Sensing Spaces of Healthcare: Rethinking the NHS Hospital

Lead Research Organisation: University of Bristol
Department Name: School of Humanities

Abstract

Design is a pressing issue in healthcare. Poor hospital design impacts staff, patients and visitors, and critiques of hospitals are increasingly widespread. Such critiques often claim that we have lost 'holistic' design in healthcare and refer to historical examples to make their case, but draw repeatedly on the same few examples (Nightingale wards, sanatoria) and focus on their visual features (colour, light). This project offers a new way of approaching hospital history, for the benefit of hospital historians, designers and users. It focuses on more recent - and under-studied - hospitals of the National Health Service. It also rethinks the history of healthcare environments through the body and the senses, focusing on how places have felt rather than how they have looked.

Using a range of interdisciplinary methods, from archival research to site visits and participatory arts, the project will explore the recent history of the senses in hospitals. The project will consider how NHS hospital sensory environments (or 'sensescapes') changed as a result of new design trends, architecture, materials, technologies, nature and human behaviours. It will also consider how changing social, cultural, political, and economic factors affected people's experiences of the same 'sensescapes'. Overall, by taking the senses as productive sites of interaction between people, technologies, materials and nature, this project will rethink the history of hospitals and provide new approaches for scholars of medical humanities and sensory studies.

The project's findings will also feed into an imaginative rethinking of current and future hospital design, including the development of innovative multi-sensory design interventions for healthcare environments. In line with the UKRI strategy, the project will 'identify and tackle the complex societal challenges that matter most to people, in partnership with them ... with the aim of delivering maximum societal value'. It will work with Great Ormond Street Hospital (London), Southmead Hospital (Bristol) and Architects for Health to pinpoint issues or 'problems' for specific types of hospital user/worker or hospital spaces, which might range from sensory under-stimulation to sensory overload. In turn, these 'problems' will form the basis for sensory design solutions through a prototyping and development process in collaboration with artists, designers, charities and NHS Trusts. These outputs will be produced with and of value to all those who use hospitals, from patients to professionals. Overall, the project offers a novel approach to the history of healthcare spaces that helps us to rethink hospital histories and their relevance to current-day design challenges.

Planned Impact

This project's research will be produced with and have a valuable impact on:
> users of hospitals (including staff, patients and visitors), by identifying ways of improving the sensory experiences of hospitals through design interventions.
> hospital arts/design organisations, by providing new ideas based on historical examples and new arts/humanities-based methods for identifying 'problems' that need solving.
> the NHS, by finding sensory design solutions that promote health and reduce unnecessary drains on resources.
It has 3 key partnerships - with GOSH Arts at Great Ormond Street Hospital (London), Fresh Arts at Southmead Hospital (Bristol) and Architects for Health - to ensure that its research findings are translated into practice in the most valuable and impactful form for the NHS. By working closely with these organisations, and with individuals who have a history of spending time (as staff, patients, or visitors) in London and Bristol hospitals, the project will involve its beneficiaries throughout.

Sensory design can both exacerbate and ameliorate problems in hospitals, such as worker stress, visitor anxiety and the boredom of long-term patients. These problems are significant resource drains and are detrimental to the holistic health of staff/visitors/patients. However, many healthcare environments pay insufficient attention to the importance of the multi-sensory, affective and emotional elements of design. This project will be the first long-term collaboration between arts/humanities academics, design professionals, artists, architects, hospitals, patients, staff, visitors and others to identify the most important 'sensory problems' in hospitals, which might range from sensory overload to sensory deprivation depending on the people/place. It will develop relevant guidance for architects and arts/health practitioners relating to these problems, and develop a multi-sensory prototype to tackle one. A key goal of the prototype (years 1-4), and ultimately a final scalable product (years 5-7), will be positively to impact the experiences of hospital users and the practice of hospital design. The prototype's exact form cannot yet be known, as it will be a result of co-production with people and organisations, which is an intentionally unpredictable process; it may be a new type of multi-sensory space (or space within a space), an object or an artwork. The prototype will have a number of organising principles to maximise its impact: (1) to bring the research conducted in years 1-3 into a 'design thinking' process, to 'empathise' through focusing on people's (hi)stories and to use this to 'define the problem' to be resolved through multi-sensory design; (2) to involve hospital staff, patients and families in its development; (3) to reflect the project's principles and methods, including its understandings of the relational and highly personal nature of sensory environments; (4) to find 'low resource' solutions that are easy for NHS hospitals to maintain and which are affordable/scalable

