Inside the built environment: considerations for child-friendly hospitals

Dr. Penny CurtisReader in child and family health and wellbeing

University of SheffieldUK

Child-friendly hospitals?

Provide a context within which children and young people ….

“can experience hospitals differently according to age and where they are cared for, not as a homogenous group of individuals, but as members of families” (Department of Health, 2003:9).

• “From the minute a family drives up to a great children’s hospital, ideally they should realise that it is a very special building that does not look institutional. Once inside the lobby, which is the second most important impression, there should be a sense of wonderment, surprise and diversion.”(Komiske 1999 p.147).

What is known about children’s use of space in hospitals?

• Very little!– Post Occupancy Evaluations (POE)

• children’s hospital’s family healing garden (US) (Whitehouse et al 2001)

• healing gardens, associated with paediatric healthcare facilities (US) (Sherman et al 2005)

– Behaviour mapping in Glasgow children’s hospital wards (Canter 1972)

– Before-and-after evaluation, Bristol Children’s Hospital (UK) (Redshaw 2004).

– Child-centred evaluation of the atrium of the Toronto Hospital for Sick Children (Adams et al 2010)

… where do children go within hospital spaces, what do they do, and with whom …

Space to care:

• An ethnographic study • 3 hospitals in the north of England• 255 children aged 4-16

Derby OPD clinics and general reception area

Main reception. Morning observations 9.45-12.15. Serving ENT, General Medical and ENT clinics

computers

Reception

Entr

ance

Staff: Children up to 7yrs: Children 8 yrs and above: Accompanying adults:

Main entrance

Where do children go?

Exit

Colouring table Counter

Nintendo

Toys

Reception

Sheffield Blue (am and pm: orthopaedic) clinic. 09.15 - 16.30

Older children’s spatial use was very similar to parents’ spatial use

Age and space: decorationVisual cues signify intended age of the users and

occupiers of a space

‘If it is plain, it’s not nice for children’ (9-year-old girl)

‘It’s colourful… It’s more like for children’ (13-year-old girl)

Age and space: opportunities to ‘do things’

Spaces are seen as ‘boring’ unless there are recognizable, understandable and age-appropriate opportunities for ‘doing’ things‘It’s got pool tables, games, and loads of bigger stuff, yes – for bigger people’ (11-year-old girl)

Age and space: the iconic childBabyish spaces‘I don’t like the baby toys in the

place where I first came in’ (six-year-old boy)

‘Most toys are for babies. There is nothing to do for us bigger ones’ (nine-year-old boy).

‘babyishness’ noted particularly in the more specialist settings

Signifiers of ‘babyish’ spacesSignifiers of spaces for older

children and teenagers

Baby matsBaby toysBalloonsCatsChildren’s television programmesClownsColouringHorsesPenguinsPictures on windowsPlastic toysPlay areasPottiesPushchairsRabbitsToys everywhereVideos/DVDs for little onesYellowYoung children’s pictures

Board games and computer gamesComputersDécor ‘like in the adolescent room’Football TableMagazinesMusicPlain but colourful wallsPlainer decorationPool tablePop postersPostersSlot machinesTeenagers television programmesTelevisionsVideos/DVDs for teenagers and adults

Signifiers of spaces suitable for all age groupsColourful décor (but not too many colours all in one space)ComputersSome Disney characters and characters from popular, young people’s media cultureTelevisions

‘Look at the size of the pool table. It’s a kiddie one!’ (14-year-old boy).

Older children accept younger children’s different needs, but are not active in ‘babyish’ spaces themselves.

Older children’s spatial use was very similar to parents’ spatial use

What do children do?

The organisation of features:

Derby Yellow. Morning (general medicine) 09.30 – 11.00:

Colouring table

Train and car track

Play centre

Garage

Toy crate

Entr

ance

Colouring table

With whom do children interact?Children and parents

Nurses’ Station

Children and children

Hospital spaces do not, however, work to encourage social interactions between children

• A young boy of 7ish talks to a girl of a similar age about something on the computer, he asks her to ‘Look at this’. She is embarrassed and leaves.

Children and hospital staff

What works?…. for children and young people ….

Interstitial spaces

‘Homely’ spaces with a sense of enclosure work well for younger children

Nurses’ Station

Spaces for older children ……