Does design have the power to enhance dignity?

Many of us have the privilege to go about our daily lives unaware of the powerful role the built environment plays in supporting our feeling of being celebrated and respected. As architects and designers, we must place inhabitants’ dignity at the forefront of our design priorities. Our work has the power to create spaces that have far reaching and lasting impacts. Few places need this perspective more than spaces that serve predominantly underserved, underrepresented, or socially stigmatized communities.

To start, what is dignity?

Dignity is the right of a person to be treated ethically as well as being valued and respected for who they are. For healthcare professionals dignified care means recognizing and honoring patients’ capacities and ambitions. While patient dignity is a core tenant of healthcare staff training, it is also critically important to consider the role of the built environment to support dignity for both patients and staff.

Dignity can be defined by four main factors:

1. Respect – Respect includes self-respect, respect for others, respect for peoples’ privacy, and confidentiality.
2. Autonomy – Autonomy includes having choices, being able to make decisions, rights, needs, and independence.
3. Empowerment – Empowerment includes feelings of being important and valuable, self-esteem or self-worth, and pride.
4. Communication – Communication includes clear information, language, intuitive wayfinding and directional cues, and privacy.

Here are five considerations for designing dignified environments:

Design as a Beacon

Too often, mental health and treatment program facilities exist in hidden spaces kept out of sight from the public. We aim to create spaces which bring a sense of pride to those who enter. By considering each step of the end-user experience, from the street approach to the quality of finishes, we aim to thoughtfully apply design aesthetics to create a welcoming facility from the very earliest interactions. Welcoming patients, clinicians, and the community into a space that is beautifully designed to support the specific needs and identity of the users is a meaningful way to communicate the intrinsic value of the patients and clients within those spaces.

In initial design discussions, Compass Health requested a sense of grandeur within their new facility located in Everett, Washington. After years of making do with an aging building, the goal for their Phase II building, housing both inpatient and outpatient behavioral healthcare, was to create a space that anyone would feel proud to enter. The stigma of mental health treatment was stripped away by prioritizing a grand, double-height entry and foyer that highlights exterior garden space. The exterior finishes were selected to be warm and welcoming.

Compass Health’s Phase II: The entry design uses scale, richly colored materials, and nature to evoke a warm welcome to all who enter.

The Power of Choice

In design, when we do not acknowledge the vast spectrum of human needs, we strip away the ability to exercise autonomy and control over our surroundings. Design that is mindful of autonomy, considers a variety of mental states, capabilities, traumas, and preferences to create dynamic spaces which allow people to choose the experience that fits their needs best in that moment. Avoiding the stress of being in an uncomfortable space allows patients and clients to receive care while in the best possible mindset. It also reduces negative associations that may become barriers for seeking care in the future. In many cases, mental health, housing, or medical facilities unintentionally strip away the opportunities for personal choice due to logistics and procedures, but thoughtful communication with providers allows designers to construct opportunities for choice and autonomy within even the highest acuity patient types.

The design team on the Alameda Senior Respite and Primary Care Facility acknowledged the importance of choice and autonomy in the design of the new 30,000 sq. ft. facility serving Alameda County in California. The design, which creates permanent supportive housing for an aging subset of the local homeless population, thoughtfully addresses the need for individual choice by completely rethinking the approach to lighting design throughout the building. Acknowledging the impact of harsh or bright lighting, uncomfortable lighting when resting, or a lack of lighting when trying to read and relax, the design team prioritized indirect lighting throughout all patient spaces, designed hallways outside of bedrooms to dim to the lowest levels allowed by code during quiet hours, and coordinated a wall sconce with controls at each bedside for residents. These simple, yet impactful, solutions allow residents to have autonomy over their surroundings in a way many of us would take for granted.

Safety over Security

We deserve to feel safe in our environments, and increasingly, facilities are moving towards providing a friendly face at entry points to help visitors feel welcome in lieu of uniformed security, which can be particularly traumatizing for many populations. Through collaboration with staff and clinicians, we can facilitate safety by designing clear pathways of visibility for observation and engagement that does not feel intrusive. Doing so allows visitors and residents to maintain their sense of independence and autonomy while remaining safe. Intentionally designed spaces which focus on relationship building increase the safety of patients while also increasing the likelihood of positive experiences and returns for subsequent care in the future.

