Timeline & Program

Important Dates & Deadlines

March 15st 2022.

Submission short and full conference paper (own choice)

April 1st – 25th 2022 

Assistance in peer reviewing (full/short) paper

May 9 – 15, 2022

Feedback on review (will be reviewed by a Scientific Committee member and at least one presenter from the same session.

July 15st 2022 

  • Last day early bird & Submission final abstract for ‘book of abstracts’ (for authors of papers and posters)
  • Submission final full and short paper, and poster for publication on website and for conference proceedings

August 1st, 2022

  • submission of final abstract, and bio
  • Last changes possible to papers in pre-print

August 22-24th 2022

October and November 2022 

December 1, 2022 

ARCH22 Conference Enabling Health, Care and Well-being through Design Research

Revising the pre-print for final publication in the conference proceedings

Final publication conference proceedings expected

Program in a nutshell

Monday 22/8/22

Keynotes

Parallel sessions – 1st round

Parallel sessions – 2nd round

Erasmus MC tours

Tuesday 23/8/22

Keynotes

Parallel sessions – 3rd round

Parallel sessions – 4th round

Panel discussion & closure

Wednesday 24/8/22

tours

 

Day 1 (Monday August 22) Main conference

8.00-9.00 

Registration at TU Delft (East Suite)

9.00-10.30

Room A – 1st floor

Plenary session with opening ceremony – Chair – Clarine van Oel

  • Prof. Ir. Dirk van Gameren, dean of the Faculty of Architecture and the Built Environment at TU Delft
  • Drs. Floris Italianer, director Convergence Erasmus Universiteit Rotterdam, Erasmus University Medical Centre, TU Delft

and invited keynotes speakers:

  • prof. Marie Elf, professor in Nursing at Dalarna University and Högskolan Dalarna

Conceptualizing, planning, and implementing design solutions to support health and care processes warrant an evidence-based approach characterized by interdisciplinary collaboration. The built environment and its impact on health and care processes have recently attracted many researchers, which enables research syntheses. This talk will present the current evidence gap in healthcare architecture research and future perspectives, as well as emphasize the importance of the built environment for good and close care that extends to people’s homes.

Marie Elf is a Professor of Nursing at Dalarna University, Falun in Sweden. She is the leader of the research group Environment, Technology, and Participation. She has studied the relations between the built environment and health and wellbeing for over two decades.  

  • prof. Monique van Dijk, professor of Nursing Science at Erasmus MC

In 2018 we took into use a brand new hospital next to our outdated, old one. This newly built hospital incorporates many features of a healing environment.  These features should prove beneficial for both patients and hospital workers.

In our executive board-commissioned WELCOME study we evaluated how the new setting compared against the old one with regard to several topics. Topics included patients’ and nurses’ perceptions of the ward environments, the patients’ sleep quality, and patient-safety related topics such as falls, resuscitations and monitoring.

The findings will be presented during the presentation and will leave us with some interesting reflections. 

The 100% single-occupancy rooms in the general wards in the new hospital have their benefits but also some –partly unexpected– downsides. For example, nurses feel they cannot adequately monitor their patients, who also lack social control by fellow patients. Patients themselves may feel isolated and at the same time tend to stay in the room – with inactivity as an undesirable consequence. How to respond to these downsides is still being considered.  

With humans you never know entirely what to expect and how they respond to a new environment. Our new hospital was like a beautiful newborn with excellent genes (a matter of Nature) but was nurtured under the influence of the many occupants.    

Monique van Dijk is a former nurse and psychologist with a master’s degree in Methodology and Statistics. She defended her PhD thesis in 2001 on postoperative pain assessment in neonates and infants. She was appointed professor in Nursing Science in 2017 with the department of Internal Medicine, Erasmus MC, after having supervised nursing and medical research in the departments of Neonatal and Pediatric Intensive Care in the Erasmus MC-Sophia Children’s Hospital since 2001. In 2013  she was also appointed as Honorary Associate Professor at the University of Cape Town and collaborated in many studies in the burn, trauma and pediatric intensive care units. She has specialized in pain and sedation assessment in non-verbal and preverbal individuals. Other interests are non-pharmacological interventions, clinimetrics and essential nursing care. The last few years she also studied the effects of coaching for student nurses and evaluated the effects of the new Erasmus MC hospital with 100% single patient rooms.

 

10:30 – 11:00

coffee/tea break – East Suite

11:00 – 12:30

1st round parallel sessions

Berlage 1 Stream future-proofing – design resilience (1A) – chair: Clarine van Oel

11:00

Klara Geltmeyer

I am Klara Geltmeyer, 28 years old, from Ghent in Belgium. I am a registered nurse with a Master of Science in Nursing and Midwifery and a Postgraduate Degree in pediatrics and neonatology. Since 2018, I am working as a nurse at the Pediatric Intensive Care Unit at the University Hospital in Ghent (UZ Gent). In 2021, I got the possibility to combine this with a part-time job as a researcher for the nursing department of the UZ Gent, with the ultimate goal of obtaining a doctoral degree. My research interests are nursing care delivery models, nursing organization, ward design and hospital architecture. 

Background: 

In 2029, the Ghent university hospital aspires to start using a new hospital building for all nursing wards. However, it was unclear what the lay-out and size of these nursing wards should be. In order to determine the optimal ward design, several aspects should be taken into account, such as the future nursing care model, future evolutions and developments, legal and environmental boundaries, etc. 

Aim(s): 

The aim of this study was to identify how architecture can help the nursing department to stimulate the core qualities of a university hospital: care, research and education. 

Methods: 

A Five-Phased study was used to determine the ward design. Amongst others, an extensive literature review of 12226 papers about nursing models, the challenges for nursing and nursing architecture was conducted. Through an iterative process of expert consultation, focus groups and brainstorm sessions, different elements were combined in order to determine the guidelines for a new nursing ward. 

Results: 

The new nursing ward has 12 beds (per unit), with a partial radial structure. This lay-out was the most optimal choice in supporting the possible nursing care model of primary or modular nursing. Furthermore, this small, standardized type of unit also provides the possibility to scale up if needed, or change the care trajectories of patients in a fast and fluent matter (i.e. in case of pandemic). 

Discussion: 

There is no clear-cut answer on which design fits best for the nursing ward of the future. Each hospital should take into account their vision and strategic choices concerning nursing care in the design of a new hospital with the use of stakeholders. 

Implications and future perspectives: 

Before designing a nursing ward, main principles and care values need to be determined in order to facilitate decision-making. 

11:20

Anne Symons

Dr Anne Symons, Senior Research Fellow, the Bartlett School of Sustainable Construction, University College, London

I am a healthcare architect with over 40 years experience in the design and construction of acute hospital facilities in Scotland and England. Following the completion of my architectural degree I worked on several small healthcare projects before I was the project architect and supervising officer on a major district general hospital. This enabled me to complete the full 360 degrees of the project cycle from initial design through to completion and taking lessons learnt through to the next project.

At this point I undertook an MSc course in Construction Project Management, followed by an MSc in Planning Buildings for Health after which I worked as a Senior Design Manager for a major construction company involved in Private Finance Initiative Major Hospital Projects. I have led numerous clinical user group meetings during the early design stages, working closely with mechanical, electrical and structural engineers to deliver fully integrated projects and at the end of the project compliance checking to ensuring that the completed project has delivered the client’s expectations.

Having combined academic and work experience throughout my career to widen knowledge I finally returned to academia to complete my PhD related to Healthcare Design Management and continuing with research at UCL. This research has involved post occupancy evaluations, literature review of operating theatres, off-site manufacturing projects and the study of diagnostic hubs situated within the community rather than in hospitals.

The current COVID 19 pandemic has highlighted the need for flexibility in the provision of nursing care of extremely ill patients. A new proposition for a clinical adaptability suite of rooms is pre-sented which can be multi-functional to accommodate surgery, intensive care or isolation. 

A literature exploration of medical and nursing practice and requirements and a case study analy-sis are presented. We explore the physical changes to the built environment which have taken place during the pandemic and undertake an analysis of the environmental and infrastructure require-ments of a clinically adaptable room. Finally, we present the initial ideas for an innovative case study which considers how we design, manufacture and assemble advanced, versatile and multi-functional hospital settings. 

The resulting proposed clinically adaptable room reflects new models of clinical care. We explore the common denominators which show similar requirements in terms of medical equipment infra-structure, ventilation requirements and sterile conditions. A more sustainable alternative scenario shows the potential for reorganisation and alteration to existing facilities. 

11:40

Liesbeth van Heel

Liesbeth van Heel is a PhD candidate and guest researcher in both the department of Public Health at Erasmus MC and at the chair of Design and Construction Management within the Faculty of Architecture and the Built Environment at TU Delft. After years of working as an university hospital real estate professional, leading a small expertise team (PMO), her focus shifted to the coordinating effort to align the various strategic programs within Erasmus MC toward a safe relocation to the new hospital building, with fitting work processes, logistics and IT-support. This transition took place in May 2018. Her special attention has been patient’s needs, stakeholder engagement and creating a “healing environment”, using (inter)nationally acquired evidence and experience based design knowledge. She propagate knowledge sharing and network building for ‘informed clients’ in the Netherlands and beyond, and is a Board Member of the European Health Property Network. She co-coordinates the scientific Program Evaluation of our New Erasmus MC, which focusses on infection prevention, experience with wards with 100% single rooms and balance between bricks, bytes and behaviour in integrated health infrastructure project delivery. She chairs the Organizing Committee of the 5th ARCH-conference: enabling health, care and well-being through design research.

The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as increasing their ICU-capacity and enabling physical-distancing measures to prevent infectious spread. They also needed to co-house (suspected) COVID patients and non-COVID patients with different requirements enforced separate entrances and routes to keep staff and patients safe. It is suspected that even in a fully vaccinated world other pandem-ics are waiting in the wings. In a design brief, flexibility is typically mentioned as an important target, and single occupancy in-patient accommodation may be considered as a way to enhance flexibility. To gain insight in and to inform future hospital design, this study evaluated what oper-ational coping strategies and design solutions were considered important enablers to increase ICU capacity and to support different patient flows and what design solutions enabled physical distancing. We have collected data from 30 Dutch hospital organizations, including from some recently opened hospitals, with 100% single occupancy in-patient accommodation. Using a practice-based approach, in-depth interviewing was combined with document and multimedia analyses to analyze and compare successful operational strategies and design elements that helped provide the flexibility needed in this recent crisis. As we looked at existing facilities and alterations made to allow hospitals to operate in ‘crisis mode’ during the COVID-19 pandemic, we present emerging design considerations for future healthcare facilities that, preferable, can also be implemented in renovations of refurbishments. We add the perspective of staff as a limiting factor to a hospital’s pandemic preparedness. 
Keywords: pandemic resilience, flexibility, robustness, adaptability, hospital design 

 

12:00

AnneMarie Eijkelenboom

dr.ir. Annemarie Eijkelenboom (1971) – Architect (EDAC) / Head of R&D EGM architects

TU Delft Civil Engineering

The built environment has a significant impact on well-being and health. This is made clear by means of scientific research in the field of Evidence Based Design. As a project architect, I make use of the results of this scientific research; in addition I work on research projects. Precisely the link between theory and practice leads to the design of even better buildings. And this is what drives me: realizing a high spatial quality with a positive effect.

Inspired by the vision of an academic hospital, striving for excellent care with and for the patient, design interventions were developed on different scale levels. Further understanding of how to prevent, treat and cure diseases was one of the starting points during the design phase. Therefore, the design was developed in strong collaboration between the hospital, architect, and other stakeholders. A few design interventions are presented to discuss how the physical environment can support excellent patient care. 

The existing structure comprises of an indoor logistic corridor from 1.200 m, which connects several buildings, surrounded by a park. Through restructuring the landscape, and application of green roofs and gardens for therapy, wayfinding and spatial quality will be improved. The connection of outside and inside is more clearly defined through the construction of a new atrium, that strengthens the structure of the existing education building, which was transformed into an Experience Center. 

As some buildings did not meet the current standards anymore, a new, compact main building was designed. This resulted in decreased length of the main logistic connection to 200 m. The building has a flexible, generic structure that houses several functions, such as a main entrance, outpatient, and inpatient areas. Specific places, such as steppingstones and hubs enable informal care takers to help patients, exchange information with experts, and stimulate the patients’ autonomy. Based on research, VR tests and mock-ups, a standard inpatient room was developed with flexible positions of the bed and room for exercise inside and outside bed. 

Room D Stream user-needs – design of therapeutic spaces (2A) – chair: Ira Verma

11:00

Martina Di Pisco

Martina Di Prisco is an Architect and PhD Student in Architectural and Urban Composition at the Department of Civil-Environmental Engineering and Architecture of the University of Trieste (Italy). While she was graduating, she developed a strong interest in spaces where people affected by Alzheimer’s disease can feel at ease and find responses to their needs. Her studies were based on what can be done to create environments which improve daily life and how to restore the identity of the ones who need to live in a community. After completing her Master’s thesis (2017) she works as an interior and graphic designer and she specializes in the design of museum spaces. She continues with the PhD research on exhibition spaces dedicated to the narrative of mental health, investigating the relationship between architecture and mental health. During this period, she participated in conferences as the author of several publications and collaborated with the SensHome Project (funded by the European Community) which aims to guarantee autonomy to adults with autism in their own homes.

Numerous debates have emerged on the role of architecture in physical and mental health, especially in the wake of the pandemic emergency. It became clear that the design and planning of our homes and cities influenced dealing with the emergency at an individual and collective level, facing the limits of the physical and social body and of their way of life. The physical body was forced to acquire a new spatial dimension, new proxemics, emphasizing the difficulties of adaptation for those who every day, beyond the pandemic, have to deal with a different perception of the environment surrounding them. This invites us to reflect on the importance of rethinking public spaces as a process of inclusion both for people with an atypical sensitivity and as a form of empathic openness to meeting others. The paper illustrates some theories and design examples, taken from a PhD research study in progress, in which this double empathy can manifest itself. Specifically, the waiting rooms of some therapeutic facilities for people with cognitive disabilities (and mental disorders) are identified. The aim is to lead to a reflection on how we could imagine new forms of proximity and redistribution of care services, that would guarantee different degrees of integration according to individual needs: possible meeting points between therapy and society, learning to consider deficiencies, as they are often understood, as mere differences and manifestations of alterity. 

Keywords: Architecture and mental health; threshold spaces; empathy; waiting area; therapeutic design 

11:20

Eleni Tsiantou

Eleni Tsiantou is an ARB qualified architect that specialises in healthcare facilities. She is currently a Strategy Project Officer and CAD Technician at the Facilities & Estates Department of the Midlands Partnership NHS Foundation Trust in the UK. Eleni completed her Diploma of Architectural Engineering at Democritus University of Thrace (D.U.Th) in Greece with distinction and received an honourable mention for the best thesis project by Gradreview architects and designers. She holds an MSc in Healthcare Facilities from the Bartlett School of Construction and Project Management of University College London (UCL). During her MSc degree which she completed with distinction, she received the Ann Noble research award for her thesis proposal coordinated by the Noble family and Architects for Health (AfH). She has working experience as an architect in Greece and has been involved in inclusive design projects as well as research assistant experience in UCL being part of multidisciplinary teams in healthcare-related research projects. Her research interests include healthcare facilities, evidence-based design, environmental psychology, flexibility and sustainability in healthcare settings.

