What is ‘a’ Hospital?
When starting a new project, it is useful to question some basic assumptions about our subject. So what is a hospital? In its current form this project excludes mental health institutions, but even the hospital for physical ailments has always taken a wide range of forms. There are a great range of different types of hospital operating at different scales, with different goals, and different sensescapes. The ‘general hospital’ is not the only kind, and a broad approach to healthcare environments might extend to healthcare centres and clinics. Some of the most important sensory design decisions are also found in specialist institutions such as children’s hospitals, hospices, and drop-in centres that specifically identify as non-hospitals such as the famous Maggie’s Centres. We should also ask questions about where the sensory history of hospitals begins and ends. Graham Mooney, for example, argues that the ambulance has an important place in medical history and medical geography: should we consider this as an extension of the hospital? It is a space of crucial importance, in terms of sensory experience. As patients’ experiences in the hospital also shape their sensory perceptions afterwards, do we need to follow their stories back home?
What is ‘the’ Hospital?
Even taking one building, ‘the’ hospital does not exist; at least it does not exist in sensory terms. A limited list of examples illustrates how, in spatial-sensory terms, different locations within the hospital have very different histories and characteristics: the operating theatre; the ICU; maternity spaces; the ward; the waiting room; the relatives’ room; and the café. This list also defines space in a relatively straightforward way, in terms of rooms, but each room might also have spaces within it that have particularly sensory characteristics. Patients’ embodied experiences change in these spaces-within-spaces, such as experiences of claustrophobia in CT scanners. This kind of sensory space takes us into the realm of technology design and the history of technology, as well as into changes in room layouts and their impact on sensory experience. The changing location of a nurses’ station, for example, might seem a minor aspect of the history of hospitals, but has had a significant impact on the sensory experiences of patients and of staff.
We know also from the extensive work done in spatial theory that spaces are always in flux, no more so than in a hospital. A recent study of noise levels in the ICU by the Hospital Project on Noise, Sound and Sleep project, for example, showed the strong fluctuations in noise levels over the course of a day in a single location within a single space. Flurries of activity when new patients arrived, the sounds of deliveries, among other fluctuating sounds across the day and evening, show that no space ever has a static sensescape. Waiting rooms provide another example of spaces/places where people come and go, and in which there has been an increasing turn towards positive sensescapes (also in flux) such as live music. Efforts to keep consistent temperature in hospitals and to minimise smells may have had some effect on minimising flux in relation to certain senses, but did not eliminate it.
As with many of the issues associated with the diverse nature of hospital sensescapes, and the perception thereof, these points are easy to raise but difficult to integrate into a methodology. How can we find a history of hospital sensescapes if every hospital is different, every hospital space is unique, every space-within-a-space is distinct, no sensescape is ever static, and every individual embodies / gives meaning to sensescapes in their own way? The answer may lie in comparing a limited number of key sites, spaces, and scales, which have historically been of particular interest to hospital designers and/or people in hospitals. It may also be valuable to select examples of spaces that allow for international comparisons. We must, though, choose these case studies with care. As tempting as it is (from the available sources) we should avoid a ‘great men’ of hospitals approach, which would focus only on examples of ‘pioneering’ or ideal design. For every example of a space that represented high-profile ‘best practice’ at a particular historical moment, we need also to consider the extent to which these operated as real practice.