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functionality and humanity

December 12th, 2022

This could be the start of a blog about gender bias in design but it isn’t. Last week I had a routine mammogram for the first time. The mammogram machine used was taller than most women and was a chunky construction of clean lined cream and black metal. To x-ray a breast, it has a device called a “bucky” which is two large moveable plates that clamp the breast and flatten it – it rotates so it can clamp both vertically and horizontally. It also moves up and down to address people of different heights. It is an entirely functional machine. It squishes the breast into a pancake for a few seconds and then releases after the x-ray is complete.

Breasts are all shapes and sizes, but one thing they are not is flat like pancakes, unless you are very unlucky. My mammogram was routine and voluntary and the lovely nurse who did it was at pains to tell me that I did not have to do it, because it clearly hurts.

It is really tempting to explore gender issues here – would men tolerate testicle screening that involves flattening their balls into pancakes? – but the less obvious discussion is about functionality versus humanity in healthcare design.

Functionality in design is essential but should never be the only consideration. In 2017 the mammogram machine was redesigned with smooth edges, a “spa-like” exterior, a plastic “ shawl” and a much smaller softer bucky. The new design is much smaller, less intimidating and more comfortable – it performs its medical function whilst offering reassurance, comfort and privacy.

At erz we design outdoor spaces for healthcare – although often what we are actually doing is redesigning single function outdoor spaces that have been built to house cars, get folk from A-B, allow ambulances to move unimpeded – but which have removed any vestige of multifaceted humanity from the experience of visiting a hospital or health-centre. 

As an example, when I was with my friend D as she had her son at a Glasgow maternity unit, she needed to walk to keep comfortable, so we were told to go and walk around the campus but not to go to far as her waters had already broken. We went outdoors and spent the rest of the day doing laps of the packed bitmac car park, because there was no other place to go. Another example recently, was a nurse I spoke to recovering from 15 weeks in ICU with Covid, who then spent another 15 weeks in a single room in the recovery ward with a view of an empty car park and no visitors. She said the second 15 weeks were what did in her mental health.

These are examples of single function design. The outdoor spaces are not designed in an integrated way. When I am explaining what clinical and therapeutic landscapes should do, I say each intervention should have at least five benefits. A car park at a maternity ward could so easily have a beautiful path around and through it for doing laps when in labour – and seating, biodiversity, SuDS and artworks. Better still - ditch the car park altogether and create multifunctional therapeutic greenspace for exercise, labour, mums groups, physio, OT and rest and respite.

It was therefore with genuine interest that I read the recently published Scottish Government and NHS Assure Climate Emergency and Biodiversity Strategy for the next four years. The NHS in Scotland is targeting net zero by 2040. The Lancet describes climate change as the “greatest global health opportunity of the 21st Century” and this document recognises that climate change is inextricably linked to health inequality – one of Glasgow’s biggest issues. It is a really good document exploring issues as diverse as the disposal of anaesthetic gases to the need to embed active travel.

The inherent challenge lies in joining things up in an organisation full of embedded silos. Greenspace is an effective mechanism for integrated thinking because it can deliver benefits to almost every aspect of the Government policy:

  • Active travel
  • Biodiversity
  • Waste management
  • Water and flooding
  • Staff wellbeing
  • Community health
  • Exercise and physical therapies
  • Health inequalities
  • Air quality
  • Microclimate
  • Carbon capture
  • And so on…

And yet there are not any landscape architects at policy level within the health service in Scotland. The teams at the top are mostly led by project managers and architects. We are not going to be able to deliver function and humanity well without an understanding that the spaces in between buildings are more important than the buildings themselves – landscape being the very air we breath, the food we eat, the energy we use, the spaces and places that allow us to travel, the places in which we communicate and meet others, where community is formed.

Landscape is a dynamic network that allow us to think connectively and successfully create multifaceted designs that deliver both functionality and humanity for the good of us all and the good of our planet. Landscape is a key to unlocking the wider potential of the NHS.



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