denk.werkstatt 2016

Therapeutic Architecture:
Structures that support healing

At denk.werkstatt 2016 Resopal GmbH highlighted the megatrend of healthcare. The 16^th round of this established forum brought together some 160 architects, designers and experts on 11 November 2016 in Gross-Umstadt to discuss the future of Therapeutic Architecture, a topic currently attracting ever more attention. The number of people hospitalized each year in Germany alone has reached around 19 million. Although this number is rising, new technologies have resulted in ever shorter hospitalisations. It was within this context that the specialist lecturers examined the crucial role of architecture in healthcare.

“Health is not only something that concerns each of us individually, but also an intriguing field because its constantly shifting horizons” summarised Henning Risse, Commercial Sales Director of the laminate manufacturer Resopal, in his opening remarks at the 2016 denk.werkstatt. In the run-up to the 2016 event, the plenary meeting spoke in favour of a visionary topic. In line with this, Resopal chose to alter the structure of the denk.werkstatt after 15 successful years, sharpening its focus, deliberately directing its focus further into the future, and presenting brilliant inspiration for entirely new ways of thinking.

Dutch visionary and businessman Bas Lansdorp’s talk on “Health on Mars” prompted a particularly fervent discussion. The co-founder and CEO of Mars One presented his plans for a permanently habitable settlement on the planet Mars by 2027. “Our objective is not to achieve something positive for the second best planet in our solar system, Mars”, he said, “but rather for the project to benefit the best planet, the earth”. The reality of having people living on another planet in the not-to-distant future will strongly influence the 21^st century. The necessary technology already exists, and Mr. Lansdorp is convinced that the six billion US dollars needed to carry out the plan can be raised.

Many people are of a similar opinion. The Dutchman started the Mars One project five years ago, and it wasn’t long before 200,000 people from over 100 countries had applied to participate in the project, despite its immense challenge. The 40 people ultimately chosen during the selection process will set out on a journey of no return. “It is a one-way street.” says Bas Lansdorp. “Those who go, go forever. They will never see this planet or their family and friends again.” He considers a return to earth impossible, because the technical and human infrastructure needed for a missile take-off is not available on Mars.

After two exploratory flights in 2020 and 2022, Mars One intends to transport equipment to the new home in 2024. Things will get serious in 2026, when a vanguard of four people will land on Mars. They will be the first ones to set off into a new living environment, a task they are preparing for in an intensive decade-long training program. Health will be very important. “The weight of materials is also a crucial consideration”, Lansdorp commented, with transportation costs amounting to 100,000 US dollars per kilogram. This is a reason why the mission will trigger so much innovation in the healthcare segment as well. Just as important is the medical training of the Mars settlers. “Each of them must be a competent physician”, said Lansdorp, “because, although communication with earth will of course be possible, it will involve a 20-minute delay.”

These points offer more than enough food for thought to be able to start the interactive as well as emotional phase following the lecture – a new approach that set this year’s Resopal denk.werkstatt event apart from previous ones. In ten Mars stations – all addressing different topics relating to health on Mars, participants were asked to spontaneously come up with new ideas, which they were then to sketch out, develop, and discuss. “It was really astonishing how many ideas and approaches were developed in such a short time”, commented Mars visionary Bas Lansdorp about the results of this workshop lasting barely an hour.

Prior to this, Martin Kern, an expert on the operative planning of hospitals, had reported on challenges already facing the field of healthcare. The CEO of the company Teamplan, which has completed some 1800 projects since 1973, drew on his experience to draw attention to the generation Y, those young people born between 1980 and 1995, who are digital natives, extremely mobile, flexible and tech-savvy. “How much of a normal hospital do we need?” was how Martin Kern formulated what he considers to be one of the key questions.

For, although hospitals have long had to function economically, informed patients – or customers, as it were – increasingly have additional and new expectations. For example, the attractiveness of a hospital’s surroundings already plays a decisive role, emphasized Martin Kern. Family members want to be able to spend the night, and inquiries about shopping are heard more frequently; on the other hand, the number of multimorbid patients will increase, altering the demands on hospital architecture.

“The hospital system will gain attractiveness and technical possibilities if we can further standardise the types of space” according to Kern, who spoke about modular layouts as well as flexible-use service lines that can be passed through linearly by patients. Increasingly the cell phone will serve as the interface, replacing previous forms of organisation as a navigation, management, and communication system. Kern is also certain that tomorrow’s hospital structures will have to deal with considerably higher volumes of data.

The newest research findings on structural hygiene in hospital buildings were presented by architect Wolfgang Sunder, who carries out research on the topic at the Technical University of Braunschweig. This is an exciting field, especially in view of the some 14 billion euros of investment backlog currently weighing on German hospitals. A parallel development, reported Sanders, is the pharmaceutical industry’s reduction of research on antibiotics research, despite the increasing impact of multi-resistant germs. Confirmed statistics report 10,000 deaths a year, in addition to around five billion euros in financial damages, with actual figures probably much higher.

