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Maggie's Cancer Caring Centre's: a

healing environment in practice.
joran marijsse

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Belinda Mkony
 Joran Marijsse
ir. architect
VK Studio Roeselare

Maggie’s Cancer Caring Centre’s: a healing environment in practice.

knowledge sharing meeting | Roeselare | 20-11-2013
 INTRODUCTION
Prologue
Maggie’s Cancer Caring Centres
Maggie’s London
Prologue
ir. architect /KUL (2013)

additional master year anthropology (KUL)

Interests:
The intersubjective relation between
people and their environment, Healthcare
and sustainability

Specialties:
Healing environments, Phenomenology,
Inclusive design, Sustainable design
“Who are the users in your current project(s)
you design for?”

“How do you think they will experience your

project?”
Maggie’s Cancer Caring Centre’s
a healing environment in practice
LITERATURE:

Annemans, M., (2012), What makes an environment healing? Users and

designers about the Maggie’s Cancer Caring Centre London.Out of control.

Jencks, C., (2006), The architectural placebo. In The architecture of hospitals,

p449-459. NAi publishing, London.

Jencks, C., (2012) Can architecture affect your health? Unpublished

manuscript.

Mc Donald, M., (2011), Gardens of hope? The restorative paradigm and the
Maggie’s Centre Gardens. Proceedings.
HONG KONG
Charles Jencks Maggie Keswick

Why shunt people into miserable surroundings?

ARCHITECTURAL BRIEF

Described atmospheres

Guidelines, no checklist

(Available on http://www.maggiescentres.org).
Website organization
STARARCHITECTS

1) Capital + reference ~ good centre for free

2) Challenge

3) Feeling of care for users

Maggie‟s Dundee by Frank Gehry in 2003.
Maggie‟s Dundee by Frank Gehry in 2003.
Maggie‟s Glasgow by O.M.A.in 2002.
Maggie‟s Glasgow by O.M.A.in 2002.
Maggie‟s Five by Zaha Hadid architects in 2006.
Maggie‟s Five by Zaha Hadid architects in 2006.
Maggie‟s Aberdeen by Snohetta in 2013.
Maggie‟s Aberdeen by Snohetta in 2013.
Maggie’s London
Context
Maggie‟s London by Richard Rodgers and partners in 2008.
Maggie‟s London by Richard Rodgers and partners in 2008.
ETHNOGRAPHY:

Observations

Participant observations

Walk-along interviews

Depth-interviews
 INTRODUCTION
Prologue
Maggie’s Cancer Caring Centre’s
Maggie’s London

FRAMEWORK
Healing Environments
User

ETHNOGRAPHY
Arrival
Domestic Environment
Containment
Stimulation
Anchoring
Relaxation
Visitor

CONCLUSION
References
Further Reading
 FRAMEWORK
Healing Environments
User
Healing Environments
WE ARE ALL AFFECTED BY OUR SURROUNDINGS

prison cell exotic island

E.G.: DON JON

PROMOTE
WELL-BEING

Lower stress

Relaxation

Stimulation

Bridgepoint Activer Healthcare new hospital Toronto

(Healthcare Design magazine November 2013 p30-31)
PEOPLE ARE IN DIALOGUE WITH THEIR ENVIRONMENT THROUGH THE BODY

“To be is to be at a place”
(Merleau-Ponty 1996)

body

cancer
“The sense of self is closely tied to
the sense of place”
(Hall 1969)
environment
Architects can contribute in their design to a
less stressful and wholesome environment!
EVIDENCE BASED DESIGN

~ Evidence Based Medicine

Influence of:

Light, greenery, temperature, ventilation, orientation…

 Research Based Design

ARCHITECTURE

Form? Space?

Scale? Colour?

Texture? Light?

Structure? Function?