Purpose: The purpose of the study is to identify if the design of the non-clinical spaces of hospitals, particularly the waiting areas, is considered equally important in the healing process as the clinical areas by regulators. Background: Many countries provide architects and designers of healthcare facilities with guidelines which intend to support the design and planning process as well as to give examples of best practices. The waiting area is an indispensable part of the healthcare experience, who often creates negative feelings as a response to stress. There are plenty of studies proving that specific design elements have a positive effect on patients, alleviating their stress and increasing their wellbeing. Methods: An analysis and juxtaposition of three countries’ guidelines namely the UK; Health Building Note 00-01 General design guidance for healthcare buildings, USA; guidelines for design and construction of hospital and healthcare facilities and Australia: Australasian Health Facility Guidelines under the scope of specific evidence-based design features used as a method to demonstrate the consideration given to the design of waiting spaces. Results: There is a range of information offered through the different guidelines, with the UK being the most inclusive, Australia being limited to functional requirements and the USA ignoring the waiting spaces design in the guidelines of healthcare facilities. Conclusions: Guidelines are based on the functionality of waiting areas and do not introduce enough therapeutic features. Actions to improve them could be beneficial for architects during the design process and consequently for waiting areas’ environment and patients’ wellbeing. 

11:40

Yifat Rom

The increasing number of older adults and the ones needing 24-hour assistance and hence liv-ing in long-term care facilities (LTCFs) has led to the development of well-being models that acknowledge the environment as an important factor the influences well-being. Acknowledging this importance, numerous studies on the effects of the environment in LTCFs on well-being among older residents have enriched the knowledge on environmental variables affecting well-being. These studies have yielded conflicting results on topics such as the recommended hallway shape and optimal nursing-station position. Moreover, complying environmental as-sessment tools that rely on different amounts and combinations of the researched variables were formed. Most of these tools assess the variables in a dichotomous manner (either the var-iable is present or not); thus, the significance and weight of each variable are overlooked. A need for an additional quantitative measurement tool led to the development of the Psy-cho-Social Evaluation Tool (PSET) (Rom et al., 2022), which measures the effect of the units’ physical layout on well-being. By analyzing architectural plans from 40 long-term care units with the PSET, the current study demonstrates how the effect of physical layout on well-being is re-lated to various variables in different domains. To demonstrate this, this paper focuses on con-flicting recommendations regarding hallway shape, which affects the overall unit layout during the design process. We argue that all physical layout variables related to well-being should be measured during the design process and viewed as a part of the bank of resources since one variable (like hallway shape) is not sufficient to predict how LTCF units support residents’ well-being.

12:00

Malavika Nair

A recent Bachelor of Architecture graduate from KMEA College of Architecture, Kochi, Kerala, India. I am fascinated by the world of architecture and want to constantly build my ability to understand the story of brick and mortar. With a penchant for writing and research and a passion for perpetual learning, I believe that architecture holds the answers to many of the questions plaguing the world today. I hope to build a career in understanding and improving the interaction between health, climate, culture, equity and society with architecture. My research paper, ‘Translation of Therapeutic Architecture as a Guideline for Residential Design’ is my first step towards doing my bit in bringing the wonders of healing architecture to the public. Its aim is to make opportunities for a healthy lifestyle more accessible to everyone and make designing for health a part of everyday design discourse.

Therapeutic architecture creates evidence-based healing environments, which is predominantly used in healthcare spatial design at present. But the worsening mental health scenario of the world highlights the need for this branch to extend beyond the medical field. The onset of COVID-19 further amplifies the need of residential spaces to be conducive of a healthier lifestyle. The research addresses this need by designing strategies for translating the principles of therapeutic architecture to residential spatial design, to thereby fit the user requirements of residents instead of patients. Literature review and case study methods are used to understand the theories and models of therapeutic architecture, its current applications, and the impact of its design elements on human psychology and physiology. The analysis of the theories is used to build an evaluation tool, which is used to analyze the spatial design of the literature case studies, as well as the survey answers. Survey of psychiatrists and psychologists give first-hand information of healthcare spatial design for healing patients. Survey of 100 individuals gives insight into their mental health and design of their current residential spaces. The results of these surveys are analyzed according to the evaluation tool to compare the spatial design of healthcare centers to those of residential spaces, and how they promote or deter better health. Findings from these are evaluated in this research to generate new guidelines for appropriately integrating therapeutic architecture to residential spaces, to positively reinforce the health of its residents and expose them to spaces that support their well-being. 

Room A Stream engagement – user-experience and co-design (3A) – chair: Göran Lindahl

11:00

Iris Beuls

Iris Beuls is a PhD candidate in Architecture at the Faculty of Architecture and Arts of Hasselt University (Belgium). Her research focuses on designing human-centred palliative environments by exploring the relationship between the physical character of palliative environments and its various users’ experiences and multiple dimensions of wellbeing (i.e., physical, emotional, spiritual, social).

The physical character of a palliative environment can (when well-designed) positively impact the wellbeing and experiences of its various users (residents, family, caregivers, and volunteers). However, it seems difficult for architects to translate quite abstract and subjective multi-user perspectives into more specific applicable design solutions, which is why the impact of palliative research in architectural practice seems little so far. To contribute to closing the loop between architects’ design intent and actual users’ experiences, conducting qualitative interviews with users of palliative environments seems a plausible approach to understand how they experience these environments. However, this concerns several ethical and practical challenges regarding the participants, the context, and the topic of this research. Hence, tension seems present between collecting more applicable architectural richer experiences and ensuring that this research does not unnecessarily burden participants. Therefore, this paper will focus on (1) how we can contribute to the participant-researcher dialogue in order to elicit more architecturally rich (subjective) experiences from various users of palliative environments, and (2) how we can adopt a human-centred approach when designing and conducting interviews of various users with(in) a palliative environment. For this purpose, a pilot study with three participants of a small-scaled palliative environment in Belgium was carried out to explore the potential and approach of photo-elicitation interviews. This paper reports on the pilot study and highlights methodological strengths and challenges from the lens of an architect-researcher with a strong focus on human-centredness. In this way, we hope to contribute to (re)designing more human-centred palliative environments. 

11:20

René Sorensen Overby

This paper seeks to identify how users and architects through collaborations are generating knowledge on Universal Design (UD). Besides the need for architects to build a solid foundation of architectural knowledge, insight in users’ life practices is essential in UD knowledge creation. Users’ experience and perception of space offers a qualitative alternative to quantitative notions of space. Through thirty-two interviews, the paper contributes with a qualitative perspective on collaborative practice between users and architects. An unfolding of knowledge creation shows that accessibility as quantifiable measurements, seems to have taken root in collaborative prac-tice, while knowledge on UD is still sprouting. The research also shows that interpretations of ac-cessibility, as compensating solutions for a few, has an impact on both collaborations, knowledge creation, and architecture. Hence, increasing awareness of greater collective responsibility of in-clusion and movement towards concepts such as UD and Inclusive Architecture, challenges ar-chitectural practices when expected to align with societal movements. If human diversity and architectural practice are to meet in UD ideals, advanced user-based knowledge, and awareness of social aspects of architecture, in line with legislation and technical insight, is suggested. In creation of space that are inclusive, and which increase possibilities for more, architects must seek nuanced knowledge of users and insight associated with their daily practice. The research point to, how UD knowledge, is created and put into action is crucial, to whether architectural design processes can respond to societal ambitions and international conventions.

11:40

Grant Mills

Professor of Healthcare Infrastructure Delivery and Bartlett Faculty Lead for Health at UCL. He researches advanced healthcare infrastructure delivery models, interdisciplinary design and project management. He has been investigator on EPSRC, ESRC, NIHR and IUK research and directly funded by the Department of Health, European Investment Bank and World Health Organisation. Recent research has investigated augmented reality for hospitals delivery, flat-pack modular operating theatre configuration, healthcare infrastructure capital investment and advanced data analytics in AEC production control.

The interdisciplinary evidence to support healthcare building is insufficient. New innovation processes are needed that enable clinical, research evidence and practice-based design teams to apply research-informed and evidence based design. This article aims to challenge the basis for prioritizing the reconfiguration of eyecare to respond to patient backlog and develop an innovative di-agnostics hub. Ophthalmology, the busiest NHS outpatient specialty (7.9 million episodes; 2018-19), is perfectly suited to providing a testbed for rapid, research-driven innovation and to show how research in the built environment can better inform clinical and technological advancement. A clinically-led case study is described which reports the approach taken to bring together the de-sign, engineering and modelling expertise of multiple experts in the built environment. Various disciplines contributed to three clinical trials which saw three unique building configurations, which involved 3,000 patients across three iterations of the building layout design. Circa ~ 30 staff were involved in the interdisciplinary co-design process to encourage an innovative approach to equipment configuration, layout design and an emerging scientific evidence-base. There is a significant need to address the methodological, interdisciplinary and theoretical implications of evidence-informed healthcare building. We offer up a conceptualization of an evidence-based co-production process that optimized safety, efficiency of patient movement and staff satisfaction through iterative dialogues.

12:00

Herwin Horemans

Dr. Herwin Horemans is a movement scientist and affiliated with the Rijndam Rehabilitation Gait Lab and the Department of Rehabilitation Medicine at Erasmus MC University Medical Centre Rotterdam. His scientific interest focuses on making objective data about gait accessible to clinicians. In this project, Herwin contributed to the conception of the work, the acquisition of data, the interpretation of data, and drafting and revising the manuscript. He will be presenting the paper.

For most patients with an incomplete spinal cord injury, gait rehabilitation plays a key role in functional recovery. However, few methods are available to reliably assess gait function during rehabilitation. Therefore, a study was initiated to develop a gait assessment interface that is user-friendly, time-efficient, and based on objective data and intuitive data visualizations helps physicians and physiotherapists select and evaluate interventions for patients. The paper focuses on the first phase of the design process, user research, and how user-centered design was used to identify users’ needs and expectations, and the context wherein the gait assessment interface would be used. This was done through conducting focus group sessions with professional users (physicians and physiotherapists) and using interactive activity boards to obtain answers and facilitate discussion. The information obtained, as well as user-centered design practices, will be used throughout the further development of the gait assessment interface. 

Room R Stream inclusive design/health promotion – outdoor health promotion (4A1 + 4D) – chair: Elke Miedema

11:00

Madeleine Liljegren

Madeleine Liljegren is a registered physiotherapist, specialist in elderly health, have a master degree in landscape architecture and is a PhD student at University of Gothenburg (research group: Care environment) and Chalmers University of Technology (Center for Healthcare Architecture).

The present research project focus on health and building design parameters for the development of outdoor environments at residential care facilities (RCF) for older adults. An objective of the project is to develop an evidence-based guideline and method för design, planning and evaluation. The starting point for the project is that outdoor environments at RCF often are difficult to reach from the indoor environment and not adapted for outdoor rehabilitation and outdoor stays. Most often, rehabilitation activities for older persons at RCF are performed indoors and older persons at RCF do not have the legal right to daily outdoor stays. Pending a development of outdoor rehabilitation as well as changes in the regulations regarding access to daily outdoor stays, it is important to examine health promoting qualities in the outdoor environment. It is also important to focus on the older adult’s possibilities to move between indoor and outdoor environments to reduce the risk of feeling locked in. The present paper describes and discusses a mixed method approach that builds up the five sub-studies in the project. 

11:20

Margo Annemans

Margo Annemans, trained as an engineer-architect and anthropologist, is an FWO fellow and postdoctoral researcher at the Research[x]Design (RxD) group at KU Leuven and a lecturer at the Faculty of Design Sciences at the University of Antwerp.

Her current research focuses on how space can contribute to activating end-users in healthcare environments. Therefore, she combines insights and approaches from multiple disciplines like architecture, anthropology, nursing, and movement science. Margo is also interested in how designers, clients, and other actors in care contexts can gain insight into people’s experience. In this respect, she repeatedly engages in short term projects with architecture and healthcare organisations.

Margo teaches bachelor courses on qualitative research methods for designers and co-guides a master studio on healing, working, teaching, and collective environments in the interior architecture program.

From 2010-2015 Margo conducted a PhD on how patients experience hospital buildings and how this experience can inform architectural practice. Before and during her PhD, funded by a Baekeland grant of Flanders Innovation and Technology (VLAIO), she worked at osar architects nv, an architecture company focusing on (health)care.

For her PhD research Margo was awarded the ‘L(euven) da Vinci Prize’, a prize for a junior researcher who made a valuable contribution to the implementation or future development of knowledge transfer strategies by means of research, research management or research support activities. She received this prize for the fact that her PhD research on the spatial experience of hospitals patients laid the foundations for several follow-up projects in RxD, attracted significant interest from architecture and nursing practice, and shows considerable potential for further knowledge transfer.

People in rehabilitation have been found to be motivated to be physically active by accessible and attractive outdoor environments, both vicinity of healthcare facilities and in the larger neighbor-hood. Nevertheless, even when available, outside space is not always optimally used. We aim to gain insight into how the outdoor environment of a rehabilitation center, on and beyond its premises, hampers or supports patients to be physically active. We conducted a qualitative ethnographic study informed by quantitative physical activity data. Semi-structured and walking interviews with 16 patients from one rehabilitation center were supported by output from activity trackers. Two focus-group interviews with four nurses and a physio- and an ergo-therapist provided extra perspectives. All data were inductively analyzed guided by a grounded-theory based approach. An analysis of sensory information, affordances and meaning making showed a wide variety in the roles the outdoor environment plays in patients’ physical activity, both inside and outside the building, ranging from patients travelling to near villages to others staying inside all day but en-joying the view when walking to the end of the hallway. Concrete destinations motivate patients to go outside and be physically active, but also smaller interventions like avoiding even the smallest physical boundaries, facilitating visual control, and providing psychological support have a positive impact. If a rehabilitation center is to encourage physical activity amongst patients, inside and outside, it is important that inside and outside spaces are connected physically, visually, and psychologically. 

11:40

Fatemeh Amirbeiki Tafti

I am Fatemeh Amirbeiki, a Ph.D. candidate in the department of social and healthcare buildings, in TU Dresden. In 2015, I graduated with a Master of Architecture from Yazd University, Iran. Currently, I am conducting my Ph.D. project entitled “Restorative environment: psycho-physiological health benefits of exposure to natural blue elements (sky and water) in windowless areas of healthcare facilities” under the supervision of Prof. Dr. Gesine Marquardt. I am focusing on the research area related to restorative healthcare environments associated with nature, specifically natural blue elements. Referring to my background, Iran, I have found the influential role of sky and water in Iranian traditional architecture and I am trying to translate these effective interactions into current healthcare facilities. The outcomes of my Ph.D. project intend to increase the awareness regarding blue elements’ role specifically water among architects and the decision makers in healthcare facilities.

(1)Objectives: This paper explores architects’ opinions on the implementation of natural blue elements (sky and water) in windowless areas of healthcare facilities specifically computerized tomography (CT) scan environments (2)Background: Com-pared to green elements, there exists little evidence about the beneficial aspects of exposure to blue elements in healthcare facilities. (3)Methods: Participants were architects involved in designing healthcare settings and an online photo questionnaire was distributed among them: 25 responses were analyzed. It was followed by 6 semi-structured interviews. All participants evaluated the restorative qualities of 1)Sky panel on the ceiling of CT room, 2)Water pool adjacent to the wall between CT and control room, 3)Sky panel on the wall in front of the door to the CT room, 4)Water pool behind the glass wall in CT room, 5)Sky panel on the ceiling of changing room, 6)Sky panel on the wall of changing room.(4)Results: According to architects’ opinion, exposure to the sky panel on the ceiling of CT room and exposure to water pool behind the glass wall in CT room might create a more restorative environment. Furthermore, architects regarded implementing interventions such as adding movement to the content of blue elements, considering specific architectural layouts, considering specific size of sky panel and adding water wall are capable to increase the positive influences of blue elements on reducing patients’ stress. (5)Conclusions: The findings aim to increase the awareness regarding blue elements’ role specifically water among architects as a group who design environments that cater to the patients’ needs.  

