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Picture the last hospital you were in – there are reasons it looked like that. At any moment, a healthcare setting is balancing the needs and priorities of patients, clinicians, management, and administrative and support staff. Efficiency, servicing, privacy, infection control, comfort, safety, and cost add further complexity. Design guides, evidence-based solutions, and building regulations are guide rails for the architectural process. But established processes often engender established solutions.
Now, picture an oncology day ward. A row of treatment chairs and drip stands separated by curtains, buzzing overhead lights, nursing staff filling notes on their knees. But what if those treatment chairs were more comfortable, more functional? What if jump seats [1] created useful spaces within a corridor, taking advantage of city views while maintaining required clear widths? What if instead of tired divider curtains, privacy came in the form of beautiful, artist-designed screens?
This is the kind of 'fresh perspective' design students offer, says Cathal Mac Dhaibhéid, doctor and 2022-23 Innovation Fellow with HSE Spark Innovation. HSE Spark is a frontline, staff-led initiative to improve healthcare using design principles and innovation methodologies [2], which has run many successful partnerships with students of design. Mac Dhaibhéid cites the example of Interaction Design Master’s students who whittled a 'fifty or sixty' page nursing admission form to just twelve pages, through a series of user interviews and prototyping. 'These students look at problems through a design lens', says Mac Dhaibhéid, 'and they’re not jaded by working in the public health system'.
But up until the recent ‘Healing Spaces’ elective – delivered with TU Dublin School of Architecture, Building and Environment (SABE), the Mater Transformation Team, and the Mater Hospital’s Oncology Day Ward and Inpatient Unit – HSE Spark hadn’t collaborated with architecture students. Like many good ideas, Mac Dhaibhéid’s engagement with schools of architecture was borne of frustration. Galvanised by the spaces he encountered in medical practice – some illogically laid out, some poorly functioning, some merely uninspiring – and Christine Nickl-Weller and Hans Nickl’s 2013 book, Healing Architecture [3], he became increasingly interested in the therapeutic potential of space, and the missed opportunity that is unimaginative design. He says, 'You have all these advances in how cancer is treated, but where it’s treated hasn’t really changed'.
For Emma Geoghegan, architect and Head of Architecture at SABE, Mac Dhaibhéid’s proposal to collaborate was too good to miss. There are established postgraduate programmes in healthcare architecture, but a focused module on healthcare spaces is absent from most undergraduate architecture syllabuses. Geoghegan notes that this is a 'gap', saying the design of healthcare environments is 'not just about typology, it’s about how you engage with people'. User engagement is key to the profession of architecture, and though many final-year architecture students have worked in practice, few have much experience of engaging with end users – this task generally falling to more senior team members.
In designing and delivering ‘Healing Spaces’, it made geographical and ideological sense for Geoghegan and Mac Dhaibhéid to work with the Mater Hospital. The hospital is within TU Dublin's direct community, and 'Community Engaged Research and Learning' is a stated aim of the university [4]. Critically, the Mater is, according to Mac Dhaibhéid, 'fertile ground for doing things a bit differently', as evidenced by the existence of Mater Transformation, an embedded unit within the hospital that’s dedicated to working with frontline staff to co-design and deliver change [5].
Regularly collaborating with both HSE Spark and the National College of Art and Design, Mater Transformation has extensive experience of running collaborative problem-solving processes. ‘What we’ve done is set up structures that can bring people together,’ says Aileen Igoe, Mater Transformation’s Lean and Systems Thinking Lead. These structures were critical to tackling potentially sensitive issues related to working in a functional hospital, such as GDPR and access, says Geoghegan. 'Things that might normally be challenging, we were able to resolve very quickly' [6].
