The Aesthetics and Architecture of Care Environments (2019) Freja Ståhlberg-Aalto
As the writer states, this is “a study that explores the aesthetic dimensions of the care environment as experienced by the users and stakeholders” (pp.6) of healthcare buildings (hospitals, clinics, rehabilitation centres and facilities for the elderly) as it is believed that the environment can induce wellbeing and happiness as well as support and facilitate the care and cure patients and residents. The research aims to enhance the understanding of careenvironment aesthetics and to improve the future designs of care buildings. The author states that some of the challenges the study faced were related to her own concept of aesthetic features of a care environment, i.e., spatial solutions, surface qualities and details of the building. Ståhlberg-Aalto then navigates through defining aesthetics in relation with the different care environments and their perception in several cultures, as well as how users and stakeholders experience aesthetic elements to understand if awarded healthcare architecture is considered best by users and not only by experts.
The author conducts 45 Q methodological interviews in ten case study buildings “allowing users and stakeholders to generate their own conception of the aesthetic environment in which they work.”
Chapter 1. The Care Environment: Research Approaches. The first chapter focuses on the definitions concerning the care environment and previous research studies with special emphasis on potential aesthetic dimensions and features.
“The chapter concludes that although environmental psychologists have attempted to find law- abiding tendencies in human reactions vis-à-vis aesthetic features, studying preferences and measuring the physiological reactions occurring in the body while exposed to an environment, work still remains to be done before the connection between health outcomes and specific environmental features can be established.” (pp.15)
Chapter 2. Aesthetics and Architecture: Buildings a Theoretical Model The second chapter focuses on the literature review of philosophical aesthetics and architectural theory to create a framework for the Q methodological investigation. The author turns to Yuriko Saito’s (2007) definition of everyday aesthetics any reaction we form to the sensuous and/ or the design qualities of the care environment to build a theoretical model “by cross-tabulating the four ways by which the aesthetic experience can be sensed (sensory qualities, contextual features, the social dimension and function) with the architectural features of any built environment, that is, the design level (stuff, surfaces, space and light and the surroundings).” (pp.15)
Chapter 3. Investigating the Care Environment In the third chapter the research design is identified and elaborated (qualitative case study research), the building types are chosen, the Q methodology is introduced, the Q sample is defined, the respondents are chosen as well as the methods for analysing the results.
Chapter 4. The Case Study Buildings The ten case studies buildings are analysed in the fourth chapter: five case studies in Japan and five in Europe, respectively, four acute high-tech environments (hospitals or specialized clinics) and six chronic low-tech environments (rehabilitation centres and care homes). Each of the ten care environments are individually presented and analysed.
Chapter 5. Results of the Q Methodological Experiments Chapter five presents the elementary/raw results from the Q experiments and five aesthetic statements/discourses on the care environment surfaced: the ‘putting patients first’; the Nightingale discourse; the nature – wellbeing – personalisation; the ‘my home is my castle’; and the rational wayfinding system.
“When statistically analysing the similarities and dissimilarities between these discourses, the so-called consensus statements conveyed some common values for all discourses, which could be seen, in the context of this study, as universal aesthetic values that transcend the building types, the stakeholder’s and user’s statuses and the cultural contexts. The normative implication of these universal aesthetic values is that the dimensions and features of such aesthetics should be taken into consideration in the design of any care environment, if we want to design environments that respond to the basic elementary needs and expectations of the users and stakeholders.” (pp.17)
Chapter 6. Discussion In the sixth chapter, the author revisits the initial questions and compares them with the findings from the Q methodology as well as with previous research on healthcare architecture. One of the findings of the analysis regarding the case studies argues which of the healthcare facilities could be considered future best-practises from the user perspective as well. The other one consists of comparing the architectural best-practises (as all ten case studies are awarded or celebrated buildings) with users’ and stakeholders’ best selections and see whether they match or the assessment on best architecture needs to be recalibrated. The end of the chapter discusses the adaptability of the methodology.
Chapter 7. Conclusion: Reconciliation Between Discourses The seventh chapter summarises the main findings and conclusions trying to reconciliate the currently disparate discourses:
“… there are four main practical implications of this study. Firstly, all user and stakeholders should be involved in the design processes, in the decision-making and in research endeavours. Architecture is about more than the architect. … various parties involved have valuable viewpoints that need to be respected when designing state-of-the-art care environments or conducting comprehensive research. If this is ignored, we will be missing out on important and relevant dimensions. On a methodological level, this study has provided a tool – Q Methodology – for studying architecture in such a way that the subjective voices of the users and stakeholders can be heard. Secondly, this study verifies the existence of shared conceptions of aesthetics. We need to understand and apply these shared conceptions in order to design excellent care environments that answer to the needs and expectations of all the users. Thirdly, even best-practices show both positive and negative features when they are evaluated by the users and stakeholders. Therefore, we need systematic research that would investigate the content and implication of these evaluations. Finally, designers and architects would profit from broadening their toolkit by picking and mixing, adopting and adapting from one that is more user-sensitive, in their search for future aesthetics of care environments.” (pp.307)
Ioana Mădălina Moldovan
Universitatea Tehnică din Cluj-Napoca
Ståhlberg-Aalto, Freja. The Aesthetics and Architecture of Care Environments: A Q Methodological Study of Ten Care Environments in Japan and the European Countries of Finland, Sweden, the UK, France and Austria. Espoo: Aalto ARTD Books, 2019