Material? …?
We need a holistic approach!
NETWORKS

Local level: experiences visitor <> architectural analysis

Global level: Maggie‟s London <> context

User
USER-EXPERTS Sickness =
role transforming experience

Human => Human + patient

Healing is a process

Persistant state of liminality

Cancer related system:

cancer, patient and relatives
 “Everywhere where there is interaction
between a place, a time and an expenditure
of energy there is rhythm.”
(Lefebvre 2004)
RHYTHM

Human body has different independent body-

rhythms

E.g.: Breathing, beating of the heart, sense of

hunger…

Cultivated rhythms in the natural and social

environment

E.g.: Daily walk with the dog, weekly coffee

table,Frequent visits to the hospital
A building also affords a rhythm!
USER-EXPERTS

People are closely involved with their environment during the healing
process

Maggie‟s Cancer Caring Centre‟s are places for anybody who is affected with
cancer

All visitors are user-experts for research

!! Don‟t use label patient (Latin: patiens = waiting, suffering)

 ETHNOGRAPHY
Healing Network
Arrival
Domestic Environment
Containment
Stimulation
Anchoring
Relaxation
Visitor
HEALING NETWORK

Maggie‟s Centre and home is a

centrum

Maggie‟s, home and hospital = triad

Context is important!!
The Haven, centre for people with breast cancer
The Thames
Frank Benfeld Park
HEALING RHYTHMS

Hea lin g
s p a ce

“As soon as I walked through the door, I thought 'what a wonderful place'(...) I
mean and I just love coming here” (Tony, visitor)
HEALING ATHMOSPHERE
“Comfortable, Welcoming, Nice,
Safe, Energize, Motivating,
Adventure, something kind of
exciting, something were they
can be proud of, that they feel
Hea lin g like an ownership of” (Bernie
s p a ce Byrne, Maggie„s Londen)

“Peaceful, calm, safe, homely,

friendly. It is very open” (Alyse,
visitor)

“It„s very hard to describe, but,

just makes you feel good and it
makes you feel home and it is
so important to come here”
(Anna, visitor)
 Arrival
Domestic Environment
Containment
Stimulation
Anchoring
Relaxation
Visitor
 Arrival
Implantation
Path
Form and Colour
No Threshold
IMPLANTATION

“It is convenient to the hospital

and I like the fact that it is at side.
It‟s a different place to go, just
different experience. It‟s so, you
know, it‟s so different. It’s more of
an oase, you know, of an enclave,
it’s some kind of thing, away from
the hospital (laughs)” (Stephanie,
visitor)

“Pff (sigh) in the hospital, I would

rather not be there, but that‟s why
today i went to the hospital to MRI
scan and they said that they had
a delay of one hour so I came
here (...)” (Caprice, visitor)
MEANDERING PATH

“When you walk in, it’s very

welcoming, very welcoming” (Anna,
visitor)

“When I come up, when I start to

come to Maggie, the garden and
the flowers. It’s really nice”
(Caprice, visitor)
Walk with Anna from Charing Cross Hospital to Maggie‟s London
 “It represents the centre. It’s away
FORM and COLOUR from the hospital. „Cause Maggie‟s
Centre when people doesn‟t know
wher Maggie‟s Centre, you just tell
them what colour of the building you
make the term (...)(Young
Yiang,visitor)

“When I, when I get up, Wedns-, on

Wednesday night I think, we are
going to Maggie's tomorrow! so I
get ready. I get my bag ready, my
clothes ready and think ow I go to
Maggie's tomorrow and already a
feel good that I'm going to
Maggie's___in the morning and then
when I get up, my focus is right get
ready to go! It's Maggie's, yes, and
I'm on the tube looking forward to
it,____ yes-” (Anna, visitor)
NO THRESHOLD

“As soon as I walk in the gate, and

at the little, is a little walk, a path,
and as soon as I step on that path
(laughs), I feel the feeling of
Maggie’s” “Just literally on, on that
step, because of the way that the
path is integrated, and the
gardens are integrated into the
whole experience, when you. It‟s
different from that concrete carpark
and the outside space. Fortunately
you’ve got the flowers and the
nature. And you know it’s
Maggie’s” (Stephanie, visitor)
Domestic Environment
Scale
Things
SCALE
FURNITURE

So there is the, I think, the light

furniture, the light colour helps.
Different seatings, we‟ve got like
the rockery thing (Alyse, visitor)

They are all comfortable (Elisabeth,

visitor)

