We were in Barcelona last month with our two favorite architects, Julia and Elliot. Of course, we wanted to see the many buildings created by another favorite architect, Antoni Gaudi. A friend also clued us in that, if we wanted to see some really good architecture, we shouldn’t miss the Hospital de Sant Pau.
I enjoy discovering cities but had never thought about visiting hospitals as part of a tourism agenda. Hospitals seem very functional and efficient and somewhat drab. They also look pretty much alike whether you’re in Denver or Paris or Bangkok. They seem to be built for the benefit of the medical staff rather than the patients.
So I was very surprised to find that the Hospital de Sant Pau contained some of the most beautiful buildings I’ve ever seen. The hospital dates to 1401 but the major complex that we visited consisted of about a dozen buildings constructed between 1901 and 1930. The Catalan architect Lluis Doménech I Montaner designed the entire campus, which today claims to be the largest art nouveau site in Europe. The campus is like a fairy tale – every which way you turn reveals something new and stimulating. (My photo above barely does it justice).
(The art nouveau campus was a working hospital until 2009 when it was replaced by a newer hospital – also an architectural gem – just beside it. The art nouveau campus is now a museum and cultural heritage site).
As I wandered about the campus, I thought if I were sick, this is the kind of place I would want to be. It’s beautiful and inspiring. That led me to a different question: Can the architecture of a hospital affect the health of its patients? The answer seems to be: Yes, it can.
The earliest paper I found on healing and architecture was a 1984 study by Roger Ulrich published in Science magazine. The title summarizes the findings nicely: “View Through a Window May Influence Recovery from Surgery.” Ulrich studied the records of patients who had gall bladder surgery in a Philadelphia hospital between 1972 and 1981.
Ulrich matched patients based on whether they had a view of trees out the window or a view of a brick wall. He studied only those patients who had had surgery between May and October “…because the tress have foliage during those months.” He also matched the pairs based on variables such as age, gender, smoking status, etc. As much as possible, everything was equal except the view.
And the results? Patients “…with the tree view had shorter postoperative hospital stays, had fewer negative evaluative comments from nurses, took fewer moderate and strong analgesic doses, and had slightly lower scores for minor postsurgical complications.”
Ulrich’s study (and others like it) has led to a school of thought called evidence-based design. Amber Bauer, writing in Cancer.Net, notes, “Like its cousin, evidence-based medicine, evidence-based design relies on research and data to create physical spaces that will help achieve the best possible outcome.”
Bauer cites Dr. Ellen Fisher, the Dean of the New York School of Interior Design, “An environment designed using the principles of evidence-based design can improve the patient experience and enable patients to heal faster, and better.” Among other things, Dr. Fisher suggests, “A view to the outdoors and nature is very important to healing.” It’s Ulrich redux.
I’ll write more about evidence-based design and the impact of architecture on healing in the coming weeks. In the meantime, put a vase full of fresh flowers beside your bed. You’ll feel better in the morning.
Some years ago, on a business trip, I checked into a hotel that had just implemented a new computer system. I asked the desk clerk how he liked it. He responded very positively: “It’s great. It’s so much better than the previous system.” He smiled broadly and spoke enthusiastically. I assumed that he was telling the truth.
I also noticed some telling details. He had to bend far forward to reach the keyboard. Then he had to tilt his head back to see the screen. It looked awkward to say the least. He couldn’t make eye contact with me and use the system at the same time.
More problematically, the system was rigid and field-oriented. The screen contained many fields, not all of which were necessary for each client. But you couldn’t skip a field. To get from Field A to Field Z, you had to navigate sequentially through Field B, then Field C, and so on. The poor guy must have hit the Return key a dozen times while checking me in. He couldn’t check me in and have a friendly conversation at the same time.
I noted two things about the situation. First, the man seemed genuinely pleased with the new system. He recommended it without reservation. (No pun intended). Second, the system really wasn’t very good. The man didn’t realize what he might have had.
I also thought about how I might act if I were an executive at the hotel company. If I listened to what the desk clerk said, I would congratulate the IT department, maybe give out a bonus or two, and move on to the next problem.
