uncluttered to ease movement for those with mobility or sensory impairments.

Colour, texture, art, flooring etc should be used to enhance wayfinding and to indicate the move from public to private areas.

Key Themes:

• Entrancesareobviouswithdirect,accessibleroutes• Publictransportprovisionisfullyintegratedintothesitedesign

Access and Wayfinding

What works...

This communication route is straight and direct providing clear views to assist in finding a destination. The floorcovering provides a visual indication of direction without distracting the user, intuitively guiding the user to a destination. Each area is clearly signposted with additional signage above each doorway. Artificial lighting is used well in each area to highlight signage and destination. The communication route has good natural light.

Access and Wayfinding

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• Signage/indicators/cluestomovementarehighlyvisible,accessibleandeasy to understand• Communicationroutesaredirect,shortanduncluttered• Designincludespracticalassistancetoaidmovementthroughtheuseof landmarks, texture, noise levels etc• Keyareasareobvious,wellsignpostedandeasytofind• Sharedfacilitiese.g.café,publictoilets,patienttransportareobvious, well sign posted and easy to find• Carparkingfacilitiesareappropriateforthesiteandcaterfortheneedsof users with complex needs, including the provision of appropriate pick up/ drop off facilities• Designoraestheticfeatureswhichchallengepeoplewithdisabilitiesmustbe avoided

Access and Wayfinding

Access and Wayfinding

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The provision of adequate and appropriate play facilities throughout the site is essential as a therapeutic environment for children and as a support for families when visiting or accompanying patients to hospital.

Play areas need to consider the wide range of ages and abilities of children using the site. It is essential that disabled children – those with mobility, sensory or learning difficulties – have equal access to play areas and amenities.

Play areas should be appropriate to the needs of patients and siblings in each particular area of the hospital. Facilities in waiting areas should reflect the need for distraction and socialisation while those in wards should have the additional capacity for integration with therapeutic and educational functions.

Safety and security are essential features of play areas as is access to the outdoors. Where feasible, facilities could be shared with the new South Glasgow Hospital in order to provide a resource for families visiting or supporting a relative in the adult site.

Key Themes:

• Areaccessibletoallagesandabilities• Aresafeandsecure• Provideabalancebetweendistractionandtherapy• Areavailableinarangeofareasincludingwardsandwaitingareas• Providespaceforchildrentomeetandsocialise• Areintegratedwiththerapyandschool

Play Areas

What works...

This play area demonstrates good use of an external space, illustrating the creative use of a courtyard area. The area is easily maintained and is well overlooked from the bright and airy communication route running parallel, providing reassurance to parents and family members.

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• Providefacilitiesforsiblings• Provideaccesstotheoutdoors• Offerspacesthatareavailable24/7,whereappropriate• WherefeasibleconsiderhowfacilitiescouldbesharedwiththenewSouth Glasgow Hospital.

Play Areas

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The facilities provided for families and loved ones at the time of bereavement are significant as the care and support that people receive then can affect the whole bereavement process. This area differs from others discussed in the workshops as it represents a number of buildings, facilities and amenities. As such this is a complex area and more work will be required to describe in detail the range of user experience and expectation in relation to the bereavement pathway.

Calming, reassuring, respectful spaces catering for the emotional and practical needs of bereaved families, including children and siblings, are required throughout the hospitals, but particularly in ward areas and A&E. Simple, calm spaces are needed in order to provide flexible areas for use when required. These should offer space and time for families to cope with bereavement. Adequate space should be provided so that quiet rooms are not used as office or storage space.

Mortuary and viewing facilities should consider the needs of families and carers by providing appropriate access to a reassuring environment that balances the need to protect the privacy and dignity of the dead with the emotional and support needs of their loved ones. Families should be offered privacy and dignity, with facilities able to accommodate a number of families including large families, with different needs.

There is a need to consider the provision of specialist bereavement services offering post-bereavement information, counselling and support. The relationship between these and other elements of the bereavement pathway such as family support, mortuary and spiritual care requires consideration.

The Bereavement Pathway

What works...

This space provides a calming and peaceful space for families and carers. The use of warm neutral colours with soft furnishings and finishes provides a contrast with clinical spaces elsewhere in the hospital. The innovative use of uplighting adds to the character of the space. The use of art provides a break in the uniformity of the colour scheme whilst adding to the overall ambience of the space.

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The Bereavement PathwaySpiritual care facilities should incorporate the needs of bereaved families and carers offering a sanctuary for reflection, grieving and emotional support to all religious faiths and those with no faith. Whilst spiritual care is integral to bereavement services the facilities do not need to be co-located with either mortuary or specialist bereavement services.

