Contract - Designing for Health: Are Best Healthcare Design Practices Transferable to the Middle East?

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Designing for Health: Are Best Healthcare Design Practices Transferable to the Middle East?

07 September, 2011


Rapidly increasing healthcare demands in the Middle East have led to a significant construction boom, and many of these clients are turning to western design firms to produce state-of-the-art healthcare facilities. Those of us engaged in these projects are faced with a shared challenge: how do we design projects on the other side of the world, in culturally foreign lands, in a way that responds to the particular needs of the clients, users, and patients?

Region review
One key step is taking the time to discover region-specific needs. A research and discovery effort is important for every project, but it is crucial when working in a region that vastly differs from your own.  Even within the Middle East, countries vary substantially in their cultural, political, geographic, and climatic situations. These contextual considerations can affect every step in the design process, from programming to construction.

Perkins+Will has a strong global presence with offices in Dubai, Shanghai, and London, but healthcare projects in the Middle East are often carried out in collaboration with the prominent design leaders in our 17 North American offices. These design leaders are currently engaged in a number of projects in the Kingdom of Saudi Arabia, including the Princess Nora BintAbdulrahman University in Riyadh. This project includes a 700-bed hospital, and it is both the first women’s university in the Kingdom and the largest women’s university in the world.

Perkins+Will has invested heavily in its research efforts to help teams understand enough about the region to design locally sensitive healthcare facilities. This research consists of collecting knowledge acquired by designers working and living in the region, as well as secondary research from reliable published sources. The findings have challenged some of our more common assumptions about best practices in healthcare design and raise some interesting questions. 

Evidence-based design (EBD) is driving healthcare best practices in the United States, but can any research conducted in the West be generalized to the Middle East? We cannot assume any research findings will or will not transfer to other regions until studies are done, but we can hypothesize where there are likely to be similarities and differences. For example, access to daylight has a very different meaning in Saudi Arabia where the sun is extremely intense. In this context, spaces lit by filtered natural light are more comfortable and appropriate than those that receive direct rays. 

Designing for demographics

The recent population growth in Saudi Arabia has created real implications for design. Although growth has stabilized in the past few years, 66 percent of the current population is under 25 years of age , and only 3 percent is more than 65 years old. The construction boom we are seeing now is part of the Saudi government’s effort to provide jobs, education, and healthcare for their large, young population. How do these facts change our assumptions when programming hospitals here? While United States hospitals are being programmed and designed to support a large aging population, Saudi Arabia’s hospitals must support young patients who will soon be having children of their own. Given this, should we be programming larger maternity and smaller geriatric units?

Although the Saudi Arabian population is young, adulthood begins early as it is defined by the first signs of puberty. This means patients as young as nine years old may be treated in adult, rather than pediatric, patient units. Their pediatric units will treat a smaller range of patients than those in a typical United States-based hospital, where patients can be up to 21-years old or sometimes older. How does this younger range of pediatric patients affect the way we design pediatric units? For example, there is probably no need for the separate “adolescent” spaces characteristic of western designs.

Gender constraints

David Hansen, FAIA, design principal at Perkins+Will, has been living and working in Cairo for over three years. He indicates that one significant difference in designing healthcare facilities in Saudi Arabia is how “the cultural, and in some respects religious, need for the separation of males and females becomes a factor that must be observed and accommodated. This then can affect both redundancy and adjacency aspects in the programming of facilities. Though one sees female nurses functioning much as in the western world (and without abiyahs in research and medicine venues), one cannot necessarily mix entries, waiting rooms, rest rooms, and sometimes procedure areas between the genders.”

Joumana Sayegh, an architect based in Beirut, Lebanon, has extensive experience addressing this type of cultural requirement, and notes that, “cultural differences have numerous design and construction implications. One simple example of this is in the design of restrooms. Due to privacy and ablution routines before prayer, restrooms in Saudi Arabia have unique needs.  Partitions between restroom stalls are designed with floor-to-ceiling partitions and doors rather than the United States-acceptable use of floor-mounted or ceiling-hung models. Additionally, each stall is equipped with a water sprayer, which is located, typically, next to the toilet. This is provided for general hygiene and cleanliness. As one would expect, due to the spraying of water within each stall, floor drains help alleviate standing water and keep restroom facilities dry.”  

Research requisite 

The questions raised through the course of these research efforts have led to the understanding that we cannot assume western practices common at home in the United States will translate to the Middle East. These questions also suggest hypotheses for future research specific to the Middle East. We also have realized that research efforts should ideally occur before or at the beginning of the programming effort, to ensure the program aligns with specific needs not only of the client but also of the entire region.  

Along with the rest of the world, Middle Eastern clients are demanding projects delivered in less time, and for more competitive fees than ever before. These pressures can challenge the necessity of research efforts, but they are nevertheless invaluable to the long-term success of the project. 

Sources:
1. Business Monitor International. 2011, May. Saudi Arabia Infrastructure Report Q3 2011.
2. Central Intelligence Agency. 2011.
The World Fact Book: Saudi Arabia.

Bonny Slater, NCIDQ, LEED AP ID+C, is an interior designer at Perkins+Will in Washington, D.C., where she brings a research-based approach to every project. Bonny primarily works with global clients in both healthcare and corporate sectors. She can be reached at
bonny.slater@perkinswill.com.

“Designing for Health” is a monthly, Web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. Past installments of "Designing for Health" include (click on title to access the full article): 
Best Strategies for the EDAC Exam
-
Traditional Culture in a New World
- The Perils and Pearls of Field Research in Healthcare Facilities
- What's Your Problem? A Research Approach to Quantifying Design Solutions







Designing for Health: Are Best Healthcare Design Practices Transferable to the Middle East?