Healing Spaces 'definitely felt like something special', Igoe says. Students were tasked with the redesign of the Mater Hospital’s Oncology Day Ward and Inpatient Unit, which sits within a building that’s less than ten years old, and is, as Igoe – who studied architecture – points out, generally well designed and considered. But the service has expanded, and healthcare architecture is often constrained by budgets, timelines, and HBN (Health Building Notes) standards [7]. Whereas by listening very carefully to staff needs, and through them, the needs of the patients [8], the SABE students gained a 'nuanced understanding of service' that allowed them to achieve 'the attention to detail that you might see in a domestic extension'.
Geoghegan, Mac Dhaibhéid, and Igoe all stress that the project’s success would not have been possible without the enthusiasm and openness of the Mater’s 'fantastic' clinical staff. Alongside oncology staff consultation, the SABE students received expert advice from Jennifer Whinnett, Senior Healthcare Planner at Guy’s and St. Thomas’ NHS Foundation Trust; Ailish Drake, an architect and landscape designer at Drake|Hourigan Architects with extensive user engagement experience; and Clare White, Director at O’Connell Mahon Architects.
Nine students – eight studying architecture and one studying interior design – [9] worked collaboratively, each tackling different issues to develop a cohesive solution. Daniel Herbst considered how spatial efficiency could be maximised to create more staff workstations. Alannah Hayes redesigned the bridge corridor to incorporate glare-free recessed lighting and jump seats with views of the city. Balancing the therapeutic value of nature, against the maintenance and infection control issues that planting brings [10], Isobel Walsh proposed commissioning Irish artist Sasha Sykes [11] to make operable resin privacy screens, embedded with flowers. The breadth of the students’ thinking surprised and impressed Mac Dhaibhéid: 'The final presentation was incredible'.
It’s likely that Healing Spaces will have a life beyond the module’s twelve-week duration, both in terms of the students’ actual proposals and in fostering future collaborations. Geoghegan says that within a few days of the students’ final presentation, Tracy Fitzpatrick, the Mater’s Directorate Nurse Manager for cancer, had sourced quotes for different aspects of the proposals: 'That really impressed me'. This being Mater Transformation’s first time working with architecture students, they don’t have established pathways for delivering architectural projects, but Igoe’s undaunted: 'We’ve manged it with NCAD in other design disciplines, and there’s various funds we can apply to'. She stresses that they’d like to keep the SABE students involved in some way, as the designs are theirs. Of working with Mater Transformation, Geoghegan says, 'It feels like a natural partnership for SABE. My hope is that we will continue to run an elective like this and build on it'.
As for the module’s first run, the SABE students have shown that, with focused, informed imagination, a healthcare environment can be both clinical and beautiful. An oncology ward environment can stimulate and comfort patients who may be there for extended periods, distressed, fatigued, or bored, awaiting or receiving treatment. There is so much energy and innovative thought in architecture schools, often applied in the abstract. Healing Spaces allowed students to channel their energy and creativity towards 'something really useful"', says Geoghegan.
One Good Idea is supported by the Arts Council through the Arts Grant Funding Award 2024
1. ‘Jump seats’ are fold-down seats for temporary use, as found on the flight deck of aircraft.
2. Health Service Executive [website] https://healthservice.hse.ie/staff/spark-innovation-programme/about-us/, (accessed 7 February 2024).
3. C. Nickl-Weller and Hans Nickl, Healing Architecture, Salenstein, Braun, 2013.
4. Technological University Dublin [website] https://www.tudublin.ie/connect/communities/slwc/, (accessed 6 March 2024).
5. Mater Transformation [website] https://www.matertransformation.ie/,(accessed 29 February 2024).
6. Igoe’s colleagues, Dr Úna Cunningham (Head of Transformation) and Siobhan Manning (Service Innovation and Design Lead) were instrumental in planning and facilitating the module.
7. Health Building Notes give best practice guidance on the design, planning, and adaptation of healthcare facilities.
8. It wasn’t possible for students to engage with patients on this first iteration of Healing Spaces, but Mac Dhaibhéid, Geoghegan, and Igoe all note this as a priority for future projects.
