Listen to this article
Hospitals are machines. They are great medical mechanisms geared to treatment, efficiency and cleanliness — and getting patients out as soon as possible before they contract something worse. They are designed for processes as much as patients — who, usually, will not be staying more than a few days or perhaps weeks.
Among the medical equipment, surrounded by layers of air-conditioning ducts and cabling, or in tiny offices dotted along endless corridors are the staff, whose private work spaces are usually confined to leftover spaces in the midst of the machine. When they are not in the wards, operating theatres or waiting rooms, the staff are in tiny offices, often with no windows, or manning reception desks, or trying to complete paperwork in corners of wards or store rooms. The modern hospital might be a healing machine, but what do these spaces do to the people who work in them?
It is a problem that an innovative type of building attempts to address by adopting a radically different architecture. It has created a new kind of space that is not quite medical nor exactly domestic, a hybrid architecture that looks quite unlike the regular kind of hospital.
In the UK, Maggie’s Centres are designed for people with cancer and their families. They are buildings set beside hospitals that can accommodate a mix of uses, from consultations with cancer nurses to yoga and communal activities. They provide a space in which it is possible to talk about problems with other people or a space in which it is possible to sit and be alone.
These, though, are not the kind of neutral spaces you might imagine. Instead they have been built into a programme of challenging, radical, surprising and often quite difficult structures designed by the world’s most intriguing, best-known and often most challenging architects. There are designs by Frank Gehry, who built the Guggenheim Bilbao, the late Zaha Hadid, who built the Aquatics Centre for the London 2012 Olympics, Norman Foster, whose buildings include New York’s Hearst Tower, Richard Rogers, who built London’s Millennium Dome and Rem Koolhaas who is responsible for media group CCTV’s Beijing headquarters. Many other innovative architects have also helped create the centres, which now number around 20, with several more in development.
The centres are named after Maggie Jencks, whose treatment in inhospitable and depressing medicalised surroundings inspired the idea of a new idea of architecture. Maggie’s husband, Charles Jencks, the prominent architecture writer and landscape designer, worked with her on this idea and carried on after Maggie’s death in 1995, developing it into a remarkable architectural programme.
“I never believed in architectural determinism,” Jencks says, referring to the theory that environment can influence human behaviour. “Until I had my mind changed. I was doing a radio interview with a doctor, and I’d said buildings can’t change outcomes, and then the doctor butted in and said: ‘You’re wrong! If it’s a bad building, we don’t turn up for work’”.
Jencks was forced to reassess his view. “If you look after the carers,” he says, “the carers can really look after the patients — you create a virtuous circle.”
The Maggie’s Centres are all found on NHS hospital sites but they are run by an independent charity. They are what Jencks calls hybrid spaces, or “non-institutional institutions”. “They’re a cross between a hospital and a country club, a house that is not a home, a church that is not religious, an art gallery that is not a museum,” he says.
If that all sounds rather grand, the centres themselves are a hybrid of the highbrow and the domestic, the theatrical and the familiar. Their architecture may be surprising and radical, but at the heart of each centre is the most familiar setting of all, an image that brings them right back to earth: a kitchen table.
“The thing about a kitchen is not only that it is familiar but that we know what to do in it — how to behave, whether it’s making a cup of tea or sitting down for a chat,” says Lesley Howells, head of the Maggie’s Centre in Dundee, Scotland.
The Maggie’s Centres entirely avoid that usual marker of the institution or the office — a reception desk. People are free to walk in, but they might then be unsure what to do; the domestic setting gives them the cues and the implicit permission to move deeper into the space and use it, adopt it as their own. The Dundee centre was designed by Gehry and it was his first building in the UK. It is a dramatic form with a characteristically crumpled metal roof, a complex and warm timber interior and a solid-looking tower with wonderful views across the silvery river Tay below. The contrast between architectural ambition and domestic embrace is deliberate — it is, arguably, the essence of the Maggie’s programme.
But does the architecture not get in the way of the use, which can happen with experimental or radical design? “The architecture,” Howells responds, “immediately engages all the senses. It engenders a sense of awe and a spiritual element, which gives a bigger picture, allowing it to transcend the everyday.
“The building, as well as the Eduardo Paolozzi tapestries inside, is absorbing — they enrich but they also suggest that you [the visitor or the staff member] are worth it — worth all this investment.”
Howells, who is also a clinical psychologist, says the architecture of the centres “trains the staff in terms of how to ‘be’. It enables people to come into the moment and settle. To gain clarity. The sound, the light, the materials engage all your senses. People say it doesn’t smell like the National Health Service and it doesn’t trigger those same responses of being a hospital, which helps us when people are trying to absorb information and negotiate difficult situations. The architecture works with us.”
Stephen Wallwork, a vocational rehabilitation case manager at the Manchester Maggie’s Centre, which was designed by Foster, agrees that the building has had a profoundly positive effect on staff. “The building has definitely made it easier for me to do my job’ he says. “Weirdly, there was more footfall in the hospital where I used to work than in Maggie’s, yet I’m able to reach out to more people here. Someone might be popping in for a yoga session and you can speak to them about work issues or something else without having to have a referral, and people are surprisingly open to speaking about serious things just around a kitchen table.”
Foster and his firm Foster + Partners designed the centre as a kind of huge greenhouse. If some centres have a garden for contemplation or just fresh air — extensions of the indoor space — the Manchester centre’s interior appears like an extension of the garden. The relationship between inside and out is critical to nearly all of the buildings. Visitors are treated to a glimpse of green, a little sky or a panorama of the city outside, as on the roof terrace of the Maggie’s Centre at St Bartholomew’s Hospital in central London designed by Steven Holl.
Rem Koolhaas, founding partner of OMA, enveloped a garden in an ethereal glass doughnut so that even under Glasgow’s grey skies the users and staff are always aware of nature. The ability to choose to be inside or out is another pivotal part of the centres’ success. What makes them work so well is partly the sense that users and staff have agency over the architecture — huge hospitals can often feel oppressive and can magnify the sense of powerlessness that afflicts patients and their families.
The inability to open a window to get some fresh air, to change things around or adjust the lighting can be depressing. “In the Maggie’s Centres we very seldom have designated rooms,” Howells says.
The sense of ownership over the space is intriguing as it seems so counter to contemporary starchitecture, with its focus on spectacular, image-driven space. Instead, in the Maggie’s Centres there are small spaces where people can choose to be alone — as opposed to being made to feel alone — nooks, mezzanines, library corners or landings and window seats that create refuge.
On the other hand, those spaces where everything is visible also mean the staff are on display all the time — which must, I ask, surely be exhausting? “I think the staff learn to use that openness,” responds Howell. “We become hosts, constantly [but possibly unconsciously] scanning. It can be tiring, but it is also hugely energising because the architecture works with us.”