12:00

Sofia Sudermann

Sofia Sudermann is a research assistant for urban health at the Chair and Institute of Urban Design at RWTH Aachen University. She holds a BSc degree (2019) and an MSc degree (2022), both in architecture at RWTH Aachen University. Her research interest focus on health (promotion) and the interference of people in the built and natural environment and vice versa. Her approach is to develop insights into the role of urban design in human and planetary health.

During her master’s studies, Sofia has focused on healing architecture research and the role of evidence-based design in healthcare settings, and effects of the COVID-19 pandemic on the German health system and restructuring opportunities of the German hospital landscape. Her master’s thesis on “Healthy City Assessments“ was written with support from IDEA League research grant between RWTH Aachen University and Chalmers University of Technology.

The built environment influences health. The Healthy Cities Movement focuses on creating healthier and more sustainable cities, including healthy urban design. This focus on health is essential in an age of climate change, urban density, and inequality where planners, developers, and communities have the responsibility to design healthy places for all. There are multiple assessment tools for healthy and sustainable cities and buildings design. However, it is unclear which health perspectives are incorporated or overlooked in these tools. This paper aims to (1) map existing assessment tools relating to urban design and health, (2) examine which health-related outcomes are incorporated, to (3) propose criteria for an assessment tool for healthy cities. The methods include a questionnaire, three semi-structured interviews with experts on healthy urban design, and analysis of recent assessment tools. The results include conceptualization of healthy design criteria. The identified criteria additionally show issues for action in urban development regarding sustainable, healthy cities. The outcome can be considered an approach to develop tools for healthier cities. Assessment tools that include holistic perspectives on health may be able to reflect upon urban health and contribute to healthy communities. 

Keywords: healthy city; health-driven design; assessment tool; resilience; urban planning 

12:30 – 13:30

Lunch break – East Suite

13:30 – 15:00

2nd  round parallel sessions

Berlage 1 Stream future-proofing – healthcare infrastructure (1D) – chair: Grant Mills

13:30

Nirit Pilosof

Telemedicine for inpatient psychiatric care: remote care in a COVID-19 Mental Health Unit

Dr. Nirit Putievsky Pilosof is an associate of Cambridge Judge Business School (CJBS) and a fellow of Cambridge Digital Innovation (CDI) at the University of Cambridge, UK, studying the Smart Hospital of the Future in collaboration with the ARC Innovation Center at Sheba Medical Center in Israel. Nirit is an architect and innovation consultant working with healthcare organizations and a lecturer at the Coller School of Management at the Tel Aviv University, teaching healthcare design in the MBA in Health Systems Management program. Nirit holds a PhD from the Technion – Israel Institute of Technology, a Post-Professional M.Arch from McGill University, and an EDAC from the Center for Health Design in the US. Nirit gained experience in design process of major hospital facilities as a project manager at leading architecture firms in Israel and Canada and won international awards, including the prestige’s AIA Academy of Architects for Health award, the American Hospital Association (AHA) graduate fellowship, and the Azrieli Foundation fellowship.

 

The study examines the implementation of a new model of remote care by telemedicine technologies at a COVID-19 acute psychiatric unit. Remote care by telemedicine technologies accelerated during the COVID-19 crisis, not only for outpatient care but also for hospital inpatient care. To enhance the safety of the staff in the COVID-19 units, conserve PPE, and provide a method for communication with experts and families, hospitals developed a new model of in-patient telemedicine. The model was implemented in an acute psychiatric unit for COVID-19 patients in Israel with a control room and audio-video system to remotely supervise, communicate, and treat the patients in the contaminated unit. The study is based on semi-structured interviews of medical staff, architects and digital technology directors and observations in the COVID-19 unit in June – December 2020. The study illustrates the impact of the built environment on the implementation of telemedicine technologies for inpatient care. It demonstrates limitations caused by the location of the audio-video system to avoid vandalism and the complexity of the system due to the dynamic movement of patients in the unit. The results indicate the system’s dependency on the collaboration of patients and the need for coordination between caregivers. While inpatient telemedicine holds potential to enhance the quality of care and safety of patients and staff in COVID-19 units, its implementation in acute psychiatric units requires further development in the integration of digital technologies with the design of the built environment to address unique challenges of mental health.

13:48

Priya Boby

PhD Scholar at School of Planning and Architecture-New Delhi, LEED AP BD+C, M.Arch (UK)

Mrs Priya Rachel Boby is a PhD scholar at the School of Planning and Architecture, New Delhi. Her journey began in Zambia, where the issues of air pollution and environmental degradation perked her interest in sustainable building leading her to a career in Architecture. She was a part of the design of the UNICEF clinics in Zambia, where she noticed that health promotion was given less priority. To gain international exposure, she pursued her Master of Architecture from Northumbria University in the UK. After that, her thirst for knowledge led her to attain the LEED AP BD+C accreditation.

She took every opportunity to research throughout her practice at Aeiforia Architects and Hirsch Bedner Associates. Also, she was a guest lecturer at SRM University in Chennai and conducted webinars for events such as World Habitat Day. Her interest in health-promoting design led her to pursue PhD in the “Pandemic Resilient Hospitals” from the top institution for Architects in India; the School of Planning and Architecture. During her course, she has helped organize conferences and continues to publish to contribute to the knowledge base. She aims to provide health and well-being through architecture.

The emergence of the COVID-19 virus has forced humanity to rethink the design of hospitals and prepare for probable future outbreaks. Even before the pandemic, there was a causal link between the design of hospitals and the spread of nosocomial infections. Also, previous studies have revealed correlations between climate change and the increased rate of the spread of infectious diseases. Hence, this review created a framework of strategies for pandemic resilient and sustainable hospitals while emphasising the role of architects in health promotion. The study conducted a qualitative content analysis of existing studies on the design of healthcare facilities post-pandemic to build the framework of strategies. The research was organised into short-, medium- and long-term measures for pandemic resilient design. The study has demonstrated that the framework for the space planning, ventilation and material specification of hospitals must be revised for pandemic resilient hospitals. The findings reveal that most of the design strategies that can control the spread of infection in a healthcare facility could also be a panacea for decreasing the carbon footprint of the hospitals. Nonetheless, the paper has established the need for further interdisciplinary study on design strategies for impending pandemics and applicable to all building typologies.

14:06

Emma Smyth

Introduction At the height of the Covid-19 pandemic, healthcare Trusts were stretched to capacity, utilising existing Intensive Care Units (ICU) and general wards to treat severely ill patients in respiratory distress. Current design guidance and healthcare infrastructure has had to accommodate these new needs, with little flexibility within the current system to cope. However, the facilities and clinical teams have confronted this challenge, doing a crucial job brilliantly whilst in difficult circumstances. Objectives The pandemic has raised three issues; why are ICU facilities inflexible, a major problem pre-pandemic but compounded by the last 18 months? How can medical advancements still be achieved while addressing the backlog of patient referrals and outpatient procedures? Finally, how fit-for-purpose is our current design guidance legislation? Concentrating on the ICU model, we will question how flexible it can be to meet future patient requirements, including personalised medicine, while maintaining effective isolation within intensive care. Methodology Current ICU designs will be evaluated, and hypothetical clinical models for care will be developed for testing and investigation. These are later analysed for suitability, effectiveness and versatility, at clinical and patient level. All findings will inform recommendations for changes to design guidance. Conclusion This paper seeks to examine what can be achieved while working outside the constraints of the current clinical model and design guidance. With flexibility at its core, can the current ICU clinical design be updated to allow for the needs of current and future requirements?

14:24

Maryam Siddiqui

Health and well-being have a very direct relationship. The purpose of this research is to understand the impact of design of the healthcare facility to the recovery of those inside it. The most apparent differences between healthcare facilities built with human-centric approaches and those built with a broader or more ‘number-centric’ approach, is found when the exemplar facilities being compared, belong to different eras. For this research, the first facility chosen is one built during war- a promptly designed and promptly set-up hospital where patients were mostly nameless, faceless soldiers considered most important for numbers in the army- and the second, a hospital of the twenty-first century, one built involving residents, psychology, nature and aesthetics. This research compares the buildings on various architectural as well as general factors, including ideology, humanity of approach, design, materials, construction techniques, context and setting, aesthetics, socio-cultural parameters, morals and overall medical treatment merits. It concludes with an analysis of the similarities and differences of the two approaches, the changing requirements of a post-pandemic world, and what the latest definition of “future-ready” means for healthcare infrastructure.

14:42

Gunther de Graeve

A new approach to health system planning has been developed for the Australian Health System and piloted for Queensland Health. The pilot project has demonstrated exciting results achieving a sustainable, adaptable and integrated health system. It now forms part of a new strategic plan for health services across the State. Sustainability of the health system has been a topic of increasing awareness and focus for many years. Where previous studies have fallen short of quantifying actual outcomes, this planning study has articulated the new health system. A more sustainable system due to reduced capital and recurrent cost, more integrated with the community and more accessible for patients. Enabled by an advanced digital health network which supports virtual care and navigation, this jurisdiction can realise a reduction of 30% demand on their acute hospitals over the next decade. New, more appropriate care typologies were developed to suit the defined health need. These were positioned in the right location to improve access and experience. Adaptability was a key focus for facility design to respond to a community health profile changing over time. Keeping the patient need at the centre of the planning and design process is at the heart of creating a truly integrated, sustainable health system.

Room D Stream user-needs – stroke & dementia (2B + 2C) – chair: Maja Kevdzija

13:30

Stefanie Lange

Occupancy data for administrative workplaces in hospitals are scarce so far but are needed as a basis for planning. A secondary analysis from four space utilization studies shows that…

  • … workplace utilization in hospitals is low. Medical staff spend a large part of the working day away from their backstage desks.

  • … occupancy rate is lower than in administrative offices and activities differ from offices to hospitals.

  • Results suggests significant space efficiency improvement potentials.

13:48

Leonie van Buuren

Leonie van Buuren PDEng MSc is a researcher at the chair of Smart Architectural Technologies at the University of Technology Eindhoven. Her research focuses on housing typologies for seniors (with dementia). Currently, Leonie works on her PhD study and two research projects. In her PhD study, Leonie investigates the effects of architecture on seniors with severe stages of dementia while wayfinding in nursing homes. In the research project ‘Healthy Smart Neighborhood’, she is studying how social interaction could be established in the first enabling senior citizen neighborhood in the Netherlands (Slimme Wijk Waalre). In the other research project ‘It takes a village to grow old’, she studies how an interactive art object could encourage public familiarity among seniors with early stages of dementia in a neighborhood in Amsterdam.

This research aims to provide design (process) requirements based upon insights into the relationship between the spatial layout and the daily movement behavior of seniors with dementia in the common living room of a nursing home. Currently, 28% of seniors with dementia in the Netherlands live in a nursing home and spend most of their time in the common living room. To design a user-centered living room, knowledge about the behavior during the day of this special target group is necessary. A spatial analysis combined with fly-on-the-wall observation and per-son-centered behavioral mapping has been performed in two living rooms with a varying num-ber of residents in one care organization in the Netherlands. The behavioral (movement) pat-terns of twenty-one residents with severe dementia (n=21) have been observed. Although the same features were present in the living rooms, the rooms were shaped differently. Some places in the living room were unused during the observation, while other spaces were used frequently. Results show that the same types of movements (e.g. none, direct, or wandering) occurred in both living rooms during similar periods. This study detected three diverse move-ment behaviors, predominantly bound to time. As design (process) requirements for the living room, behavioral patterns (e.g., scheduled activities) during the day and night should be con-sidered. Furthermore, the expected dominant walking patterns (based upon the entrances and zoning areas of the living room) should be determined during the design process. These barri-er-free paths should enable different means of movement (e.g., wheelchair, walker).

14:06

Silvia Mangili

I am an architect, and I received my master’s degree in architecture in 2019 from the Polytechnic University of Milan, where I also attended a Master’s degree in Planning Programming, and Design of Health and Social Care Systems in 2020.

My research on Alzheimer’s disease began in 2019 with my master’s thesis, in which I created a checklist to analyze whether nursing homes are suitable for people with dementia.

Since November 2020, I have been a Ph.D. student at the Polytechnic University of Milan, Department of Architecture, Built environment, and Construction engineering. I am also collaborating with the department’s Design and Health Lab, directed by Prof. Stefano Capolongo, where I am involved in preliminary design, feasibility studies, and research in the healthcare and socio-sanitary built environment. With my doctoral thesis, I am still working on the topic of the relationship between the built environment and dementia by analyzing what will be the future of healthcare facilities for the elderly considering advances in medicine and technology that can anticipate adverse outcomes and prevent disease progression. The goal of my work will be to understand how the environment of long-term care facilities can impact the well-being and health of patients living in those facilities.

Background: The relationship between Built Environment and Dementia is nowadays a fundamental theme to investigate in the healthcare field because the elderly population is growing worldwide. Epidemiological data show that Alzheimer’s disease incidence is forecast to increase rapidly. Furthermore, the health and socio-sanitary structures for elderly patients represent a fundamental social infrastructure that collects significant investments but must be suitable to host people with dementia. This paper aims to describe the application of a tool able to evaluate architectural design features in facilities for patients with Dementia.

Methodology: The evaluation framework is based on a Systematic Literature Review on the relationship between the built environment and patients with dementia, different case studies, and existing evaluation tools analysis. The tool comprises four criteria (Quality, Spaces, Activities, and Wayfinding), 19 indicators, and 71 variables validated by recognized experts in the geriatric, psychiatry, and architecture field. The tool has been applied to five facilities, all accredited to the Italian National Health System and located in Lombardy that differ in period of construction and type.

Results: The maximum score is 100%, and results lower than 60% are considered inadequate, between 60 and 80% are sufficient, and more than 80 excellent. The results of the evaluation tool show that two are inadequate (47 and 54% of compliance), two sufficient (65 and 75%), and one excellent (92%). The newest building was evaluated as “excellent”, while the structure with the lowest score was created by reusing existing structures. Future applications are needed to make the results more scalable.

14:24

Maja Kevdzija

Dr.-Ing. Maja Kevdzija, EDAC is an Assistant Professor in Healthcare Design at the Faculty of Architecture and Planning at TU Wien, Austria. Her interest in rehabilitation environments developed during her Master Studies in Architecture at TU Delft. She continued research in this field and obtained her PhD at the Faculty of Architecture at Technische Universität Dresden, Germany. Her research study on mobility-supporting rehabilitation clinics for stroke patients was awarded several national and international awards, most notably the Healthcare Environment Award 2020 (USA), the 2021 European Healthcare Design Award in the Design Research category (UK) and the 2021 EDRA Certificate of Research Excellence (CORE) with Merit Status (USA). Her research work focuses on improving built environments for recovery after a stroke.

The purpose of this research is to provide insight into the various ways stroke patients use and interact with the built environment during their inpatient stay in rehabilitation clinics. Re-habilitation clinics are multi-story buildings where stroke patients live for weeks or months to re-ceive intensive individualised therapies. Regardless of their impairments and abilities, patients are commonly accommodated in the same ward types with shared therapy rooms. They are generally inactive during rehabilitation, and the built environment’s impact on patient experience and recov-ery is still unclear. Five stroke patients (LOS on the observation day ranging from 7 to 128 days) were shadowed for one whole day, each in a different clinic. They were all wheelchair users in the same rehabilitation phase. Patients’ movements in the clinic, their comments, the spaces they vis-ited, and the challenges they encountered were recorded. A patient survey accompanied shadowing. The physical barriers that patients encountered, the level of dependence on staff members, how much they relied on various built environment elements (e.g., handrails) for mobility support, and their spatial preferences varied considerably. Their use of free time during the day and amount of socialisation with others also differed. While some patients may greatly benefit from a supportive and barrier-free environment, others may find that a more challenging environment with training opportunities contributes better towards their recovery. These differences in patients’ behaviours and experiences may help to inform the design of rehabilitation environments.