In terms of the UKRI's aim of 'societal value', this project will thus have a significant national and in the long term potentially international impact through such interventions. In relation to more specific council strategies, this research connects particularly to the AHRC strategy in relation to 'design research' and is likely to connect to specific sub-sections of this strategy such as 'healthy aging' as long-term hospital patients (in-patient or repeat visits) are often young or elderly. Finding design solutions for new kinds of hospital patient (such as the growing proportion of elderly patients) and new challenges (such as staff workload) requires innovative thinking and a long-term, co-production model of design which this project offers.

Publications

10 25 50
 
Title Exhibition 
Description Exhibition at Great Ormond Street Hospital and Southmead Hospital (April-end 2023). Artworks created 2022-23. 
Type Of Art Artistic/Creative Exhibition 
Year Produced 2023 
Impact N/A at present, exhibition feedback to be gathered soon 
 
Title Sensing Spaces of Healthcare Activity Book & Kit 
Description Each activity invites the participant to think about the hospital environment creatively, and to explore their sensory experiences through the arts. 
Type Of Art Artefact (including digital) 
Year Produced 2021 
Impact This activity book and creative research kit has been designed and made as part of our research methods, but will soon be developed as a toolkit to share more widely. We are currently trialling its use as part of hospital planning. 
 
Title These Sounds Save Lives 
Description This short animation was painted entirely by hand in virtual reality (VR) using Oculus Quill. The minimalist, stripped back, duotone aesthetic puts the focus on the soundscape, whilst the POV camera and calm narration immerses us in the environment and guides us through the hospital setting. The purpose of the film is to promote & demystify the topics within Victoria Bates' book titled Making Noise in the Modern Hospital. As we developed the script and style, we found that by broadening the audience and centering the patient experience the film could also serve a therapeutic and educational purpose. If this film can help us reframe how we hear and listen within hospitals, maybe then it can help us cope in future moments of distress or anxiety. A visit to hospital can be a uncomfortable experience and noise is often a source of complaints. Over the years, the NHS has spent significant amounts of money on things like sound-proofing and internal communications campaigns to try and reduce noise within the hospital, but as our film makes clear - silence is never the goal. Through the calmness of the narration, we call for compassion, patience and understanding - encouraging an appreciation for the layers of people and place that make our NHS tick. Direction: Reuben + Jamie Copywriting: Jamie Neale Animation: Reuben Armstrong Voiceover: Victoria Bates Sound Design: Jamie Frye 
Type Of Art Film/Video/Animation 
Year Produced 2021 
Impact This video currently has 250+ views on the Vimeo site, and has led a number of people to get in contact with me about to discuss and support the ideas that it presents (particularly the opportunities that it offers for reducing the distress caused by noise in hospital settings, through a social/cultural model rather than a design approach). 
URL https://vimeo.com/623693499
 
Description The creative research methods that we have developed for our project have started to have an impact in arts & health practice, within and beyond our named partnerships. We have collected impact statements from new hospital sites about the ways in which they are integrating creative approaches into hospital design and planning. We have also received more informal and anecdotal feedback about the ways in which our project is encouraging people to think in more multi-sensory terms, particularly from members of our working group. Our creative research methods are also having an impact on academic research. We ran an online workshop for interdisciplinary researchers on creative research methods in July 2020, sharing our own methods-in-progress, exploring the challenges posed by Covid-19 for doing creative research, hosting discussion papers, analysing the ethics of creative research, and assessing the benefits/challenges of creative research methods in healthcare. This workshop helped to build a small research community and resulted in a graphic representation of our conversations for the benefit of other researchers, on the website. In 2022-23, with the support of a Plus Funds grant, we are running a training programme on 'Working with Creative Industries' for researchers. Many of these researchers work in healthcare and science. We are also developing a methodological 'toolkit' for people who want to improve hospital spaces, drawing on creative research methods designed in the project, and developed in collaboration with architects, artists, NHS professionals, other researchers, international collaborators and more. Though this toolkit has not yet been finished or used, the working group itself is having an impact on the practice of its members. We have also collaborated extensively with local creative industries throughout our processes to date, ensuring that we support the local creative economy, and that we work in a knowledge-exchange model where both parties benefit from the work.
First Year Of Impact 2021
Sector Creative Economy,Healthcare,Other
Impact Types Cultural

