Case Study: AHMM's North London Hospice
Allford Hall Monaghan Morris [AHMM] are an award winning international practice designing for all building typologies. The North London Hospice was designed to offer specialist palliative care to patients with life-limiting illnesses. This case study used the opportunity to explore the process of creating a care environment from the perspective of the architect. The aim of this case study is to explore; the drivers and funding, architecture for marginalised people, and design for mental health. Interestingly, throughout the interview the architect, Paul Monaghan, mentioned “The hospice isn’t really about mental health”, however the achitecture of the hospic paves the way for positive mental health.
The North London Hospice came about due to a high demand in service all over North London. The client believed in the importance of this group of marginalised people.“It’s about bringing the building to the people who might need it.” (Paul Monaghan) AHMM won the right to design the project though a competition.
The project cost £1.8 Million, funded though the north London hospice charity, “the charity shops plus the families of people who passed will make donations”(Paul Monaghan). Charities do not receive the same investments a business organisation would, therefore funding is harder and budgets are smaller by comparison. Fortunately, AHMM were able to implement all design ideas from start to completion, it is clear to see the final outcomes come from their initial design intentions rather than a diluted concept.
The existing hospice gave the architects opportunity to talk with the staff in the old environment, Monaghan said that they
“we were able to go and meet the nurses, meet the doctors and talk to them, we did a lot with them and formed the brief with them.” (Paul Monaghan)
The main principle was to provide a non-institutionalised environment. The purpose of the building is day care for terminally ill patients and therefore no improvement to physical health can be made. “No, no impact. Apart from rest for carers, this building is for terminally ill patients who are going to die, we can’t make any change to their health.” (Paul Monaghan) Therefore the only improvement to their quality of life is to improve their mental health.
Paul Monaghan said the main principle to get right when designing non institutionalised environments was scale. “In a hospital the ceiling is 4m high, this is too high for people.” (Paul Monaghan) An important observation of how the architectural parameters of a space can make people feel in connection to a previous environmental experience. The building is a series of rooms designed to provide different spaces for the patients and the scale is addressed accordingly, designed to feel like a big house. “every room has its own character” (Paul Monaghan). The kitchen is not a commercial kitchen at the back of a building, it is open with familiar appearance, placement, and scales of a residential kitchen. The patients can help out in the kitchen achievable because of this set up.
The impact of the architecture is unable to be recorded via the terminally ill patients “Research feels too intrusive, the stages people are in, people are very very ill connected to tubes.” (Paul Monaghan) But you can measure the impact on the staff. “It’s really hard work being a member of staff there” (Paul Monaghan). The staff at the North London Hospice are not paid highly, and a lot of the staff at the hospice are volunteers, however the impact of the new building has seen a higher retention of staff compared to the old building.
The working environment can be a tool to keep the staff’s mental health at an optimum, rather than solely focusing design to cater for patients. “it’s central to it that they would have a real oasis that looked nowhere near the main part of the building that looked into the park” (Paul Monaghan) Talking to the staff in the early stages of design the architect understood how hard the job was here for the staff and saw they were key for the business and the patients.
“part of it being successful is people volunteering to work there so you need to keep them happy.” (Paul Monaghan)
The importance of the staff is reflected in the ‘oasis’ environments design by AHMM rather than seeing the staff as an after thought.
A further important concept was, the user experience from arrival to exit. The car park is a necessity for the patients being transported to and from the building, but AHMM designed it so “it feels like you’re entering a posh hotel” (Paul Monaghan), with a large canopy hanging over the entrance. Inside the building a room of great importance is the hairdressers.
“They feel pride in getting their hair done and it’s a sensuous thing they can enjoy” (Paul Monaghan).
These spaces show value is given to the patients and they are not seen as a burden. Their quality of life isimportant which is reflected in the design.
The external building fits in with the vernacular of the residential environment. The purpose built building was able to be “quite exemplary in terms of sustainability” (Paul Monaghan), something difficult to achieve in old reused buildings. The design intelligently uses natural light, fresh air, and landscape bringing the outside in.
“I suppose comfort was the key thing. Comfort in the most basic sense, good light, good views. Trying to put yourself in the picture that if you couldn’t move at all and all you could do was sit in a wheelchair when you looked around was there some delight in what you looked at. Were there 3-dimensions, were there shadows, were they gardens, were there beautiful materials, was there lovely furniture”
The architect immerses himself in the needs of the patients, creating empathy for this marginalised group of people.
Another important principle was the furniture. “It is so hard to find furniture that looks good for old people.” (Paul Monaghan) If you don’t want your care home to look like a hospital you cannot put the same furniture in. The building materials used were design in the same principle as the furniture. AHMM have used brick and slate externally with reference to the local vernacular. Internally they use brick, timber, polished concrete, and white paint which work alongside all the natural light and views of the gardens to create a comfortable environment.
We subconsciously associate certain concepts, within our environment with those we have experienced in our past or from our local culture. AHMM have used this theory of implicit association of institutionalised environments within the UK culture to create an architectural environment that does not create the feeling of being institutionalised. The study of implicit social cognition is first seen in the psychological research by Gordon Allport in 1954 when he published ‘The Nature of Prejudice’. Many vast and complex psychological theories and branched from this including the implicit association test [IAT] that is commonly used today in social psychology research.
AHMM have applied implicit association to the whole design of the North London Hospice using the; scale, furniture, materials, and user experience throughout the architecture. The architects designed inside-out and outside-in showing value in each and every element, including the car park. The building achieves a comfortable environment for both the patients and staff that has increased staff retention and donations from relatives who want to thank the hospice for their support. The architecture has married the business and practice.