It‟s about colour, making it cheerful,

making it nice when it‟s bright and
making it comfortable for lots of
different people, lots of furnishing
is important (Alyse, visitor)
FURNITURE
FURNITURE
BOOKS Yeah, it's good, if people will, eum, it's
about information and, one, if you have
been informed, you become aware, you
become, didn't know what the kind of
benefits, didn't know what can elter,
what information is good. We used to
know, I'm not the only one, so they
could be___somebody who have been
through, what I'm going through, that
can help you. Yeah (Raphael, visitor)

I think there are wonderful books,

which you can. You can actually
borrow. You have to book them out.
Hopefully for people on his own, you
know. But euh, I mean there is a lot of
reading here, its- … If you don't have
books, just empty shelves, it's eum,
there would be something missing,
would't it? so, yeah (Tony, visitor)
 Containment
Open-Privacy
Door = Message
Nature and Patio
OPEN - PRIVACY

“I like it all, I like the fact that you

come in and it‘s a kitchen and
sort of transmittical homely,
informal, I think when you come
in. it doesn‘t make you feel like
there is a sort barrier or reception
and so I like that, and you can just
go and make yourself a cup of
tea. and then I like the fact that there
are little places like this offside, you
can just come and be private, radial.
I like the spaces generally
because of apart of this certain
light, and you‘ve got light in the
practical room, garden, and
outside and inside, you know
very much together and in the
summer you can sit outside so that„s
very modest.” (Stephanie, visitor)
OPEN - PRIVACY
OPEN - PRIVACY

Library
OPEN - PRIVACY

Computer space
DOORS = MESSAGE There is a degree of transparancy,
and there is a message in the way
that sliding doors are actually used
within the room. This is particularly
clever as well (...) This two doors
there. Why are there two doors?
Well, if you are in a room and you are
supposed to stay as you have got
teaching classes and somebody wants
to go towards the toilet, the toilet is
in this corner over here, so rather
exposing the whole room to what is
going on out in the main area, you go
through this second door and the
people outside can't directely see in
and you just open that door just a
little bit and go across to the toilet
whearas when you're going out
through the main roo (Bernie
Byrne, staff)
DOORS = MESSAGE

Annemans,M: Lying architecture: Experiencing Space from a Hospital Bed

NATURE and PATIO

Although you can see the road, it

doesn't seemed like you get there,
seems like it is further away (Alyse,
visitor)
NATURE and PATIO

)
 Stimulation
Colour and Form
Sensorium
Affordance
COLOUR and FORM

I the su er he that garde are or ally greeny, the green against this orange, and you get
snatches of the curtain walling, you can see you can get snatches in between the grey and the
ro a d the ood a d the you e got this lo ely gree , you k o sort of pla ts that o e up
the all A d here. It s really lo ely, you ha e to alk arou d a d use all your senses in terms of
your eyes, if you stand over in that corner and you look across. Ber ie, staff
SENSORIUM

so when you come here, you don't feel gloomy, you don't feel down because it is a bright
cheerful place, it's always like so, it's always warm (Brigitte, visitor)
AFFORDANCE

“Everything is so nice, I mean the people you get. They stick a cup, and it was a
cup of tea, you don’t have to ask anybody to, you really feel welcome, you
use the place, you use the, you use any- anything” (Caprice, visitor)
 Anchoring
Kitchen
Good Materials
KITCHEN

“I think the kitchentable is very

important for me because like, you
can sit down there and you can
bring food and eat and I said, your
family can talk to you, to other
people, you can introduce yourself
to, you know, people you just have
met” (Anna, visitor)
GOOD MATERIALS
I thi k its ood is ery grou di g, it s
very natural a d e e got o rete, as
well the concrete reflects the concrete
of Charing Cross Hospital but concrete
is also reinforcing and is also very solid
but I think what softens it is the wood
and it is very natural. For longtime
people could say they could smell the
wood, I ould t s ell it ut I li e here
the most of the time so I think the
ood defi itely softe s it Ber ie,
staff)
 Relaxation
Legibility
Temperature and Light
Nature
 “ Lets talk about inside the building,
it’s simplicity, the straight lines,
nothing rusted or cluttered its
light wood as well, It complements
LEGIBILITY the-” (Alyse)

“It‟s airy, I mean you can feel you

can breath. It’s clean” (Brigitte)