14:42

Ann Petermans

When in a hospital environment, whether for medical consultation, to visit a loved person, or even to start a new job, many people might experience stress and frustration. Those negative feelings and emotions impact our well-being and are not necessarily or solely the consequence of the motive we go to the hospital. They often are instigated by our experience of not finding our way through the hospital campus, or in the hospital buildings themselves. Although many healthcare environments and hospitals often invest a large amount of money and efforts in implementing a proper signage system, as it essentially entails a key aspect of their “identity”, many challenges still stand. In this paper, we point out the importance of wayfinding as a crucial element for a comfortable atmosphere of a hospital and consequently the positive experience of their public. A good wayfinding strategy is fundamental to all users involved in the daily functioning of a healthcare environment, as it can dramatically impact their well-being. Different perspectives will be analysed considering the understanding of various users groups and their difficulties and challenges to encounter when trying to find their way in hospitals: the public, the architecture, the local culture, complex buildings and sites, stress and vulnerability of the people, routes and many other aspects. Together, these data will bring input for the strategy and design of an effective wayfinding system for a healthcare facility.

Room A Stream engagement – stakeholder & project management (3B & 3C2 ) –  chair: Liesbeth van Heel

13:30

Ute Ziegler

Based on two application-oriented research projects 2012-2014 Modular Cocoon and 2019-2022 Cocoon 2.0, which have been carried out in a Swiss psychiatric hospital, it is presented how a systemic research approach is used to implement a needs-oriented design that can address the needs of different disease patterns, gender and age with individualizable elements. In hospitals, there are numerous stressors for patients. Regardless of different previous experiences, these are perceived differently and also affect individuals on different physical and psychological levels. Accordingly, the question of which design elements in which configuration and design form are suitable for reducing stress and states of arousal individually was investigated. The research process is divided into four phases for each project: 1st phase: Site inspections, observation and measurement of the actual state. 2nd phase: Co-creations and Co-Designs with the relevant stakeholders 3nd phase: Data analysis, derivation of concept ideas and construction of prototype 4th phase: Implementation of prototype and testing In both tests, it has been shown that stress-reducing effects can be presented at different levels in all patients through the individual appropriation possibilities created by the configuration of the parameters wood, light and textile. The prototypes of both research projects have influence on the feeling of security and safety, which is related to well-being. The empirical data clearly show that the design approach of individualization enables patients to self-regulate, i.e. the configurability of the design parameters enables patients to self-regulate their stress.

13:48

Ro Spankie, Alastair Blyth, Diony Kypraiou, Wing May Kong

Dr Ro Spankie is Assistant Head of the School of Architecture + Cities at the University of Westminster and Subject Lead for Interior Architecture. She trained as an architect at University College London and joined the University of Westminster in 2009. Her expertise is interior architecture, a discipline focusing on the alteration and adaptation of existing buildings, concerned not just with physical intervention but also with how space is understood and occupied, as well as well as the role of memory in how we construct the world around us. Ro is editor of the international journal ‘Interiors: Design/Architecture/Culture’ (Taylor & Francis) and a founder member of Interior Educators; the UK forum for Interior Architecture and Design Educators. https://www.westminster.ac.uk/about-us/our-people/directory/spankie-ro

For a description of her research interests see interview on Mellon Sawyer Website, Yale University, USA; https://orderofm.com/conversation/travels-to-the-interior-a-conversation-with-ro-spankie/ Publications include; ‘Revisiting Sigmund Freud’s Diagrams of the Mind’ in Working With Diagrams: 14 (Studies in Social Analysis, 14) (Berghahn Books 2022)

Alastair Blyth BSc (Hons) Dip Arch MA FRSA AoU RIBA

Alastair Blyth is Assistant Head, and Employability Director School of Architecture and Cities, University of Westminster. He is leads the Professional Studies and Ethics across the school and his research focus is the impact and effectiveness of learning environments. He joined the University in 2016 from the Organisation of Economic Co-operation and Development where he was a policy analyst in the Directorate for Education and Skills focusing on learning environments. Alastair co-wrote the book “Managing the Brief for Better Design” 2nd Ed 2010 Routledge and is working on a new book: “Integrative Briefing for Better Design, Routledge to be published March 2023.

His website: http://www.alastair-blyth.com focuses on how we might re-imagine space for learning and website: https://betterbriefingfordesign.com/ focuses on briefing

Diony Kypraiou is a Senior Lecturer, architect, researcher and the Course Leader in Interior Architecture at the University of Westminster, UK. She holds a Diploma in Architectural Engineering from the University of Patras (Greece), selected studies from the Universita Degli Studi di Firenze (Italy), and a MArch(Dist) and MPhil in Architectural Design from the Bartlett School of Architecture (UCL, UK), where she is currently completing her Doctorate studies (PhD in Design). Diony’s research explores practices of polyvocalism and performativity as analogies staged across theatre, psychoanalysis, interiors, and architecture. Her research interests include explorations of areas of innovation in practices of teaching and learning in studio-based pedagogy. Diony is a Fellow in the Higher Education Academy, UK.

Wing May Kong is a consultant diabetes physician at London Northwest University Hospital NHS Trust and Head of Ethics and Law for Undergraduate Medicine at Imperial College London and a domain lead for Professional Values and Behaviour. Her teaching interests include addressing the gap between ethical reasoning and ethical practice with a focus on the use of humanities and experiential learning to improve ethical sensitivity and reflection. Within the new curriculum at Imperial, she has introduced co-production workshops in which students work in partnership with people with long term health conditions to improve the quality of health care. Engagement with the lived experience of illness enriches understanding of respect, autonomy, dignity, diversity and inclusivity. She is a Module lead for The Humanities, Philosophy and Law Medical Sciences BSc at Imperial in which students explore issues relating to the body, the mind and death through the disciplines of law, ethics, philosophy and the humanities. She is also chair of the Institute of Medical Ethics, a charitable organisation which promotes the teaching, learning, discussion and application of medical ethics in clinical practice.

In her clinical role she is clinical lead for the NW London Diabetes Foot Transformation Project. Central to this, has been the establishment of a Stakeholder network of health professionals, service users and commissioners from the 8 NW London CCGs, who have worked together to improve foot care for people with diabetes, through harmonising pathways, digital innovation and establishing new ways of working.

For more information see http://www.imperial.ac.uk/people/w.kong; @wingmayk

This paper will describe a unique cross-disciplinary collaboration between the Medical School at Imperial College London and the School of Architecture and Cities at the University of Westminster, which explored the relationship between design, mental health and wellbeing, using a co-design paradigm. The collaboration included 650 students from across six courses, four under-graduate and two post-graduate namely; BSc Medicine, BA Architecture, BA Interior Architecture, BSc Architectural Technology, Master of Architecture, RIBA Part III as well as 40+ members of staff. Three years in the planning, this innovative project comprised of two one-day co-design workshops, during which 64 cross-disciplinary groups of students reflected on four defined mental health conditions to identify problems and propose solutions for the design of four existing NHS mental healthcare sites. The terms co-design, co-creation, and co-production all describe an open design process that empowers a wide range of stakeholders to make a creative contribution to the formulation and solution of a problem. Co-design offers an immersive and experiential learning experience, and challenges the conventional pedagogy of designer-client / expert-user, introducing experts by experience. While acquisition of discipline-specific skills and competencies was an expected outcome, the structure of the workshops fostered consideration of broader qualities such as ethics, empathy and duty-of-care. This paper will describe both the workshop itself and an evaluation of feedback from students, staff and other stakeholders. http://www.openstudiowestminster.org/co-production-2020-2021/

14:06

Alvaro Valera Sosa

Born in Venezuela, Alvaro spent most of his childhood in the U.S.A. to later return and achieve an architecture diploma in Caracas. In Spain, he completed construction management and then moved to Berlin, Germany. His vision to combine health and architecture got him accepted to study at the Charité Medical University of Berlin, the first architect to achieve a Public Health master at this institution. In academia since 2011, Alvaro has been an Evidence-based Design Researcher at the Technische Universität Berlin, where he has conducted numerous pedestrian evaluation projects in various countries. At the TU-Berlin Urban Management Program, he teaches Urban Walkability, and at the Architecture faculty, he conducts research on healthcare delivery environments in collaboration with WHO Téchne. In practice, Alvaro is the founder and manager of BHL Building Health Lab, a Think & Do Tank that creates health strategies to integrate sustainable development goals in urban planning and architectural design. At BHL, he conceptualized and developed UrbanCare, a methodology to assist city planners in structuring cases for urban health in different climate zones such as the Oceanic in Gothenburg, Continental in Berlin, Intermediterranean in Florence, and the Mediterranean climate in Nicosia. Alvaro also acts as commissioning editor for the Cities & Health Journal, collaborates with the German Architects Declare for Climate and Biodiversity, and is a member of the German Alliance for Global Health and the pedestrian advocacy group “Fuß e.V.” in Berlin. https://buildinghealth.eu/ 

In planning an urban hospital, the complex priority-setting of goals often neglects how landscape designs impact ecosystem quality and threatens public health. As a result, the difficulty in counteracting the urban heat island effects and reaching sustainable development goals on time exponentially increases. In this context, a research workshop conducted with facility managers, planners, designers, and various groups of hospital users helped to analyze and propose actions to solve climate and health environmental issues for the future redevelopment of the Sahlgrenska University Hospital campus. The groups participated in community-led research and applied landscape planning tools to visualize and problem-solve climate, energy, and urban environmental health issues that affect outdoor campus users and pedestrians. This research is an illustrative case study that depicts how the methods employed in the four-session research workshop and the development of its results on (i) visualizing the street environment and spatial inequities in urban scenes, (ii) reviewing heat, runoff, and biotope data at the pedestrian level, (iii) applying prioritized planning at critical urban scenes, and (iv) proposing spatial design solutions centered on vulnerable hospital outdoor users. The results are descriptions of the group dynamics and their outputs on how public transportation stops, street crossings, free-seating areas, and spaces at building en-trances affect the local urban ecosystem, the energy balance of buildings, and mobility of vulnerable pedestrians, including outdoor workers.

14:24

Liesbeth van Heel

Liesbeth van Heel is a PhD candidate and guest researcher in both the department of Public Health at Erasmus MC and at the chair of Design and Construction Management within the Faculty of Architecture and the Built Environment at TU Delft. After years of working as an university hospital real estate professional, leading a small expertise team (PMO), her focus shifted to the coordinating effort to align the various strategic programs within Erasmus MC toward a safe relocation to the new hospital building, with fitting work processes, logistics and IT-support. This transition took place in May 2018. Her special attention has been patient’s needs, stakeholder engagement and creating a “healing environment”, using (inter)nationally acquired evidence and experience based design knowledge. She propagate knowledge sharing and network building for ‘informed clients’ in the Netherlands and beyond, and is a Board Member of the European Health Property Network. She co-coordinates the scientific Program Evaluation of our New Erasmus MC, which focusses on infection prevention, experience with wards with 100% single rooms and balance between bricks, bytes and behaviour in integrated health infrastructure project delivery. She chairs the Organizing Committee of the 5th ARCH-conference: enabling health, care and well-being through design research.

As the design of a new hospital is typically used as a catalyst for change, redesign and implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder management processes. Especially in striking the right balance between the building (bricks), processes and supporting IT (bytes) and work processes (behavior). Employees may resist the new work processes or be unable to adapt for various reasons, such as staff shortages or introduction of services and technologies in a hybrid form, not quite reaching their intended supportive nature. In additional to these ‘external’ or contextual factors, it might also be related to the trade-offs between different stakeholder needs. These kind of issues will interfere with the way employees perceive the building and the organization. From the perspective of successful integrated project delivery this might be seen as a mismatch in attention paid to the aforementioned balance in the period from design to relocation. This study aims to gain insight into the possible causes for the perceived mismatches as expressed by ward managers some 12 months after relocation. This was altogether some 6 years after the design of the facility was completed. It will in-crease our understanding of the complexity of design, construction and transition processes that have to deal with the gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing has been combined with an extensive analysis of documents collected over time.

14:42

Rosanne Steensma

The design and implementation of hospital gardens : experiences and lessons learned from using a design thinking approach

Despite the trend towards integration of care and home environments, the exact social and physical needs of elderly are largely unknown. Therefore, there is a need to better understand their preferences. 

A questionnaire was composed to study the preferences of (future) elderly for urban context, housing-types, shared places, caregivers (e.g., family, animals, informal or professional caregivers). It was based on validated instruments and new questions. The main aim was to study preferences for future home environments and social context, to develop new design concepts that fit to the social and physical needs of individuals. 

The questionnaire was tested in a pilot study with architects and building experts, because they are future elderly and are trained to imagine new environments. The results of the pilot study are reported. The respondents were asked about their actual homes (type, location, family) and their expected future needs as an 85-year-old widow, in need for care in daily life. Two third was willing to live in small-scale groups and share places in future. The preferences for context, housing-type, shared places (such as living room or garden), architectural interventions and social needs varied widely. Because of the large variation in preferences, and apparent contradictions (such as the preference for living in a farmstead ánd in a city) new design concepts, such as a farm on roofs in the city, or student housing for elderly are developed. 

The results of the questionnaire and concepts will be shown and discussed in the poster

 

Room R Stream inclusive design/health promotion – communal design (4B) – chair: Karin Høyland

13:30

Koen Coomans

Koen Coomans graduated as engineer-architect at KU Leuven in 2010 and is since then professionally active both as architect and researcher. He combines a partnership in the architecture firm D E Architecten in Tervuren with research in the Research[x]Design group at KU Leuven Department of Architecture. He is interested in improving design outcomes by gaining insight into how people with various abilities or background experience the built environment differently.

The term ‘hospice’ refers to both a philosophy of end-of-life care and a building type, dedicated to offering this care. Hospice care strives to offer dignity, personal choice, peace, calm, and freedom from pain. Hospice care is anchored in space and spatial practices; however this relation is understudied. It is a rather new building type, for which architects have few historical references, post-occupancy evaluations, or direct experiences available. The prospect of replacing a Belgian hospice offered an opportunity for a case study. We aim to understand how the built environment of a hospice affects experiences of care, and discuss design considerations derived from that. Our qualitative research approach was based on principles of Grounded Theory and combined observations with semi-structured interviews with six staff members, six volunteers, three relatives and eight patients. Our analysis shows that the built environment contributes to hospice care by the balance it affords between privacy and social interaction, by the discrete ways in which it affords offering high-level care, and by its human scale and relation to the natural environment. Insights gained challenge hospice designers to consider how meaningful encounters are often spontaneously triggered by daily activities; guests’ lifeworld changes in size; a delicate balance is required between proximity and seclusion; the built environment can support the ethos of staff and volunteers; aspects of environmental support (e.g. accessibility) are intertwined with aspects of emotional comfort (e.g. hominess); high-level care can be offered in discrete ways.

13:48

Luc Willekens

Biography drs.ir.Luc Willekens,  MD MSA

Studied Medicine at Radboud University, Nijmegen (1972-1981), and worked as general practitioner (1984-2000).

As director of a locum organization in Amsterdam (WHAM) for family doctors contributed to further professionalization of the general practitioner’s specialization (1987-2000).

Lecturer and coordinator on medical skills (internships) education at the University of Amsterdam (1985-1988, 1994-1995).

Studied architecture at TU Delft (1987-1994). Works as Independent architect at his own office, OOMarchitects (1994-now), in Amsterdam. Designed numerous out-patient health care facilities.

Lecturer and tutor at TU Delft at the department of architecture (1998-now).

Basic Qualification Education (2008-2010).

