Maggie Keswick Jencks: an author and landscape architect, she was surrounded by other designers, architects and academics. She met her husband, Charles Alexander Jencks, an architect, lecturer and theorist while studying at Architecture Association in London. Maggie and Charles travelled exhaustively, assessing buildings, meeting architects and academics, and giving lectures and attending conferences. Her extensive design knowledge and experience made her excellent architecture critic.
Diagnosed with breast cancer at the age of 47, she experienced the spaces as a patient. She had a mastectomy and was cancer-free for five years; it returned as advanced metastatic breast cancer, hurling her into the maelstrom. Maggie and her family heard of a trial at Western General Hospital in Edinburgh, and they decided to fight. This place is where Maggie, as a patient and a designer, had insights about the psycho-social needs of the patients. She was disappointed with the conventional hospital which failed to support the psycho-social needs of the patients. This experience inspired her to create an additional facility for cancer hospitals that had a different kind of space and function compared to the conventional hospital.
In these “Maggie’s Centre” series’ I will outline essential elements of these centres and critically discuss the strengths and weaknesses of them by applying environmental psychology theories and frameworks.
It is well known that the facade of a building makes the first impression. Western General Hospital failed to make a good first impression for Maggie; she says that it made her anxious. Maggie’s impression of late Victorian and Edwardian style building highlights the importance of Kopec (2006)’s suggestion to use human-scale elements in healthcare buildings and avoid massive buildings with uninterrupted facades. The importance of scale and massing is evident from the fact the AEDET Evolution checklist (Achieving Excellence Design Evaluation Toolkit) used by UK National Health services (NHS) discusses the building massing and scale as an essential factor of a fair healthcare environment.
Although Maggie and Charles encouraged architects to create building such that their exteriors are aesthetically stimulating and sensitive to surroundings, it is entirely possible that comforting and reassuring facade was achieved through human-scale elements. Since Maggie centres were designed as an additional facility to the hospitals, they resemble outposts, in Kopec’s words (2006), – ‘a small-family house like buildings’. The eccentric exteriors may not significantly contribute to the warm, welcoming quality of Maggie Centre when compared to the scale of the building.
Anyone who has been to a hospital would know that the time passes slowest in the waiting room. Maggie had a distaste for clinical appearance of the waiting areas; she believed that have a cause psychological distress and wrote: “patients like herself were left to wilt under the desiccating glare of fluorescent lights.” Kopec (2006) explains this experience in his book. He bases his argument on Barker’s Behavior setting theory (1968) which states that a physical or psychological environment elicits or supports certain types of behaviour. Kopec argues that the typical appearance of the hospital environment elicits one’s role as patient. In this case, the resulting behaviours are what Parsons (1951) called “sick role”, includes passivity in health care decision, the surrendering of one’s belief to a person of power, and behaviours related to learned helplessness. Learned helplessness, or feeling helpless in the face of a negative situation, cause depression and stress.
Because of her dissatisfaction with the institutional nature of the spaces in hospitals, she envisioned the ideal waiting area to be a well-lit pleasant room with a view out to nature, and chairs and sofas arranged in various groupings to create an opportunity for the patients to interact and relax. She wanted to provide facilities for patients where they could make their cup of coffee or tea. The kitchen often takes centre stage in the Maggie centres. She described facilities provided by Maggie centre as ‘away from home care’, and her concepts aim at creating a home-like environment, which is consistent with guidelines set by organisations such as the World Health Organization (2007) and Planetree (2009).
She despised the partitioned toilet, and her vision included an ‘old-fashioned ladies room’ – a room with hand basin and mirror, a proper door with the door frame so that the visitor can cry privately and compose oneself before getting back to the public space. Maggie was not the only one, a survey conducted by Stern and her colleagues (2003) found privacy to be one of the crucial features of the hospital care environment. Nevertheless, Altman (1975) explains that people prefer different means of achieving privacy. So, it is essential to provide more than one way of achieving privacy.
They asked: “How long have we got?”
To which the doctor said: “Do you really want to know?”
“Yes, we really want to know.”
“Two to three months.”
And then the nurse explained. “I’m very sorry, dear, but we’ll have to move you out into the corridor, we have so many people waiting.”
They sat in a “windowless corridor trying to deal with this business, having two to three months to live. And as They sat there, various nurses who I knew came up to them and said, very cheerfully, ‘Hello dear, how are you?’ ‘Well,’ managing a laugh, Maggie said ‘I’m fine!'”
Finally, she expressed concerns about doctors being dismissive of complementary treatments such as diets and exercise. She believed that her diet helped her even though she was aware of changing one’s diet was not considered to be cancer preventive and lacked evidence as treatment. She wished to help others find the complementary treatment that worked for them. So, Maggie centre was created as a warm and welcoming place with a library, an office and a gathering space that would offer information, psychological support, advice on nutrition, exercise and relaxation therapies, thereby helping each visitor to find their way of coping with the disease. It is entirely possible that the complementary treatments do not make a significant contribution to physiological health. However, these programs could restore the sense of control by involving patients in their healthcare planning and mitigate the effects of learned helplessness such as stress and depression. It is essential that designers and stakeholders consider these practices as means of improving the mental health.
The project ‘Maggie centre’ has interesting concepts inspired by personal experiences. Considering that today there are seventeen centres, arguably the project is remarkably successful. Few attempts have explored these centres in greater detail from a psychological perspective. Understanding the psychological process behind these concepts can increase the design quality and impact of these buildings. The Maggie’s Centre Series will look at different centres and highlight some fundamental design issues that are effective as well as those that could be improved.
Barker, R. G. (1968). Ecological psychology: Concepts and methods for studying the environment of human behavior. Stanford University Press.
Department of Health Estates and Facilities (2008), Achieving Excellence Design Evaluation Toolkit Workbook. UK Department of health.
Jencks, M. K. (1995). a view from the front line. Maggies Caring Cancer Centre.
Kopec, D. A. (2006). Health Care Environments. In Environmental psychology for design. (pp. 257-276) New York: Fairchild.
Parsons, T. (1951). Illness and the role of the physician: A sociological perspective. American Journal of orthopsychiatry, 21(3), 452-460
Planetree (2009). About Plane Tree. Retrieved from www.planetree.org
Stern, A.L., MacRae, S., Gerteis, M., Harrison, T., Fowler, E., Edgman-Levitan, S., & Ruga, W. (2003). Understanding the consumer perspective to improve design quality. Journal of Architectural and Planning Research, 16-28.
World Health Organization. (2007). Harmonizing mind and body, people and systems: People at the centre of health care. Geneva, Switzerland: WHO Press.
Sushil K Premkumar
Architect and Environmental psychologist