The inpatient floors for Compass Health were laid out around a central nurse station allowing care teams to maintain a direct line of sight to all patient spaces, including the outdoor patient areas. Whereas other facilities require patients to be accompanied by a staff member to outdoor or group spaces, the clear paths of visibility allow patients to move from space to space unaccompanied, fostering independence while ensuring staff are aware of any interactions which may require their attention. Similarly, opportunities for passive observation in outpatient areas allow for easy circulation and a friendly face at various reception desks to assist first-time visitors and clients, as well as to foster connection with staff in various areas throughout the lobbies.

Compass Health Phase II: The building massing prioritized sightlines for the on-unit nursing and care team from the earliest diagrams (left). Interior design focused on maintaining the connection between staff and patients (right).

Whole Person Healing

If we consider the physical, mental, emotional, and social determinates of health in the design and programming process, we can create transformational facilities that help bolster the entire community. By creating space for additional programs and prominently locating basic needs near entries, each visitor can easily access support. Furthermore, designing medical care with counseling and housing opportunities provides a holistic approach to wellness that caters to a vast spectrum of needs, removing the barriers of care that occur when visiting many different facilities for the same services. Integrating community spaces into our designs allows additional social needs to be met that may not be related to specific medical needs, while inviting the community into spaces shared by diverse populations humanizes the experience of those seeking treatment in those spaces.

The core tenant of Central City Concern’s Blackburn Center is to “help people’s health through comfort, community, and safety.” The center, which serves people experiencing homelessness, poverty, and addiction in the Portland, Oregon area also aims to create a supportive housing project which incorporates mental and physical health resources under the same roof. The design carefully integrates a complex series of support systems that begin on the ground floor with commons area, teaching kitchen, pharmacy, and community services. Moving up a floor, the medical clinic supports the housing residents onsite. Housing includes palliative care, two floors of single room occupancy housing, and a floor of apartments for permanent housing, which supports people nearly ready to live on their own. The design aesthetics and function aim to create a fulfilling and enriching home-like experience that bolsters residents in all aspects of health and wellness, truly treating the whole person.

Nature as Medicine

Biophilia states that we, as humans, are part of nature and are inherently attracted to, and supported by, natural environments. Using nature as a tool to promote healing and wellness is a key part of providing users with the respect and dignity they deserve. Many at-risk populations receive care and housing in aging spaces that do not receive quality daylight, and access to outdoors is deemed too unsafe and difficult to monitor. By incorporating nature connections such as views, natural materials, fresh air, and plants into the requirements for healing spaces, we ultimately acknowledge the humanity of the occupants within a space. Whether they are patients, residents, visitors, or staff, everybody benefits from contact with nature through positive distractions, lowered blood pressure, increased resilience to environmental stressors, and the benefit of aligning our sense of time and place with the observable natural rhythms of the world around us.

Early on in Compass Health’s design process, the importance of fresh air and contact with nature was identified by the client and design team. As a result, the earliest building massing schemes explored how to bring nature as far into the building as possible. The resulting form for the inpatient floors is two separate wings positioned beside deeply cut rooftop gardens with a central connection space that serves as the primary gathering and dining area for the inpatient population. Each of the two floors of inpatient treatment have access to dedicated outdoor garden spaces that are designed to allow residents to move freely between interior living spaces and outdoor areas. Beyond the patient outdoor spaces are extensive green roofs which are visible from interior spaces in the public, staff, and patient spaces. This impactful design decision will support the healing and restorative vision of Compass Health’s mission to treat the whole person.

Compass Health Phase II: Both inpatient floors provide residents, staff, and visitors views of nature by utilizing the space between buildings for extensive green roofs.

Why design for dignity?

By implementing these five strategies, designers can create spaces that honor the core aspects of dignity by respecting each visitor and their unique place in the world, supporting their autonomy through choice, empower occupants as they move through the space, and ultimately communicate equitably inhabitants. The resulting designs are spaces which can be as meaningful as they are beautiful while actively participating in the health and growth of our communities.

By Ashlee Washington, Senior Associate