Teacher’s trainer at TU Delft design education  (2004- now).

Co autor on typology studies on Town Halls and Libraries (2012).

PhD candidate:  research on the connection between architecture/urbanism of Community Health Centers and Wellbeing:  Community Health centers of the Future.

The design of healthcare buildings influences healthcare quality: hospital and ward design features can increase patient and staff satisfaction, improve treatment outcomes and reduce stress. However, due to societal changes, there is increasing attention to outpatient healthcare facilities close to the communities, such as healthcare centers (HCC). However, few studies concerned HCC. Nor has there been much attention to entrance areas of healthcare buildings. This study, therefore, investigates four health-related design features (i.e., privacy, nature, daylight, and wayfinding) in the entrance area of two award-winning Dutch HCC. Research question – How does the entrance design of HCC support views on nature, privacy, daylight, and wayfinding? This study compares two awarded HCCs based upon a selective thematic analysis focused on descriptions and observations of the four features in the HCC design. Data include descriptions by professionals, jury reports, floor plans and photos. The data show that views on nature are not mentioned in the data, privacy is mentioned and observed implicitly in both projects, and daylight and wayfinding are only observed in the floor plans and pictures. Most attention concerned daylight, wayfinding, and privacy in the waiting areas. However, while the importance of view of nature has been highlighted in many previous studies, these projects show little attention to view of nature and privacy for HCCs. The study revealed that the awarded healthcare buildings incorporate health-related design features, mostly implicit in the designs. However, in the descriptions by professionals and jury, they are not explicitly mentioned.

14:06

Ann Kathrin Salich

The Circle of Health – expanding Berlin’s medical care

Ann-Kathrin Salich is a young architect with a specific interest for visionary ideas and practices. She currently works at the German leading office for healthcare architecture “Nickl&Partner” . She is part of the competition and design team. Her latest contribution was the “Charité Mitte” competition. She holds the “Charité Prize” for her Master thesis project “The Circle of Health” and was speaker at the “ENAH symposium 2022”. Further she teaches at the “Leibniz University Hannover” digital designing and modelling methods. She finished her master degree at the TU Berlin and was on exchanges at TU Delft and Zürich.

Her interest for healthcare started early due to her medical parenthood. Now she aims to make a positive contribution to the healthcare sector and its designs.

Statistically one can recognise a world-wide increase of chronic diseases such as cardiovascular diseases, cancer and diabetes mellitus. This presents a huge future challenge for the healthcare sector and the whole system as severe illnesses lead to incapacity for work, need for care and very expensive treatment. However, science proved that many illnesses are strongly linked to the living conditions, health behaviour and social status. Sorrowfully, Germany’s health statistics are very worrying. Nevertheless, this provides information on ways to prevent these kind of illnesses. Therefore this master thesis questioned if architecture can help preventing chronic diseases by encouraging people to do regular health checks and establish a healthy lifestyle e.g. with a balanced diet, sufficient physical activity and any kind of drug abstinence. Accordingly, the overall goal was to develop a concept and architecture that beneficially influence the health status of the general public. My research showed me that this can only be achieved with a new typology of patient-focused health centres. Health centres that are easily accessible and reachable, compelling enough to regular review the health status, offer a comprehensive selection of medical facilities for prevention and raise awareness about health topics as well as encourage a change of behaviour. Accordingly this master thesis includes the development of a masterplan, a design and proposal for the medical organisation of those new healthcare centres. Its outcome is a modular architectural design of healthcare centres which are closely linked to the public railway system of Berlin.

 

14:24

AnneMarie Eijkelenboom

dr.ir. Annemarie Eijkelenboom (1971) – Architect (EDAC) / Head of R&D EGM architects

TU Delft Civil Engineering

The built environment has a significant impact on well-being and health. This is made clear by means of scientific research in the field of Evidence Based Design. As a project architect, I make use of the results of this scientific research; in addition I work on research projects. Precisely the link between theory and practice leads to the design of even better buildings. And this is what drives me: realizing a high spatial quality with a positive effect.

Despite the trend towards integration of care and home environments, the exact social and physical needs of elderly are largely unknown. Therefore, there is a need to better understand their preferences.

A questionnaire was composed to study the preferences of (future) elderly for urban context, housing-types, shared places, caregivers (e.g., family, animals, informal or professional caregivers). It was based on validated instruments and new questions. The main aim was to study preferences for future home environments and social context, to develop new design concepts that fit to the social and physical needs of individuals.

The questionnaire was tested in a pilot study with architects and building experts, because they are future elderly and are trained to imagine new environments. The results of the pilot study are reported. The respondents were asked about their actual homes (type, location, family) and their expected future needs as an 85-year-old widow, in need for care in daily life. Two third was willing to live in small-scale groups and share places in future. The preferences for context, housing-type, shared places (such as living room or garden), architectural interventions and social needs varied widely. Because of the large variation in preferences, and apparent contradictions (such as the preference for living in a farmstead ánd in a city) new design concepts, such as a farm on roofs in the city, or student housing for elderly are developed.

The results of the questionnaire and concepts will be shown and discussed in the workshop.

14:42

Scott Lawrence

Community-engaged design-build at the nexus of crisis response, and resource scarcity

15.00-16.00

break / transfer to Rotterdam

16.00-16.55

1st round of themed guided tour of Erasmus MC

17.00-17.55

2nd round of themed guided tour of Erasmus MC

16.00-18.45

Networking & drinks & bites at Erasmus MC

18.45-19.00

Transfer (walk) to Euromast, our dinner location ‘with a view’

19.00-22.00

(Informal) conference dinner

22.00

Return transfer to Delft

Day 2 (Tuesday August 23) Main conference

8.00-9.00 

Registration at TU Delft (East Suite)

8.45 -10.00

Room A – 1st floor

Plenary session witjk invited keynotes speakers –  Chair – Milee Herweijer

  •  prof. Gesine Marquardt, professor at Technische Universität Dresden

Architectural design decisions have a significant impact on the individual’s health, well-being, and independence. Especially with the focus on older adults, a large number of individual studies are available and reviews confirm the findings.  Although there is less research activity in architecture than in other professions, and the studies carried out were usually not able to implement rigorous study designs with randomization or blinding, a fundamental connection between architectural design and the individual’s health and care outcomes in residential housing, long-term care, hospitals, and rehabilitation clinics has been established.

However, most studies to date focus on specific clinical pictures (such as symptoms of dementia or stroke) as well as singular building typologies (such as nursing homes, hospitals, or rehabilitation clinics), aiming to answer questions about their optimal design. The results are mostly made available to other researchers through scientific papers and conference presentations. Only if there is a large body of research available, reviews may be undertaken, and, ultimately, lead to the proliferation of architectural planning manuals with evidence-based design recommendations that facilitate the transfer of research results into architectural practice.

This current situation does not make the best use of the wide scope of research results available – which would be very much desired for the care of older adults, as they often show a broad picture of age-related limitations and illnesses and also frequent different building typologies – one after the other, or even at the same time. Thus, it becomes clear that a meta-synthesis of the state of research is necessary. An overarching concept of architecture must be developed, that not only takes into account specific clinical pictures but which encompasses different forms of age-related limitations and illnesses, possibly even extending the approach towards a holistic understanding of healthcare architecture.

Prof. Dr.-Ing. Gesine Marquardt is an architect and has been Professor of Social and Healthcare

Buildings in the Faculty of Architecture at Technische Universität Dresden, Germany since 2015. In her academic and design work, she develops architectural concepts for the healthcare sector in a society impacted by demographic change. Her publications focus on the dissemination of knowledge about dementia-friendly architecture. From 2012–2017, she headed an Independent Junior Research Group funded by the German Research Association after her post-doctoral work at the Johns Hopkins Medical Institutions in the USA. Her 2007 dissertation on dementia-friendly architecture earned her several academic awards.

  •  Liesbeth van Heel, MSc, researcher Program Evaluation Our New Erasmus MC (PE-ONE) at Erasmus MC and TU Delft.

Stakeholder engagement in the construction industry is often seen as a management method to gain necessary information and mitigate risks towards project success. In this perspective the client is one of the stakeholders ‘to be managed’. In construction projects in healthcare awareness is far higher to the added value of stakeholder engagement, given the complexity of decisions to be made. Yet often these healthcare facility design and construction projects are managed ‘on behalf’ of their clients, by regional or national hospital construction agencies, PPP-consortia or specialized consultancy firms. Could design quality be further influenced by the choice to invest in in-house project management by the hospital?

The case of Erasmus MC’s new adult hospital design and construction project is a compelling one, spanning over a period of 20 years from concept development to relocation and implementation of a range of innovations and new work practices in a brown field, inner city situation. In an evaluation of the project, the in-house project organization’s stakeholder engagement has been mentioned as a major positive and contributing factor towards successful project delivery. Having been embedded in this in-house project organization for the duration of the project at a strategic level, I will now – as a researcher, with access to evaluation interviews with over 50 stakeholders and an extensive project archive – reflect on the way we designed and delivered our stakeholder engagement process over time. I will highlight what roles were crucial to gain the necessary commitment or innovation in this transformative healthcare project, how this contributed to design quality, and what lessons can be learnt.

Liesbeth van Heel is a PhD candidate and guest researcher in both the department of Public Health at Erasmus MC and at the chair of Design and Construction Management within the Faculty of Architecture and the Built Environment at TU Delft. After years of working as an university hospital real estate professional, leading a small expertise team (PMO), her focus shifted to the coordinating effort to align the various strategic programs within Erasmus MC toward a safe relocation to the new hospital building, with fitting work processes, logistics and IT-support. This transition took place in May 2018. Her special attention has been patient’s needs, stakeholder engagement and creating a “healing environment”, using (inter)nationally acquired evidence and experience based design knowledge. She propagate knowledge sharing and network building for ‘informed clients’ in the Netherlands and beyond, and is a Board Member of the European Health Property Network. She co-coordinates the scientific Program Evaluation of our New Erasmus MC, which focusses on infection prevention, experience with wards with 100% single rooms and balance between bricks, bytes and behaviour in integrated health infrastructure project delivery. She chairs the Organizing Committee of the 5th ARCH-conference: enabling health, care and well-being through design research.

10.00-10.30

coffee/tea break (East Suite)

10:30 – 12:00

3rd  round parallel sessions

Berlage 1 Stream future-proofing – post-occupancy evaluations (1B)  – chair: Lex Burdorf

10:30

Elisa Pozo Menendez and Laura Cambra Rufino

The Covid-19 pandemic revealed the crisis of the care sector for a global ageing population. Most of the countries across Europe were strongly impacted by the pandemics and one of the most vulnerable groups was the senior population, especially those who lived in care-homes. Since 2000, healthy ageing and the person-centred care model have become relevant concepts in the health sector. The application of the person-centred care model to the built environment requires the adaptation of building regulations and urban planning for providing a home-like environment. The current study was placed in Belgium for being a country where small-scale care facilities were widely implemented. The aim of this study was to analyse different domains of elderly care-homes in Belgium through a survey to question their relationship with the impact of the first wave of Covid-19. The results of the ten care-homes that responded to the survey showed a high implantation of the person-centred care model. Regarding Covid-19 infections, 5 out of 10 of the care homes had infected residents and only 2 of them had residents that passed away due to the infection. These two care homes were in the top three of the care homes with more residents. Moreover, several environmental and management aspects such as small-scaled units, individual bedrooms, outdoor access, and fixed staff for each unit were measures already implemented in the care homes and later recommended by authorities during the pandemic. Further research might investigate whether these aspects could influence the resilience of the care homes if compared with the number of infections in other care homes where those measures were still unimplemented.

10:48

Carolina Kolodziej

Carolina Kolodziej is a research associate at the Technische Universität Dresden. She is working on her Ph.D. with the topic of “Healthcare Design for radiotherapy”. Addressing the complexity of the radiotherapy departments and the various user groups, she aims to develop typologies and planning requirements in correlation to the workflow, by investigating spatial constellations and cluster formations. Her interest in Healthcare Design developed during her master’s studies in architecture at the Bauhaus-Universität in Weimar. With her master’s thesis, she took a close look at the structure and workflow in departments of surgery, intensive care, maternity, and neonatal intensive care in German hospitals. As a research associate, she is also involved in teaching at the Chair of Social and Health Care Buildings and Design, where she co-established the Student Research Lab “ARCH 4 HEALTH”. With this lab, the educational concept of research-based learning is integrated so that the students are guided through their own small research study that leads to a collective publication. 

1) objective/aim: This paper establishes typologies and spatial criteria by analyzing floorplans of radiotherapy departments in German hospitals. 2) background: The configuration of room clus-ters is a useful tool in early stages of planning radiotherapy departments. Currently there is a lack of planning requirements. With the implementation of evidence-based typologies, workflow and patient-stay can be positively influenced. 3) methods: For developing typologies and planning re-quirements a comparative floorplan-analysis from 20 radiotherapy departments in Germany was conducted. Given the complexity of radiotherapy departments, a list of rooms was com-posed, and cluster-formations were defined in correlation with the workflow of radiotherapy treatment. The rooms of the analyzed floorplans were categorized by the cluster-formations to identify their relation and arrangement towards one another. The analysis was inspecting dif-ferences and similarities in patterns of spatial relationship. 4 )results: With this comparative floorplan-analysis, a classification of radiotherapy departments on the basis of organizational and spatial characteristics was developed. Five clusters were defined: Reception, Outpatient, Im-aging, Planning and Therapy with each dedicated rooms. Typologies and spatial characteristics were derived and visualized. 5) conclusion: The comparative analysis of floorplans shows a spectrum of built environment and cluster arrangements, which lead to typologies and planning requirements. Further research will be conducted by combining these typologies with workflow, individual travel paths, environment-behavior and requirements of all user groups and expert knowledge. With this multilayered research, design recommendations for planning radiotherapy departments can be identified.

11:06

Anja van der Schoor

Environmental contamination after relocating to a hospital with only single-occupancy rooms 

Adriënne is a final year PhD student. Her PhD focusses on the effect that single-occupancy rooms have on the microbiological safety of the hospital environment. 

Aim: To determine the effect of relocating to a hospital with only single-occupancy rooms on environmental contamination with highly resistant microorganisms (HRMO). 

Introduction. In May, 2018, the Erasmus MC University Medical Center in Rotterdam, the Netherlands, relocated from an old hospital building with mainly multiple-occupancy rooms with shared bathrooms to a newly constructed hospital with 100% single-occupancy rooms and private bathrooms. 

Methods. Environmental sampling took place twice in the old building and fifteen times in the new building, from two weeks before to thirty-six months after relocating patients. At each sampling moment, samples were taken from 13 locations (e.g. nightstands) in 40 different patient rooms. Samples were screened for different HRMO, e.g. Escherichia coli. Additionally, the total bacterial load was determined. 

Results. Environmental sampling revealed that 24 of 724 locations (3.3%) were positive for HRMO in the old building, with five locations positive for multiple HRMO. In the new building, five of 4269 locations (0.1%) were positive for HRMO; a significant decrease (P<0.001). In the old building, HRMO were mainly identified from sink drains (87.5%), in the new building from shower drains (60.0%). In the first nine months after opening, an increase in bacterial load was observed. Thirty-six months after relocating, no major differences in bacterial load were identified between the old and the new hospital building. 

Discussion. This study shows that a newly constructed hospital with 100% single-patients rooms has a positive effect on the presence of HRMO lasting at least 36 months after opening. 

11:24

Göran Lindahl

Göran Lindahl is an architect and professor at Chalmers University of Technology. He is visiting professor at Politecnico di Milano and an actively works with healthcare organizations. His focus is on healthcare environments, its design, and effects. He is the director for Center for Healthcare Architecture at Chalmers.