“It‟s scandanavian style. In the way

the Scandanavians build: bright
and lights and colour and as you
say, no clutter.” (Elisabeth)
 “o it is always nice to come in, and
euh___euhm, you know and the cold weather.
And 'cause here the general atmosphere, with
the lovely logfire there, as you see, and euh, it
TEMPERATURE and LIGHT gives a feeling of ho eli ess (Tony, visitor)
NATURE

Whe I start to come to Maggie, the garden and the flowers. It's really nice (Caprice,
visitor)
 Visitor
User = Guest
Anthropomorphism
USER-EXPERTS REVISITED

Whe you o e here, you o e as a guest

but when you actually come in, your‘re part
of family Alyse, visitor)

“It's a centre where people can come

and feel at home,___and very relaxed so
it's not a hotel, it's not eum_____eum a
museum. A museum, you go there to
regard stuff, if you finish you go home-”
(Raphael, visitor)
 “Well I think that‟s nice, that
personalizes ______it brings____well it
brings a history, a story to it, you
know, once you know a bit about and
ANTHROPOMORPHISM then you identify with” (Stephanie,
visitor)
CONCLUSION
References
Further Reading
CONCLUSION

More likely to have a chronic

illness

Today‟s hospital will have to

focus on outpatients and
inpatients with their entourage
(family, relatives and caregivers)
A clinical diagram does not make a building!
A building also affords a rhythm!
“What do you think you have to have?”

“What do you actually have to have?”

(Bernie Byrne, head Maggie‟s London)

“Who are the users in your current project(s)
you design for?”

“How do you think they will experience your

project?”
LESSON LEARNT

 Provide an exciting place to visit, to be in or to work in

 Provide a homely environment (quiet, safe, stimulating)
 Provide a low-threshold building to drop-in
 Make way-finding easy and exciting
 Use beautiful and natural materials
 Support people and situations with furniture
 Provide open spaces with space for privacy
LESSON LEARNT

 Provide a small scale feeling

 Provide access to nature and distraction
 Do t forget the ceiling!!
 Give people a view!
 Provide ambient control (light, air, temperature, noise and
smell)
 Let people create an identity (variation (form, colour and
material), context, authenticity)

 Smile and be hospitable!

Thank you very much for your attention!

Questions? Dreams? Reflections?

Suggestions? Remarks?
REFERENCES

http://www.linkedin.com\in\joranmarijsse
http://joranmarijsse.blogspot.com

Annemans, M. and Audenhove, C. V. (2012). What makes an environment healing? Users and designer about the Maggie s Ca er
Caring Centre London. Out of control.

Hall, E. (1969). The hidden dimension. Anchor books, New York.

Jencks, C. (2006). The architectural placebo. In The architecture of hospitals, pages 449–459. NAi publishing,
Rotterdam.

Jencks, C. (2012). Can Architecture Affect Your Health ? Unpublished manuscript, pages 1–10.

Keswick Maggie and Jencks Charles (1995). A View from the Frontline. beschikbaar op
http://www.maggiecentres.org.

Ma do ald, A. . Garde s of Hope ? The ‘estorati e Paradig a d the Maggie s Ce tre Garde s.
Proceedings.

Merleau-Ponty, M. (1996). Phenomenology of perception. Routledge, London.

Lefebvre, H. (2004). Rhythmanalysis: space, time and everyday life. Continuum, London.
FURTHER READING

Alexander, C. (1979). A Pattern language. Oxford University press, Berkeley.

Bollnow, O. (2011). Human space. Hyphen Press, London.

Huelat, B. a d Wa , T. 8 . Heali g E iro e ts: What s the Proof? PeecaPress, Alexandria..

Ingold, T. (2000). The perception of the environment: essays on livelihood, dwelling and skill. Routlegde, London,
2011 edition.

Jencks Charles & Heatcote E . The ar hite ture of hope: Maggie s Ca er Cari g Centres. NAi publishing,
London.

Nightingale, F. (1893). Sick nursing and health nursing. Journal of Holistic Nursing..

Sternberg, E. (2009a). Healing spaces: the science of place and well-being. Belknap Press of Harvard University
Press Cambridge, Cambridge.

Wagenaar, C. (2006). The architecture of hospitals. NAi publishing, Rotterdam.