9. The students involved were Gabija Baltrunaite, Aoibhe Burke, Jake Coleman, Alannah Hayes, Daniel Herbst, Anastasia Hlibiciuc, Samuel Owen, Nicholas Tannam, and Isobel Walsh.
10. ER. Timko Olson et al, ‘Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review’, Int J Environ Res Public Health , vol. 20, no. 3, 2023.
11. To contact Sasha or learn more about her work, visit: https://www.sashasykes.com.
A town stretches itself towards fields beyond. At its edge, a low, long building is beached parallel to a road that heads away, towards somewhere else. Marooned in a sea of tarmac, the building’s facade is repetitive. Windows reveal the backside of photo frames and potted plants. A large sign at the gate proclaims the building’s function. Its aged residents listen to the drone of passing traffic.
At another end of a town, identical low-pitch warehouses hold production lines of pharmaceutical and engineering innovations, small businesses, and product showrooms. One building in their midst marks its difference by solid fencing painted brightly to look like giant multi-coloured pencils. At regulation height, the fence conceals one-, two-, and three-year-olds as they play in the narrow space between it and the rectangular-box building. Their squeals spill over the fence.
A town. Any town. Many towns. Such scenarios repeat.
Within these nursing homes, crèches and early years centres, there are incredible nurses, carers, minders, and educators supporting the needs of our youngest and oldest citizens. Their commitment is humbling, their contribution to their communities often greatly undervalued [1]. A profound shift has, over decades, taken place in terms of formerly intergenerational relationships of care, likely due to society being tied by the structures and priorities of capitalism. Our built environment reinforces this separation of generations with institutional typologies that silo us in terms of age and mobility, at either end of our lives, the stages at which we are potentially most vulnerable. Whilst this might make sense for many rational reasons, in this separation of old from young, we have lost something of what it means to be human.
We must question whether these built forms of care, located often at the edges of our settlements, are really the spatial models that we wish to replicate again and again and again. How, instead, can architects, urban designers, and planners generate proposals to enable clients, governments, and citizens to recognise that in the built environment there is so much potential for the establishment of alternative scales and spatial relationships in how we care for our youngest and oldest. Whilst there are notable well-designed examples of care facilities, all doing tremendous work, we seem to be somewhat unquestioningly translating commercially viable, increasingly larger models of care provision into monolithic building types. The rate of closure of smaller and medium-sized nursing home and childcare providers, often family-run, is concerning [2]. The vulnerability of the nursing home typology was highlighted, with profound trauma, during the recent pandemic and, as Fintan O’Toole recently reminds us, we must not forget this so readily [3]. Indeed, it is welcome to note that in the 2023 Draft Design Guide for Long-Term Residential Care Settings for Older People the Irish Government commits to “supporting older people to remain living independently in their own homes and communities for longer” [4], and recommends the household model of long-term residential care, with maximum twelve residents per household [5].
This is a time when Ireland’s ageing population is projected to continue rising for the next three decades [6]. It is a time where childcare providers are under sustained pressure and can barely match the demand for places. It is a time where the government’s Town Centre First policy aims to “regenerate” town centres [7]. The opportunity is ripe for an integrated approach.
There are emerging examples of relationships between such care settings. Here and there in Ireland, preschooler groups make weekly visits to their nearby nursing home in a pedagogical strategy known as intergenerational learning [8]. Research from the US notes that the co-location of childcare and elder care helps “both generations thrive” [9]. The work undertaken by the two-year “TOY – Together Old and Young” project, across seven European countries including Ireland, facilitated “young children and senior citizens learning and developing in intergenerational community spaces” [10]. The built environment could facilitate these fruitful exchanges more easily. This text, then, is a call for spatial and design leadership to explore, develop, and promote the potential of this intertwining and integration. Both childcare and elderly care are understandably highly regulated sectors. To bring these care settings together or alongside one another into a new architectural typology – a model approach that could be replicated across towns, villages, and city neighbourhoods – a vision is needed that looks beyond the inevitable challenges that must be overcome. Architectural design is well placed to explore and develop such a vision, a blueprint that can be worked towards through policy and planning shifts. A professional design ideas competition could be one such starting point, as could advanced university design studios, each accompanied by public exhibition, publication, and advocacy.
