A Framework for Community Wellbeing in Healthcare
Imagine being able to design happiness or resilience into the blueprint of a hospital. Imagine a hospital that contributes to the health of people, long before they need medical support.
Hospitals are intended to be a cornerstone of life and health across Ontario. Today, new doors are opening to reveal how hospitals can contribute to a larger understanding of wellbeing – for individuals, families, and communities. The imperatives of healthcare delivery have often been overwhelmed by the priorities of mitigating the spread of infectious diseases through sterile environments and caring for immune-suppressed patients. These continue to be extremely pertinent issues. However, there is more to the story.
New conversations are starting to take shape in the development of health facilities. Bringing natural light into an operating room, for example, or integrating waiting areas with amenities, food vendors, and public transit systems, are emerging as part of design explorations that seek to address a more wholistic understanding of wellbeing.
Public health and modern-day urban planning took hold of each other during the 19th Century to address the critical issues of the day – it was a time when fast-growing urban centres were stumbling out of the industrial revolution, riddled with pollutants and pathogens. Well into the 20th century the leading cause of death was infectious diseases such as tuberculosis and influenza. Accordingly, new cities and neighbourhoods were designed to control and contain the spread of these diseases. The green-city movement, and the flight to the suburbs emerged in part from an aspiration to escape the perceived ills of cities. This paradigm continues to exert much influence on the thinking of policy makers, urban planners, and architects.
Much has changed since then. Today, the leading causes of death are chronic diseases, such as heart disease, diabetes, or cancer, resulting from lifestyles and behaviours: what we eat, if we exercise, where we live. In Ontario, the major contributors to lifestyle diseases being unhealthy eating, use of harmful substances, and physical inactivity. Nevertheless, much of our policy and planning continues to try and address 19th Century problems. It is time for us to renew the relationship between the health and wellbeing of communities and the design of the cities and buildings they inhabit, to meet current day health challenges.
Despite a shift in the conditions of public health and the corresponding causes of health exigencies, many of our policies continue to hold onto ideas about health premised on conditions that are no longer relevant. Consider land use planning, often still attempting to segregate industry from residences, as if these were equally detrimental to health today as they were in the 19th century, while simultaneously creating car-centric environments that discourage active lifestyles.
And while important strides are being made in city planning and architecture to promote active lifestyles and healthy eating, there are significant areas where our collective understanding of the relationship between health and physical environments has much yet to be investigated. Consider mental health and social wellbeing.
How then, can we shift the conversation?
Hospitals will regularly engage patients to elicit feedback on the quality of their experience. This is a good thing. It is a priority of the health care system to deliver services in the best way possible – and this should continue to be the case. Now, what would happen if the conversation expanded to ask: how can we (society) keep you (patient) from needing a hospital? How can we address the wellbeing of individuals and communities upstream, thus diminishing or delaying the need for a medical intervention?
This is at the core of the Community Wellbeing Framework – developed by the Conference Board of Canada, DIALOG, and a number of partnering organizations – an open-source methodology for designing places, or the built environment, within the interests of the wellbeing of a community, or occupants of a place.
In fact, seeds of designing for community wellbeing have been planted in Ontario and elsewhere. In the southwest, the Town of Petrolia and Bluewater Health are together redefining the city in a first-ever town and hospital-designed master plan. Nearly 300 kilometres east, Niagara Health is distilling their extensive understanding of health to create a vision within the framework that will stand the test of time. Both projects have engaged their stakeholders through workshops to address community health and wellbeing.
Community wellbeing is at the core of what happens at a hospital. A hospital is just small component of keeping people well, and I believe that improving the infrastructure around the hospital will actually enhance not just the hospital, but the health of the whole community. – Mike Lapaine, President and CEO, Bluewater Health
Subtle features can have a major impact. For example, a window with views to greenery and sunlight support biophilia – this is one of the metrics used by the Framework to evaluate the positive effect we derive from finding delight and enjoyment within the environmental domain. Biophilia has been found to reduce stress and improve mental health, with studied employees and patients exhibiting reduced frustration, increased patience, and increased healing.
Spaces for socialization, another indicator of community wellbeing, can help to offset dementia and mitigate loneliness.
These are a few of many examples, but this is not about idealism, it is linked to evidence. People spend less time in a hospital bed when they are healing in a space that is designed to help them heal. People are more productive when they are working in a space that is designed to enhance their wellbeing while they work.
Successful outcomes of this approach are observable through research post-design – by, for example, evaluating the rate of patient recovery time, staff performance and absenteeism, and operational costs. A significant difference, however, can be made pre-design. This is a moment when the conversation on wellbeing can, and should, be reframed – are people talking with each other about how wellbeing can be nourished? Is the conversation shifting toward a shared vision? Is the understanding of the implications of decisions to a wholistic aspiration of wellbeing growing? Are communities gaining a sense of stewardship about their wellbeing? ‘Yes’ to any of these questions signals that change is underway.
The Community Wellbeing Framework is an inclusive tool to engage our patients, families, staff and community about the planning and design of the new hospital in Niagara Falls. The tool’s scalability means we can have discourse about health and wellbeing at the scale of the community, site and building. Engaging all of our stakeholders in meaningful ways is extremely important to Niagara Health, and this process with DIALOG will help to bring our Vision of a Healthier Niagara another step closer to reality. – Angela Zangari, EVP Finance, Operations, and CFO, Niagara Health
Antonio Gomez-Palacio and Diego Morettin are principals at DIALOG, a design practice of architects, urban planners, engineers, interior designers, and landscape architects that partnered with the Conference Board of Canada to create the Community Wellbeing Framework. The open-source methodology interprets the correlation between wellbeing of people and the physical world of built and natural settings. Obtain the free report at dialogdesign.ca/community-wellbeing or contact Antonio and Diego at ac.ngisedgolaidnull@gpa and ac.ngisedgolaidnull@nitteromd.
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