  • The aim of the short paper is to set the problem and define the possible drivers for future research in exploring the relationship between healthcare built environment and staff retention

  • Today the physical environment, the architecture, of healthcare facilities is considered having various effects on patients and staff

  • Especially in the western world healthcare staff shrinking and ageing will have a significant impact

  • Hospital organizations are defining strategies for staff retention improvement

  • Usually, this issue concerns management of risk, leadership and motivational aspects but the built environment might as well play a role in this process

  • In the recent COVID-19 pandemic these issues have been raised considering staff burn out and stress

  • Future research will need to deepen the relationship between staff retention and physical space of healthcare settings starting from the proposed framework

11:48

Göran Lindahl (for Andrea Brambilla)

The paper reports and reflects on an evaluation project at Malmö Nya Sjukhus, NSM, Sweden, where the relationship between healthcare performance objectives and indi-cators in the built environment have been studied. The starting point of the study was the outcomes in performance set by the hospital and a retrospective analysis of how these could be related to evaluation of the design of the new hospital. The paper discusses evaluation against a backdrop of existing studies on evaluations and with an argument that that there is a need for tools and methods to strengthen design work in general. The main argument is that it is valuable to evaluate the work processes in healthcare against spatial configurations in addition to studying effects of specific design features. Con-necting healthcare process indicators to spatial design also envision several challenges and possibilities that are addressed in the paper. The study presented is mainly quali-tative with and explorative approach.

Room D Stream user-needs – inclusive maternity design (2D) – chair: Luc Willekens

10:30

Lisa Björnson Skogström

As part of a new health care building project and the research project Room4Birth (R4B) as well, a birthing room at a hospital in the West of Sweden was built and furnished with physical features designed to be more adaptable to women´s personal wishes and needs during labour and birth. The physical environment can have an impact on both staff and birthing women’s experiences. A number of issues, related to the design and integration in overall hospital design, has been raised. This paper presents the design of this new birthing room, decision making concerning the room when planned and constructed and how the nine prominent features in the room has been assessed in relevance by women being cared for in the room. The purpose is to share experiences and knowledge to contribute to the development of birthing rooms and labour wards.

10:50

Carmen Martens

Carmen Martens graduated as an architect in June 2017 at the University of Hasselt (Belgium) and is now a Ph.D. candidate at the Marketing Department of HEC Liège, Management School of Liège University (Belgium) and the Architecture Department of Hasselt University (Belgium). Her research explores how (service) designers can create ‘enabling’ environments to strengthen customer experience in the context of healthcare services. Promotors of this joint Ph.D are Prof. Dr. Cécile Delcourt (ULiège) and Prof. Dr. Ann Petermans (UHasselt). 

This article aims to explore the critical incident technique as a useful method to understand the impact of healthscapes on patient experience. More specifically, we identify elements of the maternity healthscape that affect patient experience in a positive or negative way. In this respect, 39 in-depth interviews were conducted with various maternity stakeholders—mothers, midwives, heads of midwives, and senior managers. As the journey of (soon-to-be) mothers is technically and emotionally complex, and as many critical touchpoints must be managed care-fully to ensure a smooth experience, the key challenge during the interviews was to find a way to directly and indirectly discuss healthscape elements influencing the patient journey with the interviewees. Therefore, the authors explore the potential gains of the critical incident technique for architectural research.

11:10

Sarah Joyce

Babies are born here too: new ideas for using medical specialists and ‘familiarity’ with spaces for operating theatre design

11:30

Hala Barakat

Room A Stream engagement redesign & rethinking processes (3C1) – chair: Laura Arpiainen

10:30

Aaron Davis

Purpose: This paper sets out a framework for planning co-design processes for complex sys-tems-based projects typical in healthcare settings. Background: Healthcare systems and environments are complex. Innovation often requires the redesign of physical spaces or objects, social processes, and the complex associated layers of ser-vice systems. Co-design is an established methodology for catalysing innovation in products and services because the scope is often well-defined but can be more challenging when working in sys-tems where complexity impacts boundary definition. Co-design uses interdisciplinary and mul-ti-level engagement with diverse stakeholders to catalyse innovation at the intersection between disciplines, experiences, and knowledge sets. The evaluation of these processes often utilises con-trol over decision-making as a defacto measure of participation quality, reflecting potential for stakeholders to influence key outcomes. Yet there are also practical and theoretical reasons to val-ue well-designed participatory processes in their own right. Methods: The framework presented in this paper combines the evaluation of participation in co-design processes and in decision-making as two distinctive activities, applied to real-world and hypothetical case studies that demonstrate the potential of this framework as a transparent plan-ning and evaluation tool. Results: The framework allows participation to be planned and valued independently without defaulting to control over decision-making processes as the (only) valued option. The case studies demonstrate its potential in structuring a range of collaborative processes that suit different types of system innovation. Conclusions: The formalisation of a framework for planning co-design activities that values participation in co-design processes in parallel with participation in decision-making provides a more transparent and beneficial way to structure co-design for complex systems-based challenges that recognises the humans at the heart of co-design.

10:48

Andrea Möhn, Jacqueline Roos

Andrea Möhn is the principal of AM__A Andrea Möhn Architects, an international architectural firm situated in Rotterdam, and a lecturer at the Academy of Architecture and Urban Design in Rotterdam, the Netherlands, the Texas A&M University and the Universities of Applied Sciences in Frankfurt and Dortmund, Germany. She has 24 years of designing bespoke, high quality architecture with a focus on healthcare design. She attended the Technical University of Berlin, the University of Stuttgart, and the Technical University of Delft. Her multi-disciplinary approach in design, which is based on research and her extensive interaction with both clients and users of the buildings, has led to many innovative new concepts, resulting in numerous successful projects, many of which have received international awards and appeared in publications and lectures around the world. Since 2021 Andrea Möhn is a board member of the EUI – Epidemic ~Urban Initiative.

MSc. J.L. (Jacqueline) Roos, Psychologist and Researcher, Ipse de Bruggen, The Netherlands. Jacqueline has worked for over 20 years as a practitioner and head of treatment department at the (forensic) SGLVG treatment center Middenweg in the Netherlands, where clinical and outpatient treatment is offered to people with mild intellectual disabilities and severe psychiatric and behavioral problems. Since two years she does research on the influence of the physical environment on health, behavior and quality of life of people with intellectual disabilities in long-term care. A scoping review on this topic was recently published in HERD (Health Environments Research & Design Journal). 

 

Aim: We will present our ongoing experiments on home makeovers of private rooms of people with intellectual disabilities and severe behavioural problems living in a Dutch long-term care facility to demonstrate that a tailored environment contributes to a better quality of life. Background: Eight years ago, the transformation of ‘D’s room’ changed the life of D, a person with severe intellectual disabilities and behavioural problems. This was done in close collaboration between a Dutch care facility and an architect. It is because of D’s drastically and positively changed behaviour that the care facility decided to transform the physical environment of twelve of its most vulnerable patients and to study the impact on patients and staff. Methods: A project is started to transform the rooms within a four-year period and to open up a knowledge platform. To streamline and replicate the transformation process, it is broken down into ten steps. Part one of the multiple case study consists of a narrative representation of the four completed room transformations. Results: An open cooperation between caregivers, architect, and family seemed to be very important in the process. The study shows a reduction in behavioural problems of patients and improved working conditions. Conclusions: A new approach to the living environment of people with intellectual disabilities and severe behavioural problems in long-term care can have remarkable results for patients and staff. It is important to raise public awareness of the importance of a suitable living environment as an integral part of disability care.

11:06

Hannelore Schouten

Co-creation as important factor for successful implementation of Lean-led hospital design

Hannelore Schouten (born 1972) is a parttime PhD candidate at Vrije Universiteit (School of Business and Economics) and conducts research into the way in which lean-led hospital design (further: LLHD) as a concept can be translated into the practice of a hospital building and what the effects are. This is done through an extensive case study at a Dutch hospital that used this concept as the main design principle during the development of a new facility. Hannelore looks at the implementation of LLHD from three perspectives. First, she investigated the way the concept of LLHD is translated into practice by different stakeholders / participants. Second, she tries to provide insights into the context in which this translation happens. At last, she addresses the effects of the implementation on two main lean indicators: (adding) value and (reducing) waste. Hannelore has published several academic as well as non-academic papers (in Dutch) on this subject. Also, she gave many presentations on the subject. 

Hannelore works on this research as a participative action researcher, and has an affiliation with both the university and the hospital. Hannelore has a background as a health scientist and is currently working as a management consultant in health care at Berenschot. She works and lives in the Netherlands. 

Purpose: Documenting and analyzing experiences with building a new hospital guided by Lean-led Hospital Design (LLHD) (Grunden and Hagood, 2012), and investigating key mechanisms enhancing healthcare professionals’ participation and collaboration in implementing this innovative approach. 

Design/methodology/approach: An in-depth case study of the implementation of LLHD in a Dutch hospital was performed based on multiple data sources. The case hospital presented a unique opportunity since there was embedded access to the data by the first author. 

Findings: Three mechanisms supporting participation and collaboration of staff for implementing LLHD were identified. 1). Co-creation as a key element of LLHD results in a supportive attitude towards lean and lean facility design. 2). Freedom in translating a concept enables managers to balance it with variations in practice. 3) A set of key principles governing the design process appeared an important anchor on a managerial level in a changing environment. 

Practical implications: By using the emerging mechanisms, managers/change agents can enlarge collaboration and participation of hospital staff when designing new hospital facilities. Collaboration and participation are necessary conditions to create active engagement in a new facility. 

Originality/value: This case study delivers a unique inside view on the dynamics evolving in the complex change processes at organizational, managerial and personal levels involved in implementing LLHD / designing new facilities. 

11:24

Johanna Eriksson

Day surgery is an expanding service, yet in many cases the current built environment is based on the general surgical department, with access to day bed wards and has changed very little since 1950s in the UK. In Dec 2019 a one-day workshop was organised to investigate the future concept for day surgery services and to explore the spatial provi-sions. The event consisted of a range of stakeholders from government, practice and aca-demia involved in healthcare environments. A design dialogue methodology was imple-mented, exploring the ‘ideal model of care’ through a series of activities using word, image and free association from user experiences. A design game, using tangible materials, let the participants develop and build visual proposals of new surgical environments. The workshop outcome was further processed through identification, sorting and coding of key themes for improvement, such as; user experience, logistics, adaptable design, after-care and recovery. By defining high and low parameters of patient experiences, a number of topics were discussed, including social community systems, information awareness, safety and wellbeing, continuity of patient pathways as well as efficiency and effectiveness of staff. The final design game combined the themes and topics and further deepened the in-sights. The use of a variety of design dialogue methods combined perspectives and knowledge and the workshop clearly identified the value and impact of interdisciplinary collabora-tion to deliberate and explore ideas for future healthcare facilities.

11:48

Elke Miedema

Patients’ health & well-being in inpatient mental health-care facilities: A systematic review

Room R Stream inclusive design/health promotion inclusive communal living (4C) – chair: Birgit Jurgenhake

10:30

Kim Hamers

ir. Kim Hamers is a PhD candidate at the chair of Smart Architectural Technologies at Eindhoven University of Technology and the research group Architecture in Health at HAN University of Applied Sciences. She conducts research into new housing typologies for seniors in the social rented sector in relation to co-reliance. Kim studied architecture at Delft University of Technology where she graduated in 2004. Since 2016 she has been working as a researcher at the research group Architecture in Health (HAN), where she conducts research within a multidisciplinary team into the role of the built environment with regard to the social component of living. She is interested in the way the design of the home and living environment can contribute to the ability of (vulnerable) seniors to age in place in a pleasant way. 

Dutch housing associations focus on communal living with the aim of stimulating social interaction between (older) residents and strengthening cohesion. Although the added value of communal living for social interaction between residents has been discussed in the literature, there is still little known about the broad range of variants of communal living for seniors in the social rented sector. Therefore, it seems relevant to explore how socio-spatial factors of communal living that may stimulate social interaction are reflected in different variants of communal living in the Netherlands. Based on relevant influencing factors from the scientific literature, we performed an explorative cluster analysis in order to distinguish between variants of communal living with quantitative data from national housing association Woonzorg Nederland. As a result, four variants of social communal housing for seniors were identified. Some variants distinguish themselves mainly on the basis of spatial factors, while other variants mainly differ with regard to social and organizational factors. Strikingly, only two of these variants resemble the more intensive forms of communal living as described in the literature. There seems to be a discrepancy between communal living as described in the scientific literature and communal living as it occurs in Dutch social housing. The question of how the different variants of communal living relate to social interaction has yet to be answered.

10:50

Solvår Wågø

Objective Establishing a safe and worthy place to live is an important step for people struggling with substance abuse and psychiatric disorders. In this project, we have followed Trondheim Municipality in the process of establishing a new housing model that contributes to safety and mastery for people with combined disorders and violent behaviour. Background Providing comprehensive services to people with violent behaviour affected by drug use, is chal-lenging. Trondheim Municipality aim to develop a breadth of housing and services for this target group. One of the plans in that context is to establish a home for 6-8 people in close physical con-nection to the mental health-care department at St. Olav’s hospital. Methods An action research approach is suitable when the goal is to create change and where the intention is to create new solutions to current problems (Levin, 2017). Qualitative interviews with professionals in the field, user representatives, workshops and participation in the planning process and literature studies, have been conducted. Results The need for safety, fixed routines, positive impulses and the opportunity to influence one’s own everyday life is pointed out as crucial for people with a behaviour that either scares or is exploited. Several emphasize the importance of activities and food-serving to secure that nutritional status is maintained. Conclusion Rethinking housing models for the target group is necessary but difficult in practice. There is a need for innovative solutions, design and services for the individuals that secures the employees and the neighbours.

11:10

Federica Romagnoli

Home and Healthcare. The prospect of home adaptation through a computational design decision-support system

Federica Romagnoli is an architect and PhD student in Architectural and Urban Planning Engineering at the Department of Civil, Construction and Environmental Engineering at the Sapienza University of Rome. Her doctoral thesis is titled “Adaptability of residences for Healthcare at home. Tools for evaluating design alternatives”. She spent a mobility period as a PhD student at the Chair of Design Informatics at TU Delft, Architectural Engineering and Technology, to validate a system that supports the evaluation of design alternatives according to constraints and user preferences in home modification for healthcare at home. She graduated in Architecture in 2018 from Sapienza University of Rome in Architectural Technology. Her main areas of interest are Inclusive Design, Human-Centered Design, Human Factors, and Multi-Criteria Evaluation in Architecture. 

This paper presents an ongoing research to define the framework of a computational design approach based on the idea of spatial analysis and spatial synthesis to implement multi-criteria evaluations and provide evidence of the performance of the design alternatives in the specific case of home adaptation for healthcare at home. The European health systems place among the priority objectives the strengthening of the provision of healthcare at home to guarantee the aging in place of elderly people and to limit, at the same time, the unnecessary use of resources. Therefore, existing homes must provide adequate safety, comfort, and accessibility features to ensure a high quality of life for the care receivers and facilitate the caregivers’ tasks. To address the complexity of the requirements to be met, we propose a spatial decision support system (SDSS) to implement multi-criteria assessments to ergonomic design problems at a spatial scale of apartment homes. The system is intended to streamline and assist designers and homeowners in planning interventions for home adaptations for healthcare. Such design problems can be formulated as decision problems with costs and benefits modeled within constraints of validity and quality criteria/objectives. Concerning the specific field of study, the system evaluates the degree of compliance with the accessibility and visibility quality criteria of each design alternative. The reiteration of the evaluation mechanism allows for the classification and supports the selection of satisfactory technical solutions identified with an in-formed and well-balanced trade-off between the relevant quality criteria.