Wolfgang Sunder explained that the research draws on international studies as well as on structured surveys of experts in the healthcare sector, especially physicians, nursing staff and hygienists. The findings provide the information needed to develop fundamental design principles for spaces where hygiene is a high priority, including the need for short internal pathways, single-occupancy room configurations with eight to ten units, and—especially in emergency rooms—separate sanitary facilities. Sunder emphasized the great importance of an intensive interdisciplinary exchange, which in practice remains very inadequate. He announced the 2017 publication of a new handbook designed to aid architects, designers, operators and others in their work.

Another key aspect of the topic was presented by Dr. Michael Ludes of Ludes Architekten, a leading expert in the design of structures for healthcare. “Healthy through Design?” was his quite provocative question as he began his lecture on the therapeutic effects of spatial design in hospitals. Pure functionality and intentional deindividualization, even to the point of an emotional incapacitation of the building, still predominate, with the pressure of rising costs and sinking revenues encouraging this tendency. On the other hand, especially in regard to smaller hospitals, the attention to patient and customer needs has progressively also become a factor of clearly measurable economic consequence, according to Dr. Ludes. “The attractiveness of individual hospitals has become more important since the introduction of the flat rate per case billing system”, he said, “and this trend is increasingly also understood by those responsible.”

This development represents a challenge for architects and also presents new opportunities to introduce more than just individual design aspects. Dr. Ludes referred to research on the topic of Healing Architecture at the Technical University of Berlin and called on those involved in healthcare to again view patients holistically as a people, instead placing so much emphasis on evaluating isolated factors. “Spaces trigger emotions”, he reminded his audience, “and there is also the proven healing effect of viewing natural surroundings – something that even applies to operating rooms.” Just looking at images of authentic natural scenery can also be an enormous help. Coordinated colour and lighting concepts are equally important. “Ill people perceive their surroundings entirely differently than staff or healthy persons.” suggested Dr. Ludes, “and it is the welfare of patients that concerns us.” All employed measures should therefore be reviewed regarding their therapeutic potential. “This is presently not only a great opportunity,” Dr. Ludes said, “it is simply a necessity.”

Professor Hans Nickl from the architectural group of Nickl & Partner also addressed the subject in his lecture titled “Brave New Hospital – Convalescence and Healing in Smart Times”, a wording that also describes the general principal of his work. “The important question is how the patient experiences the hospital”, said Prof. Nickl, “The person is the measure of all things.” This will apply all the more in the future, when robots increasingly take over patient care tasks. He referred to the ideals and designs of the legendary architect Le Corbusier, whose understanding of organizational principles and city components have established him as the most important hospital designer in history for Prof. Nickl.

“The hospital environment needs to be sustainable”, according to Prof. Nickl, “and this begins with the potential of its structures for development. “This doesn’t require complicated ground plans, but rather a fundamental understanding of urban functions. To illustrate this he showed the Agtharied Hospital in Miesbach, which he designed and realised in 1990. There is no longer a lobby like at a bank”, Nickl said, “but rather a space more like a promenade, or an entrance plaza.” He went on to show the new Kaiser-Franz-Josef Hospital in Vienna, also designed by Nickl & Partner, where all patient rooms enjoy a view of the green surroundings, the halls are light and divided into zones, and a multitude of individual spaces enliven the structure.” Seven hundred studies verify the effect of light on convalescence”, emphasised Prof. Nickl.

For Nickl and his colleagues, three major future trends currently shape the design of hospital structures. For instance, minimally invasive intervention is increasingly replacing traditional surgical procedures, requiring entirely new space allocation plans. In addition, the future of healthcare is definitely female and mobile – an aspect that currently is still not being adequately discussed. This development will mean that the family compatibility of workspaces will play a significant role in future designs. Another important consideration in hospital design is the need for single rooms, to contain the growing danger of deadly infections.

As the end of the day’s programme, Theo Jansen spirited the audience off into entirely different worlds. The Dutch artist is the creator of the “Strandbeesters”, or beach animals, which he represented as new forms of life. His creatures are kinetic wonderworks able to march autonomously across the sand. Theo Jansen makes them with the simplest of materials, using only yellow plastic tubes from electrical installation, cable binders, nylon thread and tape. With these limited means he is able to build coupler mechanisms, water sensors and valve cascades that can communicate with one another so sophisticatedly that his Strandbeesters can walk along the shoreline – helped only by the wind, recognise a destination, and even return.

“They are blind and deaf”, admitted Theo Jansen, “but they are able to sense the sand’s firmness. And the wind, too.” For over a quarter of a century now he has been developing his fantasy creatures, 39 of them so far. Theo Jansen also marvels at them: “Is it my designs? Or theirs? I am also surprised at how beautiful they are. I don’t work on their beauty.” They live a summer long; later he reanimates them and sends them off on a tour around the world.

But Theo Jansen is not just a dreamer. His creatures seem truly free, when they walk on the beach, apparently moving of their own free will. “What I want is that the animals will one day live on their own at the beach”, said the visionary: “I still have to care for them, but please give me another 25 years or so.” he requested of his audience, thus offering among the many future-oriented topics at the Resopal denk.werkstatt not only the perspective looking the farthest into the future, but also the day’s most poetic.