As babies and young children, our small worlds incrementally expand. In our older age, most often, our worlds gradually shrink. At either end of this circle of life, our encounters with one another, then, are more pronounced, more significant. The sense of touch has profound healing capacity: holding the hand of an older person, hugging a distressed toddler. Staying present. Taking time. Thus, though physical needs may be wildly different, for a number of years at our youngest and our oldest ages, like the intersections of a Venn diagram, there are substantive parallels in our social needs.
The simplest encounters may make for the richest shared intergenerational experiences: observing the daily passing routes of a local cat or fox. Counting the dots on a die and the squares on the board to the next ladder or snake. Playing the role of customer at a make-believe café. Tending, together, to the cultivation of flowers and vegetables. Hearing, when confined to lying in bed, the sounds of playing and chattering. Watching. Listening. Trusting.
Enabling such opportunities on a regular basis offers a sense of purpose to both age groups. For older people, the anticipation of each next encounter with non-judgemental, imaginative, and endlessly curious young children is a powerful stimulus. For the youngest, these exchanges develop instinctive compassion for others from childhood. We can make design decisions so that, even at intimate scales in urban contexts, occupants young and old are facilitated to sustain deep connections with the more-than-human world, ensuring its natural cycles are perceptible in long-term residential environments for older people and in long-hours daycare for young children.
The Dutch typology of the hofje, typically “a collection of identical cottages grouped around a communal garden” or urban courtyard, “built with private capital, originally to provide free housing for the elderly poor who could no longer provide for themselves” [11] is a beautiful fusion of social purpose and architecture, and an example that could inform this intergenerational proposal.
Through adjustments in Irish policy and planning, and with thoughtful design across all scales, keeping generations visible and connected at the centre of our towns and neighbourhoods would, via the ordinariness of the everyday, harness the potential of the built environment to foster empathy, the core of our humanity.
In this article, Anna Ryan Moloney argues for the caring potential of new spatial relationships between society's youngest and oldest members.
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Already functioning as a successful reuse of an old industrial infrastructure without any intentional architectural intervention, the Royal and the Grand Canals are likely our largest, and certainly longest, public spaces in the city. From the moment the sun emerges in spring, to late autumn, they bustle with activity, hosting commutes, walks, runs, and late-night gatherings. These truly vital spaces were gifted to the city by the cyclical nature of industrial change. Decommissioned, they have persisted throughout the success and decline of Dublin, fostering public social space which is increasingly rare within the stoic red-brick city centre. Our canals offer roots from which civic and cultural spaces may grow.
A reflection from John Banville’s Dublin memoir, Time Pieces, illustrates the canals’ enduring appeal:
“… by the canal at Lower Mount Street Bridge and watched a heron hunting there beside the lock . .. I told her I loved her, but she closed her eyes and smiled, with her lips pressed shut.”[1]
Dubliners display a love for their city on these banks every summer, and yet it goes on unrequited. Public spaces adjacent to the Grand Canal such as Portobello Square and Wilton Park are being eroded by speculative demand, despite their evident popularity in a city thirsty for space. Portobello Square is a rare open public square directly abutting the canal, so intensely popular at times that the authorities see no other crowd control option but to physically impede the public from occupying it. In 2021, Portobello Square was boarded up and temporarily privatised in return for an investment in its redevelopment.[2] This was a convenient alignment of interests, as the space had also been fenced off the previous year to prevent anti-social activity.