11:30

Clarine van Oel

Clarine van Oel is an environmental psychologist and associate professor in the Department of Architecture & the Built Environment at Delft University of Technology, the Netherlands. In 1989, she obtained her MSc in psychology at the Free University in Amsterdam. She obtained her PhD in 2001 at the University of Utrecht. Between 1989 and 2006 she mainly conducted epidemiological and user-driven research in Healthy Environments (TNO Bouw in Delft), public health (Amsterdam Medical Center), and psychiatry (Utrecht Medical Center). Since 2006, she investigates user-preferences for design solutions using visual display methods. She was granted together with Brazil, UK and Germany the NWO project uVITAL project as part of the Trans-Atlantic-Platform “Social Innovation” (2019). Together with prof. E. Eisemann (co-applicant) she was granted the VR-Renovate project (2020).

(to be updated)

In 2015 a profound change in the financing of the Dutch health care system was initiated. Purpose of the reforms was also to enable elderly to live at home as long as possible. One of the consequences of the 2015 reforms was that care providers closed care homes. It was argued that care providers could use vacant care homes to house independent living elderly of lower and middle income groups seeking a break out from loneliness, and willing to live their live in the vicinity of other elderly without abolishing the independence, thus in a cohousing group for elderly. This mixed methods study aims to gain insight into the conditions that influence the continuity of cohousing groups for elderly. A survey was sent to 114 cohousing groups for elderly, yielding a net response of 52%. The out-comes were then used to select 6 cohousing groups who participated in in-depth interviewing. Informal care is in all interviewed group provided by family caregivers and it was not the co-housing’s responsibility to look after chronically ill members. For elderly, an important motive to live in cohousing was the social connection with others in the group. This also creates a feeling of safety. However, a main reason for cohousing groups in highly urbanized areas appears to be the possibility to bypass the regular waiting list for social housing. The continuity of cohousing groups seems to depend on the regular organization of activities, and therefore membership fees need to be included in the rental agreements.

East Suite poster session 1 – chair: Jonathan Erskine

10:30

Marilyne Goulard

Designing the hospital of the future – Tarkett publishes a comprehensive white paper on the challenges and opportunities for the hospital

10:45

Marie Elf

How does the built environment affect rehabilitation outcomes in people with stroke? an explorative study

Marie Elf has a position as a professor of nursing and as an associate professor in healthcare architecture. She works as a professor at Dalarna University at the school of Health and welfare. Her background is in nursing and healthcare sciences. She received her doctorate in architecture, and by now she combined the best parts of the two disciplines. Her research interests are mainly how architecture affects/interacts with people with stroke and older people who live in ordinary housing. She is the research leader of the research group Environment, technology, and participation ETAPP.

11:00

Johan van der Zwart

 

From Nightingale and Maggie to Maia – My Artificial Intelligent Assistant

11:15

Susan Glade

 

New schools – new learning: school as health promoter

11:30

Susanna Nordin

Exploring the design of physical environments for older adults – a qualitative study on staff perceptions of outdoor areas

12:00 – 13:00

Lunch break – East Suite

13:00 – 14:30

4th  round parallel sessions

Berlage 1 Stream future-proofing –staff-perspective (1C) – chair: Milee Herweijer

13:00

Evangelia Chrysikou

 

Medical architect (architect and medical planner) i.e., an architect specializing in healthcare facilities including environments for people across the lifespan holding a PhD on psychiatric facilities. Associate Professor at the Bartlett School of Sustainable Construction UCL, Director of MSc Healthcare Facilities. Active in research having won several prestigious grants and fellowships including a Marie Curie Horizon 2020 Fellowship from the EC on acute mental health wards in the UK, with the Bartlett School of Architecture, UCL. Member of the National Accessibility Authority in Hellenic Republic by invitation from the Greek Prime Minister, Kyriakos Mitsotakis. Teaching experience involved multi-disciplinary and block (modular) teaching at medical and architectural schools, including being module coordinator at Medical Architecture Research Unit, LSBU. RIBA architect registered in Greece and the UK being the founder and owner of the multi-awarded practice SynThesis Architects. Involved in consultancy and policy such as delivering short courses for The Authority for Reconstruction with Changes of the Government of Peru in collaboration with Arup Project, collaboration with the Greek Ministry of Health and the Centre of European Constitutional Law on legislation regarding mental health facilities and the European Innovation Partnership on Healthy and Active Aging of the EC and the Japanese Ministry of Foreign Affairs on infectious diseases. Vice-President of the Urban Health Section, EUPHA. Awarded work and research in countries across Europe, Japan, the Middle East and New Zealand. Author of two books on psychiatric environments and several scientific and professional publications on healthcare environments. Accomplished speaker on multi-disciplinary and cross sector audiences, including a Ted-MED presentation and numerous TV and radio broadcastings. RIBA chartered member and Fellow of the Higher Education Academy. 

COVID-19 has affected most of our activities in multiple ways, with changing our working environment being one of them. This project explores measures for preventing or limiting the transmission of COVID-19 in indoor office workplaces, focusing on space and place by promoting healthy behaviours within those environments. Research comprised of a series of literature reviews using both systematic and narrative methods. Suggestions made from literature review were then split in a) top down guidance mainly from governmental guidance and b) bottom up guidance deriving mainly from the industry. Results were organised under three main themes: a) advice on surface interactions and virus viability); b) behavioural advice focusing on the return-to-work effects on psychological and mental health outcomes along with control measures and suggestions on preparing buildings to return-to-work during Covid-19 and c) advice focusing on thermal and ventilation conditions and how they affect virus transmission. The implications of COVID-19 for workspace are more relevant than ever. The project shed light a)to the interrelationship between individuals and their office space and how the latter influences workers and b) to the knowledge transfer from medical architecture to office design for Covid. This cross-disciplinary review raises questions that need to be considered in future studies inclusive of other topic areas apart from the ones discussed here, so as to generate interdisciplinary knowledge on other equally important fields of study which will impact companies that plan and design workspaces and the people who use it, promoting both healthy working environments and behaviours.

13:20

Mina Shokrollahi Ardekani

Mina Shokrollahi Ardekani is a doctoral student at Clemson University in the Planning, Design, and Built Environment program focusing on Architecture and Health. She holds a Master of Science in Architectural Design from the Istanbul Technical University. For her thesis, she examined the spatial perception of individuals with autism and the impact of spatial elements on their cognitive mapping process. After graduation, she moved to Sweden in 2019 and collaborated with The Centre for Healthcare Architecture at Chalmers University of Technology. Currently, she works as a research assistant at The Center for Health Facilities Design and Testing (CHFDT) within Clemson University. 

Despite years of research being conducted in the healthcare design field, we still struggle to incorporate this knowledge into decision-making across all areas of policy and practice. Integrating the knowledge into practice is even more problematic in times of crisis. The systematic documentation and dissemination of existing and emerging networks and organizations in the healthcare design context and their activities could be extremely valuable to the field to support collaboration and information sharing during a crisis. Therefore, the primary aim of this paper is to explore the knowledge transfer process among healthcare design organizations and their target group(s) and the extent of their activities in response to the COVID-19 pandemic. In order to have a better understanding of the process, we studied three organizations actively engaged in the creation and/or dissemination of knowledge related to healthcare facilities design: one from the USA “organization A”, one from the UK “organization B”, and one from Sweden “organization C”. The primary data source included some literature covering elements of the knowledge transfer process on the inter-organizational level. The supplementary data are from individual interviews with key representatives from each organization. The core part of this paper discusses the organizations’ strategies and channels for knowledge dissemination. It also reviews the COVID-19 period, the associated challenges, and the organizations’ activities to respond to the situation during the pandemic.

13:40

AnneMarie Eijkelenboom

 

dr.ir. Annemarie Eijkelenboom (1971) – Architect (EDAC) / Head of R&D EGM architects 

TU Delft Civil Engineering 

The built environment has a significant impact on well-being and health. This is made clear by means of scientific research in the field of Evidence Based Design. As a project architect, I make use of the results of this scientific research; in addition I work on research projects. Precisely the link between theory and practice leads to the design of even better buildings. And this is what drives me: realizing a high spatial quality with a positive effect. 

A PhD study was carried out on comfort and health of workers in outpatient areas because hos-pital workers are generally less satisfied with comfort than patients and outpatient areas were understudied. To better understand differences in preferences and satisfaction of individuals, profiles were produced with Two-Step Cluster analysis, based on a questionnaire, responded by 556 outpatient workers, and building inspection of six hospital locations. Thereafter, interviews were performed to explain the preferences. As the COVID-19 pandemic started after produc-tion of the profiles, changes due to de pandemic were included. A gap between preferences and satisfaction was identified for all profiles. Also, those with similar preferences for social comfort (privacy, interaction, distraction) performed similar activities. Contact with others was for all profiles important, while satisfaction was overall high before the COVID-19 pandemic. Due to the shift to digital care during the COVID-19 pandemic, impoverished interaction was a main concern of the outpatient workers. In conclusion the profiles for social comfort show that preferences for social comfort are associated with work-related aspects and can change. The profiles may open a new horizon to accommodate for flexibility and variety beyond standardized solutions.

14:00

Nadine Fayyad

A workplace’s environment has a profound impact on mental health and wellbeing. Over the past decade, wellbeing research has grown in importance as it contributes to a person’s well-being, re-duces stress, and increases performance by reducing costs for business. Further, because of globalisation, short-term contracts, outsourcing, and mergers which have ravaged the workplace to date, employee psychological wellness levels were adversely affected. As a consequence, interior design has gained tremendous importance. It is now more important for interior designers to design environments aimed at fostering both physical and psychological wellbeing. The purpose of this pa-per is to explore the extent to which the physical environmental variables (e.g., layout) affect employees psychological wellbeing reporting on the findings of methods which included a systematic literature review, field observation, and an online survey. (25) participants who were chosen upon criteria of inclusion (i.e., UK worker) and exclusion (i.e., working remotely) in an open-plan office layout. Findings show participants responding positively to open layout; however, this may have negative effects in terms of privacy, control, and noise. Natural materials and elements were found to be a demand by employees as the majority claimed that nature affects their wellbeing positively.

Room A Stream user-needs– visual tools as boundary objects (3D) – Clarine van Oel

13:00

Maja Kevdzija

Dr.-Ing. Maja Kevdzija, EDAC is an Assistant Professor in Healthcare Design at the Faculty of Architecture and Planning at TU Wien, Austria. Her interest in rehabilitation environments developed during her Master Studies in Architecture at TU Delft. She continued research in this field and obtained her PhD at the Faculty of Architecture at Technische Universität Dresden, Germany. Her research study on mobility-supporting rehabilitation clinics for stroke patients was awarded several national and international awards, most notably the Healthcare Environment Award 2020 (USA), the 2021 European Healthcare Design Award in the Design Research category (UK) and the 2021 EDRA Certificate of Research Excellence (CORE) with Merit Status (USA). Her research work focuses on improving built environments for recovery after a stroke. 

There is a scarcity of studies that critically examine the shadowing method’s versatility and applicability to various research fields. Because it is a rarely used research method in architectural research, it has some distinct advantages and challenges in the healthcare context, primarily when used in patient populations. The two approaches to shadowing – systematically recording behaviour and qualitatively understanding roles and perspectives – show the method’s versatility to explore perspectives of different users in a variety of built environment settings. In a PhD research study investigating stroke patients’ mobility in rehabilitation clinics, shadowing was used in an exploratory way. In total, 840 hours were spent observing 70 patients in seven rehabilitation clinics. Different data types were collected, such as patients’ activities, interactions with the built environment, covered daily distances and most commonly visited spaces in their free time. The data collection procedure and the different collected data types are presented and discussed, together with the accompanying fieldwork challenges and strategies to analyse the collected qualitative and quantitative data. Shadowing was confirmed to be an appropriate approach for gathering insights on patients’ activities and experiences in healthcare settings, allowing for recording the events that might be missed using other methods. Furthermore, shadowing enables the inclusion of participants who have difficulties expressing themselves verbally, which helps explore various patient perspectives in healthcare environments. The extensive time investment for the participants, combined with the physical, mental and emotional toll on the researchers, might have limited the use of shadowing in healthcare settings.

13:20

Emma de Meester

I have been working in University Hospital of Ghent (UHG) since when I graduated with master ‘s degree in 2008 from the University of Ghent. The majority of my career I have been working on the High Care Neurosurgical ward. With the intention of building a new hospital and rearranging the campus of the UHG, the opportunity rose in 2019 to participate in a research projects. Participating as a screener for a scoping review was a first step. I belief this paper and participation in the congress will contribute to a grow in the field of research. 

Background: Research has shown the impact of hospital design on patient outcomes. There is a growing body of evidence how a patient room should look like from the designers, professional or patients point of view. However little research has brought the perspectives of these three user groups together. Aim: This paper aimed to describe the stepped process of stakeholders involvement when designing a patient room. Methods: A three phased study was set-up. First, based on literature, regulation and designer experiences, eight discrete choices were developed concerning the design of the patient room. Second, professionals, patients and visitors took part in an online video-animated survey representing the discrete choices. Subsequently, in a third phase, two mock up rooms were built to assess the functionality. Focus group session were conducted with purposively selected participants. Discussion: To involve the stakeholders’ perspectives into the development process is a time consuming approach. It contributes to identify principles on which patients’ and professionals’ preferences are based. It also enhanced the professionals’ commitment.

13:40

Anne Symons

Dr Anne Symons, Senior Research Fellow, the Bartlett School of Sustainable Construction, University College, London 

I am a healthcare architect with over 40 years experience in the design and construction of acute hospital facilities in Scotland and England. Following the completion of my architectural degree I worked on several small healthcare projects before I was the project architect and supervising officer on a major district general hospital. This enabled me to complete the full 360 degrees of the project cycle from initial design through to completion and taking lessons learnt through to the next project. 

At this point I undertook an MSc course in Construction Project Management, followed by an MSc in Planning Buildings for Health after which I worked as a Senior Design Manager for a major construction company involved in Private Finance Initiative Major Hospital Projects. I have led numerous clinical user group meetings during the early design stages, working closely with mechanical, electrical and structural engineers to deliver fully integrated projects and at the end of the project compliance checking to ensuring that the completed project has delivered the client’s expectations. 

Having combined academic and work experience throughout my career to widen knowledge I finally returned to academia to complete my PhD related to Healthcare Design Management and continuing with research at UCL. This research has involved post occupancy evaluations, literature review of operating theatres, off-site manufacturing projects and the study of diagnostic hubs situated within the community rather than in hospitals. 

There is an urgent need for further research in hospital design and delivery to understand the integrative, nuanced and intricate nature of healthcare project delivery and design management. Historically, each new hospital programme develops a new delivery model that takes a different approach to the management of design. However, this approach is not sustainable. Hospitals have a significant complexity, which may be impacted by role changes and procurement methods which can result in significant errors, costly delays and lack of ability to learn from failure. A retrospective abductive, auto-ethnographic case study approach was taken in the examination of five major hospital projects of similar size and complexity reflecting five temporal periods was carried out by a project architect who subsequently became a construction design manager spanning a career of over 30 years. This variant of action research involved a retrospective mode of abductive reasoning applied retrospectively. An approach to hypothesis testing (using literature) is used to explain and theoretically frame historical practices. It was found that National delivery models (and their change over time) have had a significant influence on hospital project delivery and particularly on design and engineering systems integration. The role standards have played in design have also played a significant role, and in part may have constrained innovation and unduly increased cost. Recommendations are made for a new integrated healthcare delivery model that supports an approach to innovative design and construction of new hospitals responding to advanced clinical and technology approaches.

