Interview with Ute Ziegler: Design Interventions in the Medical Context
In form 261 the Focus section looks at the theme of Design Meets Health. In one of our articles the US American academic Ann Sloan Devlin explains the methodology of evidence-based design in the healthcare sector, which is already well established in English-speaking countries. Ute Ziegler, a researcher in design and health at the Lucerne School of Art and Design has examined this method in detail as part of her specialised work, and now provides further insights into this mode of practice, as well as ongoing projects.
When did you first start looking at the theme of design and health?
In my case, my interest with design and health has its roots in my study of phenomenology and atmospheres. In 2008 I completed my training as a building biology planner. This involved a scientific approach that encompassed disciplines such as chemistry, construction physics, physiology and biology, which all tie in to the field of healthcare and the idea of healthy living. I discovered Anglo-Saxon approaches such as evidence-based design through the literature associated with my subject.
Do you work with specific methods in particular?
The basic starting point is definitely a systematic way of looking at things that combines various approaches. Ever since I have been working in the field of design research, I have found that interweaving two methodological approaches proves particularly successful when dealing with health-related design. The first of these is evidence-based design, which measures the effects of buildings on the recovery rates of human beings. Designers and architects who work with this approach use studies and basic scientific knowledge from different disciplines to assess the physical and psychological effects of built spaces on people and patients more effectively, with a view to improving their wellbeing and reducing anxiety and stress. This also includes the rudiments of neuroscience, including chronobiology, which is hugely important for lighting design and can be implemented in an application-oriented way. The second approach is experience-based design, which was developed in England. This complements evidence-based design and makes radically patient-focused design truly possible for the first time. This approach brings the patients and employees of institutions together in participatory processes, with the aim of improving their environment, care and services. These experiences are reshaped in workshops that involve patients and employees. All of the relevant user groups also play a role by coming up with joint solutions to address wide-ranging problems, of which planners, architects and designer are often unaware. The positive effects of experience-based design have a bearing on areas such as patient autonomy, self-management, empowerment, personal responsibility and protection of privacy, which have a marked impact on wellbeing.
Is the design community working in this field in German-speaking countries similar to that in English-speaking countries? How do they differ?
No, German-speaking countries certainly bring up the rear in this regard, which is probably related to the good healthcare and insurance systems there. The healthcare systems in Germany and Switzerland are some of the best in the world, but they are also very expensive in comparison with the National Health Service in the UK. For this reason, the UK is one of the pioneers in innovative design projects and the development of procedures in the field of healthcare. The Design Council there has been promoting healthcare-related design research for years. Of course, this also filters through to higher education institutions, which have developed their own research priorities with that in mind. Scandinavian countries also see a lot of innovative approaches, platforms and projects that bring together design and health, which receive huge promotion and support from government and industry. This is noticeable in the number of specialist conferences that take place, primarily in Scandinavia and England. I work at the Lucerne School of Art and Design, where this issue has also received particular attention in our competence centre for design management for a number of years. Research priorities are currently being pursued to different extents in Lucerne and Bern.
How did the “Modular Cocoon” project come about?
The Clienia Littenheid psychiatric clinic in Switzerland was one of our research partners, and it wanted to take part in a large-scale research project on design interventions in clinics. At that time the project had not yet been approved for funding. However, Clienia Littenheid wanted to expand its knowledge as a number of new buildings were being planned as part of its complex, and the Lucerne School was asked to carry out the research project on commission. It related mainly to two stations: one for mentally traumatised patients, and the other for people with anxiety and depressive disorders.
How did the design process take shape?
The research process was divided into four phases. The objective for the trauma station was to develop equipment or environments conducive to the reduction of heightened states of excitement or stress among mentally traumatised patients. In the first phase, observations and quantitative measurements (in lux and decibels) were carried out, allowing poor lighting, unfavourable acoustics and unpleasant smells to be identified as stressors. In the second phase, interviews and discussions were held with patients, doctors, therapists and nurses. The stressors that we found were confirmed by these conversations, along with others, such as a lack of privacy or places to which the patients could retreat. In these discussions, the stakeholders were asked to put forward their own wishes, ideas, visions and suggestions for improving the environment for patients. In a further step, an artistic co-design process was carried out, involving the patients. Even from the discussions along, it was clear that mentally traumatised patients have a very clear sense of what is good for them and what exerts a calming influence. They are able to define which qualities and materials certain objects should have. Due to their need for protection, patients are highly sensitised to their contact with the things around them. In the third phase the data that had been collated was analysed, criteria extrapolated and the findings worked into concept ideas. The design parameters were selected by drawing upon the needs and wishes of the users that had been identified, and the prototype of the Modular Cocoon was built. In the fourth phase the prototype was tested in a patient’s room at the trauma station from February 2014 to December 2014. The patients’ interaction with the cocoon and the various design parameters such as light or textile layering were evaluated through interviews and questionnaires. The interesting thing was exactly what happened to the patients when they used the Modular Cocoon. Which components did the patients use at which time, and what was their emotional state? The nurses and therapists observed and scored the effect on states of agitation and symptoms of stress.
Are you working on any comparable design projects at present?
At the moment our research group is working on app projects with a social innovation slant. Once again we are collaborating with a psychiatric clinic. In this case we are examining the process through which patients are discharged, and trying to identify which resources can be made available to patients before, while and after they are discharged.
Are you drawn to any particular design projects because you believe them to be particularly effective?
It isn’t so much a matter of projects that I am attracted to, as their methods and approaches. Two figures that I believe to be exceptional in this field are Mathieu Lehanneur and Philippe Rahm. Both of them incorporate transdisciplinary knowledge about human biology and physiology into their approaches. Lehanneur worked with a sleep specialist when designing the rooms for a hotel in Reims – they developed a space in which light, sound and temperature can be individually altered to produce the ideal conditions for facilitating sleeping and waking. Lehanneur always draws upon his knowledge of the body’s natural processes, so his approach can be applied to sleep, nutrition or better ventilation. The Swiss designer Philippe Rahm forges a similar path, and has worked with the chronobiologist Anna Wirz-Justice. He suggests a new definition of architectural practice based on the disappearance of physical boundaries between the surrounding space and the body, drawing upon findings from physiology and neuroscience. He brings a new dimension to architecture by examining physical, biological, electromagnetic and chemical influences on human beings. When designing a space, Rahm uses an experimental process that combines architecture and design, neuroscience and medical expertise. His subtle interventions evoke a plethora of physiological reactions and influence the associated perceptions of the space and the body itself. So I am definitely an advocate for incorporating basic research from different disciplines into design in a targeted way. Scientists are usually very interested, keen to provide information and eager to collaborate. Design parameters are active agents that have to be chosen very carefully according to the symptoms and demographic characteristics of the patients. I am well aware that this runs counter to the mainstream approach employed in design, because it can never provide standardised solutions, but rather revolves around highly personalised, self-selectable options for patients, allowing them to shape their own surroundings and adapt their environment so that they feel comfortable.