The Grand Canal’s banks often do not inspire hope in the here and now, instead becoming a discomforting reflection of our town and country. The most recent fencing off of the canal to prevent its occupation by unhoused asylum seekers [3] proved unpopular, not solely for its inhumanity, but also its cost. Hope, however, lies within this provocation; the moment of inflection should be seized to offer a new scale of social and cultural infrastructure to the city. The canals are crying out for rejuvenation through a top-down shift in thinking, to irrigate the city with public cultural spaces, foster more pace for unexpected encounters and more feed for the friction and forum that cities are ultimately about. Another greenway won’t activate the canals’ multitudinous potential to invigorate their dense urban surroundings.
Plans released by Waterways Ireland at the beginning of this year set out to enhance public seating, increase accessibility, and combine two existing narrow pathways to form one wider path.[4] Unfortunately, these proposals fall short of the ambition these urban spaces so desperately need. Combining pathways may optimise the space as a liminal venue of commute, yet may equally alienate those who use the bank as a space for slower, un-programmed occupation. Addressing the challenge of these banks’ inability to support year-round activity within their current footprint seems quite the daunting task.
The canals would benefit from receiving intentional interventions beyond their immediate banks to amplify their use. Where possible, the tarmac roadways lining the canal banks should be reappropriated in service of the canal corridor, providing and connecting into adjacent cultural spaces. In King’s Cross in London, a sculpted mediation of the streetscape down to meet the water’s edge becomes seating for an outdoor cinema during summers[5], and in Paris, new businesses are opening in alcoves along the Seine, unlocked by the riverside’s pedestrianisation.
One thing has become abundantly clear, engagement in this issue should not be the sole task of Waterways Ireland. At minimum, council authorities should engage with W.I. to support their common ground. As it stands, similar to the redevelopment of Portobello Square, the current W.I. proposal for the Grand Canal’s banks involves a public private partnership, with IPUT Real Estate part-funding the works to the canal banks.[6] Unfortunately, investment of substantive urban change always seems to lie beyond the remit of the local authority, Dublin City Council.
When the building of the Grand Canal was commenced by the Board of Inland Navigation almost 270 years ago, it was government founded, funded and led.[7] Dublin City was building much of what we now see as its most definitive urban fabric, public and private, at a time when architectural neo-classicism proliferated with bold metropolitan might. The Rotunda, Grattan Bridge, Parnell Square, and Gandon’s Customs House, are just some of the iconic city elements built in this time. Perhaps in our government’s present moment of liquid economic abundance, we should aspire to a new era of bold urban thinking; a new scale in what we demand from our city; and, ultimately, in what we propose that our city becomes. The canals are a good place to start. Their waterway function now secondary, the city should lean in, commit to the development of this deeply urban space, and allow the future of the canals to define Dublin anew.
Dublin's canals, their original function now secondary, have untapped civic and cultural potential, proposes Peter O'Grady.
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Curated by Nuno Grande and Roberto Cremascoli, the Portuguese pavilion at the 2016 Venice Architecture Biennale exhibited photographs of Alvaro Siza meeting, in their homes, inhabitants of housing he had designed, many decades earlier, in various European cities. It included Schilderswijk in The Hague, designed between 1984 and 1993 for immigrants from Turkey, Morocco, Cape Verde, and Suriname. The design process of Schilderswijk included the construction of full-scale models to demonstrate Siza's plans to future inhabitants and to solicit their feedback. Resulting layouts include a sliding door that enables the apartments’ living spaces to be divided into public and private zones – the latter providing a realm into which Muslim women can retreat. Recognising, listening to, and designing for ‘the other’, at Schilderswijk Siza created housing that could be inhabited in multiple ways.