14:00

Berit Ann Roos

 

Berit Ann Roos, Msc is currently director of the Academy of Architecture at the Hanze University of Applied Science in Groningen, Netherlands. She is doing a PhD with Prof. Mark Mobach, professor facility management at the Hanze University of Applied Science in Groningen and Prof. Ann Heylighen, professor architecture, at the KU Leuven. 

After being born 21 December 1969 in Switzerland, she finished high school and studied architecture at the Lucerne School of Engineering and Architecture. After her degree as an architect she moved to the Netherlands to get her master degree in architecture at the Technical University in Delft, cum laude. 

Her work experience consists of working as an architect in Switzerland, Russia and the Netherlands. In the Netherlands she has worked at the office of Abel Cahen in Amsterdam and spent 13 years as senior architect and managing partner at Onix architects in Groningen. In these years she won a series of awards for her buildings in the Netherlands and Germany, amongst them is the Dutch Design Award for interior space in 2013. Berit Ann Roos has also done some research on topics like: new sorts of school buildings, building for people with an autistic syndrome and creating a valuable living environment for intellectually impaired individuals engaging in behaviours that challenge. 

As an educator she has been teaching at different architectural schools in the Netherlands and given lectures and workshops in the Netherlands and Switzerland. Since 2014 she is manager of research and education and since 2017 director of the Academy of Architecture at the Hanze University of Applied Science. 

As a researcher she has conducted research and published on the question how architecture can contribute to the quality of life of intellectually impaired individuals engaging in behaviours that challenge. 

Aim. This study aims to identify ways that allow studying how intellectually impaired persons showing challenging behaviour interact with space, without impacting their daily lives. Back-ground. Research about space that better suits these persons’ needs is challenging to conduct, since they may have difficulties expressing themselves verbally and are extremely sensitive to-wards sensory stimuli. Therefore, researchers collecting data may be disturbing and intrusive, and requires great caution. Tapping into existing data may be a promising alternative. Residen-tial care organisations routinely collect data about residents during their regular work processes, such as personal information and incident registration. Also useful may be routinely collected spatial data, such as drawings and repair reports. This study explores how routinely collected data (RCD) can provide insight into how residents interact with space, without impacting their daily lives. Methods. We reflect on the possibilities of using RCD (related to resident or space) based on explorations in the context of a case study at a Dutch very-intensive-care facility. The da-ta were analysed to identify general patterns, such as locations with a high density of inci-dents/repairs and verified initial findings by member checking with staff. Results. The RCD ana-lysed provide a basic and relevant insight into incidents and repairs connected to challenging be-haviour. However, most data were neither complete or relevant for analysis. Therefore, we dis-cussed the RCD were with staff and only then it was possible to draw conclusions regarding rele-vance of RCD and the residents-space interactions. Conclusions. Only in conjunction with an ex-tended approach on member checking the use of RCD seems relevant. RCD have little meaning of their own. But the combination of RCD with member checking seems to provide insight into the in-teraction between residents and space, without interfering with the residents’ daily lives.

Room R inclusive design/health promotion – communal living (4A2) – chair: Ann Petermans

13:00

Ira Verma and Karin Høyland

The Nordic countries have a reputation for having both universal welfare systems and high housing standards. However, the demographic development and ageing in place policies bring challenges to the present housing and care services for the older population. During the last decades, there has been a significant decrease in the coverage of care for older people. This is related to the increase of older people as well as challenges related to the availability of the workforce and raising care costs. This development is leading to increasing demand for various supportive housing solutions for seniors and older people. The objective of this paper is to provide a comparative overview of existing housing solutions for seniors and older people in Nordic countries. The objective of the comparative descriptive analyses is to point out the challenges and future possibilities for housing. This is illustrated by some new cases all of them showing solutions that enable older people to continue being a part of city life in their own neighbourhoods. They also show a variety of solutions that at the same time gives possibilities to live in-dependently and live interdependent in different kind of co-housing and neighbourhoods. This paper highlights the need for a more systematic evaluation of housing solutions for older people across the Nordic countries, to be able to learn from each other and to be able to manage the impacts of the ageing society for the welfare system.

13:20

Gwendoline Schaff

Gwendoline Schaff is a PhD candidate in Architecture at the University of Liège (Team11 and Inter’act research groups) and at Hasselt University (ArcK research group), in Belgium. After a Master’s degree in Architecture, she obtained an Aspirant FNRS research grant to complete her PhD. Her doctoral research focuses on the architecture of non-institutional home for older people and explores the relationships between housing and the wellbeing of the inhabitants in later life. During three years, she conducted different field studies in Wallonia (Belgium), both with older people (to grasp their home experience) and architects (to grasp their design dynamics). She aims to understand how and when designers can intervene on older people’s home to improve the quality of their living environment and favor “ageing well in place”. 

A large majority of older people wish to live in non-institutionalized housing for as long as possible. However, current homes are generally not suitable for later life, leading us to rethink our living environments to support health and wellbeing. Architects, in that regard, have a key role to play. Yet, to date, they seem to have a limited knowledge of emotion-related users’ preferences, which could be the consequence of a frequent lack of care perspectives in design teaching, as well as a difficulty to pick up and translate research findings into practice. This study therefore sought to understand how (interior) architecture students design housing that facilitates ageing well in place, when they are prompted to consider older people’s needs/aspirations more holistically. We conducted design exercises with 16 students from two architecture schools and we fed their reflections with “theoretical key themes” and “personas”. These inputs were nurtured by a literature review on “ageing well in place” and focus groups organized with multidisciplinary experts. At the end of the exercise, the students completed a questionnaire to summarize their design considerations. The results focus on the preeminent spatial features designed by students to meet inhabitant’s needs, as well as some pedagogical aspects of the workshops. The paper finally concludes by recommendations to train future architects to design living environments with an eye for ageing well in place.

13:40

Birgit Jürgenhake, Peter Boerefijn

 

Birgit Jürgenhake, graduated in Architecture in Karlsruhe, Germany, and obtained her PhD from TU Delft, has lived in the Netherlands for 30 years. From a practicing architect (Mecanoo, Erick van Egeraat and KCAP(Kees Christiaanse Architecten) she developed into a teacher and researcher at TU Delft, Faculty of Architecture and the Built Environment (from 2004 onwards). People in our built environment are central to her. That’s why she works at the Faculty of Architecture at the chair of architecture and dwelling. Social issues form the basis of both, her education and her research. During her dissertation on the façade of the residential houses in the urban environment, she investigated who actually determines the façade: the architect, the government with its legislation, the culture, the ‘zeitgeist’ or the resident? Below more the conclusions of this thesis have inspired her later to work together with an anthropologist and to focus on the resident himself, who, in her opinion, remains underexposed when it comes to choices about housing and the living environment. 

In recent years, her research interest has mainly been the living situation of the elderly people in need of care in an inclusive living environment. She combines the method of observation, interviews and notes with the method of visual perception, for research. Her research is often combined with education. She collaborates with architects, anthropologists, managers, among others and medical professionals. An investigation is currently finished for ‘Design & Government’ about public space for the elderly, a collaboration of the TU Delft with Eindhoven University of Technology, Dr. ir. I. Ossokina. In collaboration with Habion, a housing association that specializes in housing for the elderly, Birgit developed, for four years now, the education and research program ‘Designing for Care’. From anthropological and participatory research on the daily patterns of the elderly, new design. 

 

This study focuses on research about the spatial and social living environment of elderly with care demand. It developed from the urge for new ways of thinking about the design of care for elderly in neighborhoods and houses. In a collaboration between an architectural school of education and a social housing association housing the elderly, an interdisciplinary research method to come to new models for elderly living was developed. The study describes the method and main findings. In the Netherlands the demographic transition to an aging society runs parallel with transitions in the policy and practice of elderly care. Due to a steep rise in the cost of care and a shortage of staff, care moves away from institutional buildings and organizations towards a more informal support network with professionals in the background. The research questions addressed in this study concern the everyday life of elderly needing care. Within a one-week stay in a nursing- or elderly care home, participating in the daily life, we aim to get answers through anthropological and par-ticipatory research to understand, document and visualize the needs and living conditions of elderly today. Finally, these data are translated into architectural design. We claim that the person whom we design for should be the first to meet and talk to. In that way we learn about their wishes, needs and capabilities. This argument was our starting point of collaboration. Our methodology leads to unexpected results. The study will show main findings and topics of discussion.

Berlage 2  Workshop and seminar on an academic network on healthcare environments design (ARCHnet) – chair: Göran Lindahl

A workshop and seminar on the research field of healthcare environment design. A key question is if we, the researchers at the conference, see a need and benefit for such a network. All conference participants that find this endeavour relevant are welcome to the discussion. (more info in the book of abstracts / to be linked)

To:
A workshop-based discussion on the research field of healthcare environment design. The main focus will be on approaches used and if there is any such thing as methods specific to research on design of healthcare physical environments, which these are and how they are structured. Inputs from participants in the workshop will be required. Most likely we are multi methods, multidisciplinary, transdisciplinary etc. which makes a clear cut one for all approach impossible. However, a platform for an academically based discussion on this would most likely support the development of research in the field of healthcare physical design and its conceptualization, execution, understanding of its effects etc. A key question is if we, the researchers at the conference, see a need and benefit for a research network on theory and methods related to the research field of healthcare physical design. An even wider approach to health and design of physical environments might either make a need of a network obsolete or even more crucial – let us discuss these matters. All conference participants that find this endeavour relevant are welcome to the discussion.

East Suite poster session 2 – chair: Greet Vos

13:00

Coen van den Wijngaart

Joseph Bracops: an urban hospital based on the sustainable principles of the circular economy

13:15

Coen van den Wijngaart

How does a large hospital act as a good neighbour?

13:30

Tara Veldman

 

Healing our space: how our environment influences our wellbeing; how we can design to heal

Managing Director | Principal | Health Sector Leader 

Tara is the Managing Director and Health Sector Leader instrumental in the expansion of BLP. She brings 25 years of experience and a dedication to designing a healthy world in a cross-section of spaces, including hospitals, health hubs, education precincts, high-tech research labs, and residential communities. 

Combining her interests in psychology, art, and architecture, Tara is fascinated by how buildings and spaces make people feel. Her passion for sustainable architecture is inspired by her time living in Australia, the Netherlands, Frankfurt, and the Middle East. These life experiences have driven her to create designed environments and places that work and complement their urban setting while using and integrating nature and the natural landscape where possible. 

Underpinning projects with Evidence-Based Design, Tara’s work exemplifies innovation, strategic thinking, and best practice. She is a regular contributor to health design conferences and seminars, presenting alongside some of the world’s most respected thought leaders in the sector both at home and abroad. 

Grounded in research and insight, Tara’s human-centred design approach and active stakeholder engagement allow the voices of those who will occupy the spaces to be heard. Design outcomes are considered and impactful and exceed both her clients’ and the end ‘users’ expectations. 

How does architectural design contribute to our overall feeling of wellbeing? How does design support physical, emotional, intellectual, spiritual, occupational, environmental, and social health? 

With the user of the environment as the focus, the design of healthcare, education and workplace environments can become places that support wellbeing in its many facets. 

DESIGN TOOLS FOR CONSIDERATION: 

  • Providing inviting social spaces, private spaces, and transition spaces – giving personal choice of environment.
  • Maximising natural elements: daylight, views, ventilation to trigger biological and psychological responses and extend experiences – human biorhythms respond to these elements.
  • Providing art, distraction, colour, and texture – has proven benefits in healthcare environments, such as reducing length of stay and medication use.
  • Design elements that engage all our senses – contributing to overall experience and memory.
  • ‘Atmospheric Inclusiveness’ * – for a paediatric environment that does not trigger feelings of exclusion for patients of any age, from newborns to young adults – combine all design elements to create a unified whole.
  • ‘Positive Distraction’ ** – for a paediatric environment, environmental features positively transform expectations of visiting the hospital to ignite the imagination and incite a desire to return.

By understanding the importance of the built environment and its impact on people, we can better design for healing and overall wellbeing. 

_____ 

* Article citation: McLaughlan, R. & Willis, J., “Atmospheric Inclusiveness: Creating a Coherent and Relatable Sense of Place for a Children’s Hospital,” Journal of Architecture (advance online publication, November 2021). 

** Article citation: Attractions to Fuel the Imagination: Reframing Understandings of the Role of Distraction Relative to Well-Being in the Paediatric Hospital 

13:45

Anneke Speelman

 

 

Residential care zones: an important aspect in future urban developments?

14:00

Carolina Kolodziej

 

Outcome and challenges using Behavior Mapping in therapy-cluster of radiotherapy department

Carolina Kolodziej is a research associate at the Technische Universität Dresden. She is working on her Ph.D. with the topic of “Healthcare Design for radiotherapy”. Addressing the complexity of the radiotherapy departments and the various user groups, she aims to develop typologies and planning requirements in correlation to the workflow, by investigating spatial constellations and cluster formations. Her interest in Healthcare Design developed during her master’s studies in architecture at the Bauhaus-Universität in Weimar. With her master’s thesis, she took a close look at the structure and workflow in departments of surgery, intensive care, maternity, and neonatal intensive care in German hospitals. As a research associate, she is also involved in teaching at the Chair of Social and Health Care Buildings and Design, where she co-established the Student Research Lab “ARCH 4 HEALTH”. With this lab, the educational concept of research-based learning is integrated so that the students are guided through their own small research study that leads to a collective publication. 

1) objective: For developing typologies and planning requirements for radiotherapy departments an analysis of settings, workflow, and pathways was conducted. Behavior Mapping in the cluster formation of therapy rooms was one of the applied methods. 2) background: The complexity of radiotherapy departments with different cluster formations and various user groups is a challenging endeavor. For evidence-based typologies on cluster and room constellations, various methods were conducted and evaluated on outcomes and challenges. 3) method: Aim of the method of behavior mapping was to document the travel paths of all users in the setting of the Therapy Cluster. The Therapy Cluster consists of the following rooms: a) hallway, for access to the cluster and connection to the waiting area; b) control room, where staff controls the radiation device and monitors the patient in the therapy room; c) changing cubicle for patients; d) anteroom, connecting all rooms in the Therapy Cluster; and e) therapy room, where cancer patients get their radiation treatment. For this analysis, each individual of all user groups was documented by time, pathway, objective, and incidents. 4) results: By observing and documenting the Therapy Cluster, individual travel paths, wayfinding challenges, workflow settings, and distances can be analyzed. Furthermore, path crossings of the same or different user groups can be acknowledged. The challenges of this method are the missing relevance of time and effectiveness in the workflow. Due to the wide variety of treatments performed in one observation phase, there is no possibility of comparing frequencies and timeframes of different analysis days or departments. 5) conclusion: Although the method of behavior mapping can show characteristics for travel paths and interaction, there is a limit on the comparability of time-dependent data and treatment methods that limit the results of the method. 

14.30-15.00 

coffee/tea break – (East Suite)

15.00-16.30

Conference closing panel discussion with invited panellists, chair: Clarine van Oel

  • Lex Burdorf, chair of the department of Public Health, Erasmus MC
  • Cristiana Ciara, partner and board member at White Arkiteker, artistic professor at Chalmers University of Technology
  • Nico van Meeteren, executive director of Health~Holland and professor at Erasmus MC
  • Ann Petermans, assistant professor at the Faculty of Architecture and Arts at Hasselt University

introduction to the ARCH24 conference theme by prof. Ira Verma and/or prof. Laura Arpiainen from Aalto University, and closing remarks

16.30-17.30

Networking during farewell drinks & bites

Day 3 (Wednesday August 24) Optional tours

Amphia hospital and Zierik7 tour
AM_A ZigZag 03
Tour to Dolf’s Room, ZigZag and Wooden Forest
Tour to the Drive-in OR (Reinier de Graaf hospital), Orthopaedic Clinic (HAGA), and Rosa Spier House