But if I looked instead of listening, I might have had a very different reaction. The system was awkward, physically uncomfortable, and not conducive to good customer communication. I might not have torn the system out, but I certainly would have requested an upgrade.
This is a pretty good illustration of the difference between seeing with your mind and seeing with your eyes. The desk clerk was seeing with his mind. He had a mental image of the old system (“clunky, user hostile”) and of the new system (“much improved”). He didn’t see what he was actually doing. He didn’t perceive any shortcomings because he was comparing it, not to an ideal system, but to an old system.
A good observer, on the other hand, would not compare the system to preconceived notions. A good observer would have no preconceived notions. She would merely observe and identify problems and opportunities.
My experience reminds me of the women who designed the Volvo concept car some years ago. If I were designing a car, I would assume that it “should” have a hood (bonnet) that opens. After all, all cars have hoods that open. There must be a reason. That’s a notion that I see in my mind’s eye, not in my physical eye.
The Volvo designers, on the other hand, simply observed how people used their cars. They noted that drivers rarely open the hoods. Indeed, they do so only to add windshield washer fluid. The designers asked a simple question: Why bother? They put a fluid filler opening on the outside of the car and simplified the entire front end of the car by eliminating the openable hood.
The designers created a car that is simpler, cleaner, lighter, and stronger. That’s good design. It comes from seeing the world as it is, not as it’s assumed to be.
When I was in graduate school, I got a heavy dose of systems thinking. The basic idea is to take a problem, break it apart, and build it up. Let’s say I’m building a house. The house clearly is a system unto itself but we can also break it into subsystems — like plumbing. Plumbing is a logically coherent system with specified inputs and outputs. We can further deconstruct plumbing into more specific subsystems, like sewage versus potable water. As we deconstruct systems into subsystems, we look for linkages. How does one subsystem contribute to another? How do they build on each other?
We can also build upward into larger systems. The house, for instance, is part of a neighborhood which, in turn, is part of a city. The neighborhood also has wastewater systems and electrical systems that the house needs to connect to. If I want to get my mail delivered, it also needs an address — part of a much larger system of geographic designators.
It turns out that systems thinking is a pretty good way to build computer programs. A subroutine that calculates your sales tax, for instance, has specified inputs and outputs. It’s not logically different from a plumbing system. In either case, we start with a problem, break it down, build it up, and find a solution that fits with other systems. Note that we start with a problem and end with a solution.
When Elliot went to architecture school, he got a heavy dose of design thinking. He’s now light years ahead of me. (Isn’t it great when your kid can teach you stuff?) I still find design thinking challenging. I think that’s because I was so heavily invested in systems thinking. Frankly, I didn’t realize how much systems thinking influenced my perspective. It’s like culture. You don’t recognize the deep influence of your own culture until you visit another culture and make comparisons. As I learned design thinking, I realized that there is a whole different way of seeing the world.
The trick with design thinking is that you begin with the solution and work your way backward to the problem. What a concept! Here’s what Wikipedia says:
“…the design way of problem solving starts with the solution in order to start to define enough of the parameters to optimize the path to the goal. The solution, then, is actually the starting point.”
And here’s what John Christopher Jones says in his classic book, Designing Designing:
“The main point of difference is that of timing. Both artists and scientists operate on the physical world as it exists in the present …Designers, on the other hand, are forever bound to treat as real that which exists only in an imagined future and have to specify ways in which the foreseen thing can be made to exist.”
Why would a business person be interested in design thinking? After all, most B-schools (and computer science programs) teach systems thinking. Unless you’re an architect, isn’t that enough? Well…. I’ve noticed that a lot of leading business thinkers now include designers on their teams. In yesterday’s post, I mentioned that A.G. Lafley of Procter & Gamble had designers (from IDEO) in his coterie of advisors. Similarly, was Steve Jobs more of a business genius or a design genius? Design thinkers give us a different way of looking at the world. Maybe we should take them more seriously in business.