07 September, 2011


Andrew Kordon

Rapidly increasing healthcare demands in the Middle East have led to a significant construction boom, and many of these clients are turning to western design firms to produce state-of-the-art healthcare facilities. Those of us engaged in these projects are faced with a shared challenge: how do we design projects on the other side of the world, in culturally foreign lands, in a way that responds to the particular needs of the clients, users, and patients?

Region review
One key step is taking the time to discover region-specific needs. A research and discovery effort is important for every project, but it is crucial when working in a region that vastly differs from your own.  Even within the Middle East, countries vary substantially in their cultural, political, geographic, and climatic situations. These contextual considerations can affect every step in the design process, from programming to construction.

Perkins+Will has a strong global presence with offices in Dubai, Shanghai, and London, but healthcare projects in the Middle East are often carried out in collaboration with the prominent design leaders in our 17 North American offices. These design leaders are currently engaged in a number of projects in the Kingdom of Saudi Arabia, including the Princess Nora BintAbdulrahman University in Riyadh. This project includes a 700-bed hospital, and it is both the first women’s university in the Kingdom and the largest women’s university in the world.

Perkins+Will has invested heavily in its research efforts to help teams understand enough about the region to design locally sensitive healthcare facilities. This research consists of collecting knowledge acquired by designers working and living in the region, as well as secondary research from reliable published sources. The findings have challenged some of our more common assumptions about best practices in healthcare design and raise some interesting questions. 

Evidence-based design (EBD) is driving healthcare best practices in the United States, but can any research conducted in the West be generalized to the Middle East? We cannot assume any research findings will or will not transfer to other regions until studies are done, but we can hypothesize where there are likely to be similarities and differences. For example, access to daylight has a very different meaning in Saudi Arabia where the sun is extremely intense. In this context, spaces lit by filtered natural light are more comfortable and appropriate than those that receive direct rays. 

Designing for demographics

The recent population growth in Saudi Arabia has created real implications for design. Although growth has stabilized in the past few years, 66 percent of the current population is under 25 years of age , and only 3 percent is more than 65 years old. The construction boom we are seeing now is part of the Saudi government’s effort to provide jobs, education, and healthcare for their large, young population. How do these facts change our assumptions when programming hospitals here? While United States hospitals are being programmed and designed to support a large aging population, Saudi Arabia’s hospitals must support young patients who will soon be having children of their own. Given this, should we be programming larger maternity and smaller geriatric units?

Although the Saudi Arabian population is young, adulthood begins early as it is defined by the first signs of puberty. This means patients as young as nine years old may be treated in adult, rather than pediatric, patient units. Their pediatric units will treat a smaller range of patients than those in a typical United States-based hospital, where patients can be up to 21-years old or sometimes older. How does this younger range of pediatric patients affect the way we design pediatric units? For example, there is probably no need for the separate “adolescent” spaces characteristic of western designs.

Gender constraints

David Hansen, FAIA, design principal at Perkins+Will, has been living and working in Cairo for over three years. He indicates that one significant difference in designing healthcare facilities in Saudi Arabia is how “the cultural, and in some respects religious, need for the separation of males and females becomes a factor that must be observed and accommodated. This then can affect both redundancy and adjacency aspects in the programming of facilities. Though one sees female nurses functioning much as in the western world (and without abiyahs in research and medicine venues), one cannot necessarily mix entries, waiting rooms, rest rooms, and sometimes procedure areas between the genders.”

Joumana Sayegh, an architect based in Beirut, Lebanon, has extensive experience addressing this type of cultural requirement, and notes that, “cultural differences have numerous design and construction implications. One simple example of this is in the design of restrooms. Due to privacy and ablution routines before prayer, restrooms in Saudi Arabia have unique needs.  Partitions between restroom stalls are designed with floor-to-ceiling partitions and doors rather than the United States-acceptable use of floor-mounted or ceiling-hung models. Additionally, each stall is equipped with a water sprayer, which is located, typically, next to the toilet. This is provided for general hygiene and cleanliness. As one would expect, due to the spraying of water within each stall, floor drains help alleviate standing water and keep restroom facilities dry.”  

Research requisite 

The questions raised through the course of these research efforts have led to the understanding that we cannot assume western practices common at home in the United States will translate to the Middle East. These questions also suggest hypotheses for future research specific to the Middle East. We also have realized that research efforts should ideally occur before or at the beginning of the programming effort, to ensure the program aligns with specific needs not only of the client but also of the entire region.  

Along with the rest of the world, Middle Eastern clients are demanding projects delivered in less time, and for more competitive fees than ever before. These pressures can challenge the necessity of research efforts, but they are nevertheless invaluable to the long-term success of the project. 

Sources:
1. Business Monitor International. 2011, May. Saudi Arabia Infrastructure Report Q3 2011.
2. Central Intelligence Agency. 2011.
The World Fact Book: Saudi Arabia.

Bonny Slater, NCIDQ, LEED AP ID+C, is an interior designer at Perkins+Will in Washington, D.C., where she brings a research-based approach to every project. Bonny primarily works with global clients in both healthcare and corporate sectors. She can be reached at
bonny.slater@perkinswill.com.

“Designing for Health” is a monthly, Web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. Past installments of "Designing for Health" include (click on title to access the full article): 
Best Strategies for the EDAC Exam
-
Traditional Culture in a New World
- The Perils and Pearls of Field Research in Healthcare Facilities
- What's Your Problem? A Research Approach to Quantifying Design Solutions




 


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