Economic

 
Description Working with Creative Industries
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Workshops with NHS Staff
Geographic Reach National 
Policy Influence Type Contribution to new or improved professional practice
Impact Our workshops have all fed into professional practice, but providing tools for creative thinking about hospital environments. For example, we have co-authored a journal article with one participant of the 'listening to the hospital' workshop which highlights how it changed the way they think about hospital sound in their work.
URL https://www.sciencedirect.com/science/article/pii/S2666558122000288
 
Description Autistic people's experiences of mental health wards: using film-making to understand sensory, embodied, and emotional experiences in hospital
Amount £2,210 (GBP)
Funding ID AH/X003094/1 
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom
Start 07/2022 
End 04/2023
 
Description Plus Funds. 'Working With Creative Industries: A Workshop Series''
Amount £24,585 (GBP)
Organisation United Kingdom Research and Innovation 
Sector Public
Country United Kingdom
Start 08/2022 
End 07/2023
 
Description Architecture 
Organisation Architects for Health
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Our team is leading the development of guidance on 'good' sensory design for hospitals, including running a working group with members of AfH.
Collaborator Contribution Our contacts at AfH are helping us to recruit for the working group, by working with us on a brief and sharing it with their members.
Impact This is a multidisciplinary collaboration between architects, a historian and a sensory arts researcher. We will also collaborate in the working group with hospital arts organisations and with makers/designers. The collaboration will result in a guidance document on sensory design, but it is not yet published.
Start Year 2020
 
Description Hospital Arts Collaborations (Fresh Arts at North Bristol NHS Trust, GOSH Arts at Great Ormond Street Hospital, ELFT, and the Hospital Arts, Heritage & Design NPAG) 
Organisation Great Ormond Street Hospital for Children NHS Foundation Trust
Country United Kingdom 
Sector Hospitals 
PI Contribution We host regular online team meetings with Fresh Arts at Southmead Hospital / North Bristol NHS Trust and GOSH Arts and Great Ormond Street Hospital NHS Trust. The project PI and RA are leading the development of a research plan/methodology, in collaboration with the partners, and have submitted an ethics application which was approved in 2021. We are working with ELFT on a film project, and with the NPAG to develop a sensory methods guidance toolkit.
Collaborator Contribution Our partners have given their time 'in kind' by reviewing our methods-in-progress, supporting our ethics application, and attending online workshops at which we have tried out research methods. They have given significant input despite the challenging circumstances of Covid-19 for the NHS.
Impact This is a multi-disciplinary collaboration between two hospital arts organisations, a historian and a sensory arts researcher. So far the outputs have included a research 'toolkit' prototype and an ethics application, and we are currently in the process of developing an exhibition and some project prototypes which will translate the research into impact.
Start Year 2020
 
Description Hospital Arts Collaborations (Fresh Arts at North Bristol NHS Trust, GOSH Arts at Great Ormond Street Hospital, ELFT, and the Hospital Arts, Heritage & Design NPAG) 
Organisation North Bristol NHS Trust
Country United Kingdom 
Sector Academic/University 
PI Contribution We host regular online team meetings with Fresh Arts at Southmead Hospital / North Bristol NHS Trust and GOSH Arts and Great Ormond Street Hospital NHS Trust. The project PI and RA are leading the development of a research plan/methodology, in collaboration with the partners, and have submitted an ethics application which was approved in 2021. We are working with ELFT on a film project, and with the NPAG to develop a sensory methods guidance toolkit.
Collaborator Contribution Our partners have given their time 'in kind' by reviewing our methods-in-progress, supporting our ethics application, and attending online workshops at which we have tried out research methods. They have given significant input despite the challenging circumstances of Covid-19 for the NHS.
Impact This is a multi-disciplinary collaboration between two hospital arts organisations, a historian and a sensory arts researcher. So far the outputs have included a research 'toolkit' prototype and an ethics application, and we are currently in the process of developing an exhibition and some project prototypes which will translate the research into impact.
Start Year 2020
 