When, during construction, he was invited to present the project in the Berlage Institute, a conversation ensued that can be analysed through De Carlo’s triad of publics [2]. The presentation itself was addressed to an architectural public. A member of this first public, Herman Hertzberger, pointed to the second – the client. Siza’s housing in The Hague was commissioned by a city council engaged in the urban renewal of a district in which 46% of the population originated from outside Europe (rising to 93% by 2016) [3]. Hertzberger objected to Siza’s spatialisation, within Dutch social housing, of traditions at odds with that nation state’s ambivalence towards cultural, religious and gender differences. He evoked a homogeneous welfare state coming to an end; Siza had been approached by a local council deliberately seeking out an architecture open to immigrants’ requirements. At stake within the conversation was the architect’s responsibility to these immigrants, the project’s instantiation of De Carlo’s third and most elusive public: buildings’ users. Often unknowable to the client, it is a public with whom, in ways that range from the sincere to the performative, architects occasionally overtly engage in discussions about architecture. However, it is simultaneously a public with whom, through their design of ordinary environments, architects habitually engage, in an indeterminate, intimate manner.
During his 2016 visit to Schilderswijk, Siza met its original residents, but also newcomers; people he could have encountered during his participative workshops, but also people unborn when he was designing the scheme. What compelled Grande and Cremascoli to organise these encounters? What relationship was explored in the ensuing photographs? In what way is Siza connected to the current inhabitants of his buildings, and they to him? Recent analysts of the architectural design process have resorted to the spectral when describing how architects imagine the future inhabitation of their buildings. Paul Emmons suggests that, through the act of drawing, architects project an ‘imaginal body’ or ‘skeleton self’ into the spaces they propose [4]. For Beatriz Colomina and Mark Wigley, architects’ assumptions that inhabitants will, in some measure, be formed through being in their spaces, necessarily reduces them to shadowy, ghostly figures; the inhabitants do not yet exist [5]. The Berlage conversation between Hertzberger and Siza indicated a shift in European architectural culture, away from the relative certainties of designing for the default subject of the modernist welfare state, towards the more onerous task of designing for a postmodern heterogeneous public. Celebrating the newly unknowable public emerging in the 1980s and 90s as differences in gender, class, culture, and race were increasingly acknowledged, Rosalyn Deutsche repurposed the idea of the ‘phantom public’ in her argument – validated in works such as Schilderswijk– that this unknowability was generative rather than problematic [6].
For the architectural public of a Biennale, some of the potency of the 2016 photographs rests, I think, in an intimation that they capture Siza encountering the everyday, corporeal manifestation of his phantom public. During an interview, Yüksel Karaçizmeli, a Turkish long-time resident of Siza’s Bonjour Tristesse housing in Berlin, asked Esra Akcan to thank the Portuguese architect for the design of her living room [7]. This would suggest that the Schilderswijk photographs might also record the inhabitants (similarly residents of authored architecture) meeting a person heretofore phantasmic in their lives. In my interpretation of them, the images of duffle-coated architect and tea-serving hosts (perhaps too cosily) register architecture as the site of a multi-layered human relationship between designer and inhabitant that persists across space, time and states of being.
Colomina and Wigley propose that design is a practice that seeks to negotiate ‘the indeterminacy of the human’ [8].With the advent of Artificial Intelligence (AI), it is becoming imperative that architects articulate the critical role of human agency and indeterminacy in design, and develop methodologies that demonstrate to themselves, clients, and the general public the discipline’s capacity to sensitively create social realms. These methodologies will presumably harness the capacities of AI (to, for instance, enable the observation of ‘agent populations’ navigating simulated buildings) [9]. But, drawing lessons from architecture’s recent history, the use of AI should be tempered by a scepticism towards any certitude latent in such methods. Projects such as Schilderswijk suggest that robust architecture emerges from design processes involving consideration of and openness to the mysterious lives of others. I believe that such architecture is founded upon a resolution to work, with and through uncertainties, towards the establishment of a human relationship with De Carlo’s utopian phantom public – all those people who use architecture.
In this article, Brian Ward argues that the best architecture is made through design processes that consider the heterogenous and mysterious lives of all the people who use architecture.
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