Key Themes:

• Providesintegratedcalming,reassuring,respectfulspacescateringforthe emotional and practical needs of bereaved families including children/ siblings• Aresafeandsecureenvironmentsthatmaintainprivacyanddignity• Recognisetheneedtoprovidebespokeandintegratedfacilitiesforfamilies and carers in different areas of the hospital i.e. ward, A&E, mortuary and consider accessibility of post-bereavement support• Providefacilitiesthatasfaraspossibleprovidespaceandtimeforfamiliesto cope with bereavement and considers the needs of different users• Accesstomortuaryfacilitiesshouldprotectthedignityandprivacyofthe deceased whilst providing ready access for families and carers• Accesstodifferentmortuaryfacilitiesshouldbeseparatebutshouldconsider integrating access to support facilities• Themortuaryfacilityshouldprovideafacilitythatisabletoaccommodatea number of families with different needs within a peaceful and reassuring environment including the external environment• Mortuaryfacilitiesshouldhaveadedicated,discreetcarparkingareaadjacent

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External areas are viewed by patients, carers and families as offering additional facilities to the hospital buildings and having the potential to make a significant contribution to the patient experience. External spaces should be both attractive and functional.

External areas should be designed to reflect and be appropriate to the local area and community. They need to be appropriate to Scottish weather conditions, thus ensuring that they continue to provide an attractive feature.

External areas should make creative use of the available land within the site and bring light, views and connectivity with the outside world into public, waiting and treatment areas.

The design of external areas should help guide patients with wayfinding and orientation; providing landmarks and paths to/ from car parks and public transport access points.

Co-location with waiting areas and wards should offer therapeutic space for patients and carers to sit, meet and wait and additional play areas for patients and siblings.

In all external areas, design solutions need to be sustainable, offer security and be easy to maintain.

External Areas

What works...

This external space provides ready access to greenspace within a built up environment. The use of a central feature provides a focus. The landscaped area provides discreet seating and waiting spaces within easy walking distance of the main hospital buildings. The use of trees and plantings provides seclusion without impacting negatively on the overall visibility and connectivity.

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Key Themes:

• Provideexternalareasthatbalancetheneedforpublic/privatespace.• Externalareasshouldbesecure.• Spacesshouldbetherapueticandprovideopportunitiesforpatientstosit outside • Providespacetositandmeetwithvisitorsandotherpatients,where appropriate this should include sheltered areas.• Provideadditionalplayfacilitiesforchildrenandsiblings• Connecttheinsidetotheoutside• Providesafe,accessiblepedestrianroutesthatassistwithorientationandway finding• Areappropriatetothelocalcommunityandlocalweatherconditions• Areattractivetoallthesenses• Areeasilymaintained

External Areas

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This programme of 16 design workshops provided a second major opportunity for patients, families and carers to contribute their views, ideas and aspirations for the New South Glasgow Hospitals Project. Their views, concerns and aspirations have informed the Design Brief for the new Adult and Children’s hospitals.

The programme addressed 12 key areas for the new hospitals as identified by patients, families and carers in earlier work for the Outline Business Case and, using the IDEA framework, gather detailed views on design solutions that could address the challenges faced by users. It can be seen that many of their views are shared with those of other stakeholders in the new hospitals. Some ideas build on existing high quality facilities that are valued by patients, families and carers while some may be innovative and present challenges to building and service design.

These views will now be shared with the Project and Design Teams for the New South Glasgow Hospitals Project for consideration in the preparation of the Design Brief. Briefings will be provided in order to ensure familiarity with and to further clarify user’s views, ideas and aspirations for the design of their new hospitals. Future work will develop on these workshops, offering on-going opportunities for patients, families and carers to influence the planning and design of the new hospitals.

On completion of the development process for the Design Brief, feedback will be provided to participants on how their views, ideas and aspirations have been used in the Design Brief and associated tender documentation. As further work and detailed planning on buildings and facilities emerges, the Community Engagement Team will ensure that opportunities are provided for the on-going participation of patients, families and carers.

Conclusions and Next Steps

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Further informationTo discuss any of the issues raised in this report or for further information on the design of the New South Glasgow Hospitals, contact:

New Childrens Hospital Kate Munro 0141 201 4755

New Adult Hospital Dan Harley 0141 201 4420

New Hospital Campus Mark McAllister 0141 201 4789

Conclusions and Next Steps

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