Description Article for Psyche online magazine 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact I wrote an article for Psyche magazine, called 'How the noises of a hospital can become a healing soundscape'. The magazine has around 1 million readers per month overall.
Year(s) Of Engagement Activity 2022
 
Description BBC Radio Show - 'Ways of Talking about Health' 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact 'New Thinking: Ways of Talking about Health. Arts & Ideas. Des Fitzgerald talks to the winners of the AHRC and Wellcome Trust Medical Humanities Awards 2020 about their research into the connections between the arts and health.'
Year(s) Of Engagement Activity 2020
 
Description Blogs: booklet 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The 'Hospital Senses' network and website has been publishing blogs since 2020, as part of its public-facing website described more in a separate entry. In 2022, the 'Sensing Spaces of Healthcare' project co-sponsored (with the Wellcome Trust network) the development and printing of these blogs into a downloadable booklet that people could read offline in order to improve the accessibility and reach of the blogs. The first ten blogs were put online in 2021. The next group of 10 are part of a series sponsored by the 'Sensing Spaces of Healthcare' project, as part of a series called 'Responding to a Sensory History Manifesto'.
Year(s) Of Engagement Activity 2021,2022
URL https://hospitalsenses.files.wordpress.com/2021/12/sensing-spaces-of-healthcare-blog-project-booklet...
 
Description Hack the Hospital 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Mentors (V Bates and R Fleetwood-Smith) for 'Hack the Hospital 2' on the subject of: 'how might we design the pediatric room of the future (whether at a hospital or at home) to improve the overall experience of comfort, safety, and efficiency?'
Year(s) Of Engagement Activity 2023
URL https://www.5gtransatlanticlab.com/hackthehospital2-challenges
 
Description Hospital Senses Guidance Note: A Working Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This ongoing interdisciplinary and international working group started in 2021 and will develop a guidance document for hospitals on sensory architecture and design. We want to design a document that prompts engagement with 'good' sensory design in new-build hospitals and hospital redevelopments. The working group brings together existing expertise on sensory design at a range of scales: from furniture and objects, to arts, interior design and architecture. Members of the working group will be named as co-authors of the finished guidance note. We will discuss the draft at a conference in 2023 and then hope to use our +3 years funding in 2024-27 to finalise, produce, and disseminate this guidance.
Year(s) Of Engagement Activity 2021,2022
URL https://hospitalsenses.co.uk/working-group-2/
 
Description Keynote speaker at the 16th International Annual Symposium of Koç University's Anatolian Civilizations Research Center in Istanbul, Turkey. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I gave a presentation on hospital noise as the keynote speaker at the 16th International Annual Symposium of Koç University's Anatolian Civilizations Research Center in Istanbul, Turkey. The talk was called "Feeling Your Way: The Challenges and Opportunities of a Sensory History of Hospitals". It attracted close to 700 guests, including many medical professionals alongside academics.
Year(s) Of Engagement Activity 2022
 
Description Listening to the Hospital - workshop for NHS staff 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact During the workshop we used various mark making techniques to explore sounds of the hospital. Mark making refers to the creation of different patterns, lines, textures and shapes. We will consider the types of sounds we hear and how we may respond to these through the marks we make. Working together we reimagined the hospital soundscape through mark making.
Year(s) Of Engagement Activity 2021
 
Description Mapping your Dream Hospital workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Online workshop for European HealthCare Design conference
Year(s) Of Engagement Activity 2021
 
Description Poetry Workshop for NHS Staff 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 15 NHS staff members attended an online poetry workshop on the senses and hospitals, some of whom allowed us to publish their pieces on our project website. Participants reported that the workshop gave them the opportunity - including the time and tools - to reflect on the hospital as a space, and supported them to express themselves creatively.
Year(s) Of Engagement Activity 2020
URL https://hospitalsenses.co.uk/2019/11/15/creative-workshops/#makingsenseofhospitalspaces
 
Description Public-facing blog on the senses & healthcare 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Starting in summer 2020, we invited website contributions relevant to the Sensing Spaces of Healthcare project. We summarise these here as 'blogs', but this is shorthand for a range of contributions from interviews to audio-visual and creative contributions. The blog statistics show international reach, but exactly who is accessing/reading the blogs is not known. Based on our mailing list, we expect it is a mixed of professional practitioners in healthcare and healthcare design, and academics working on relevant subjects.
Year(s) Of Engagement Activity 2020,2021
URL https://hospitalsenses.wordpress.com/wp-admin/index.php?page=stats
 
Description Talk for the 'Pervasive Media Studio' - These Sounds Save Lives: A Virtual Reality Film 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Details of the talk: 'In this reveal-all talk, we will be hearing from Dr Victoria Bates of University of Bristol and Reuben Armstrong, Animator and Studio Resident, as they unpack their recent collaboration working with hospital soundscapes and immersive animation software. The project builds on Victoria's latest publication 'Making Noise in the Modern Hospital', a research piece that looks at the NHS's attempts to reduce noise within hospital settings. But as the project makes clear - silence is never the goal'
Year(s) Of Engagement Activity 2022
 
Description These Sounds Save Lives - public-facing film 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This short animation was painted entirely by hand in virtual reality (VR) using Oculus Quill. The minimalist, stripped back, duotone aesthetic puts the focus on the soundscape, whilst the POV camera and calm narration immerses us in the environment and guides us through the hospital setting.

The purpose of the film is to promote & demystify the topics within Victoria Bates' book titled Making Noise in the Modern Hospital. As we developed the script and style, we found that by broadening the audience and centering the patient experience the film could also serve a therapeutic and educational purpose. If this film can help us reframe how we hear and listen within hospitals, maybe then it can help us cope in future moments of distress or anxiety.

A visit to hospital can be a uncomfortable experience and noise is often a source of complaints. Over the years, the NHS has spent significant amounts of money on things like sound-proofing and internal communications campaigns to try and reduce noise within the hospital, but as our film makes clear - silence is never the goal. Through the calmness of the narration, we call for compassion, patience and understanding - encouraging an appreciation for the layers of people and place that make our NHS tick.

Direction: Reuben + Jamie
Copywriting: Jamie Neale
Animation: Reuben Armstrong
Voiceover: Victoria Bates
Sound Design: Jamie Frye
Year(s) Of Engagement Activity 2021
URL https://vimeo.com/623693499
 
Description Workshops for Weston Arts + Health Week: Feeling your Dream Hospital and Mapping your Dream Hospital 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact We provided two interactive / remote activity kits, based on our creative research methods, for Weston Arts + Health week. These were mostly used with staff from University Hospitals Bristol and Weston NHS Foundation Trust.
Year(s) Of Engagement Activity 2021
 
Description Workshops with GOSH Young Persons' Advisory Group - Collaging your Dream Hospital, Feeling your Dream Hospital, Mapping your Dream Hospital 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact We have worked closely with the GOSH YPAG (a group of young people who advise on research), with an ongoing workshop series. YPAG members have reported that engaging with out research has made them think differently about the sensory environment of hospitals, including as future medical practitioners interested in holistic care.
Year(s) Of Engagement Activity 2021
 
Description Workshops with project partners - Collaging a Future Hospital, Touch in the Hospital, Beyond the Hospital, Mapping your Dream Hospital 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This was a series of engagement and development workshops for our creative research, run with our project partners Fresh Arts & GOSH Arts, which brought in a range of different staff members from North Bristol NHS Trust and Great Ormond Street Hospital for Children NHS Foundation Trust.
Year(s) Of Engagement Activity 2021