The new Intensive Psychiatric Care Unit at Stratheden Hospital in Fife showcases patient centred design. This is a summary of a longer case study available on the A&DS website.
The new Intensive Psychiatric Care Unit at Stratheden Hospital, near Cupar in Fife has had a marked effect on patients and staff alike. The eight-bed facility provides specialist care and treatment for patients experiencing acute psychiatric episodes, relocating the service from one of the original Victorian buildings on the hospital site.
Download this case study to find out more about how:
- Extensive consultation with staff and former patients informed the provision and types of space that should be accommodated including and art and music room, group therapy space and gym.
- A series of three courtyards provide calming outdoor space: at the entrance; for visitors to meet with patients and for patients to exercise or sit out.
- The new building with adequate space provision and freedom for patients has led to a reduction in incidents and an improvement in staff morale.
"The most important thing was the patient's perspective, to make sure it was what they wanted. It wasn’t about staff or architects making that decision. [...] we just tried to reach out to the patients that have been through the experience to get their opinion.” - Lesley Tweedie, Clinical Service Manager, NHS Fife.
The recently completed purpose-built Intensive Psychiatric Care Unit (IPCU) at Stratheden Hospital near Cupar in Fife has already had a significant effect on patients and staff alike. The new eight-bed facility, which is designed to provide specialist care and treatment for patients experiencing acute psychiatric episodes, is according to nursing staff, "night and day" in terms of its clinical facilities and overall environment compared to the previous unit, housed within one of the original Victorian buildings on the hospital site.
The new IPCU facility, which was procured under Frameworks Scotland 2, which principally focuses on new build and refurbishment within the acute health sector, opened to patients in June 2016. Designed by Edinburgh based Oberlanders Architects in conjunction with Graham Construction, the new facility's patient-centred design emerged out of an intensive and extensive period of stakeholder engagement.
Stakeholder Engagement
During the lengthy stakeholder engagement period and preparation of the main brief, Lesley Tweedie, Clinical Service Manager in NHS Fife, drew patient and staff views from Fife and other Board areas. However, the central focus of the vision for the new IPCU unit would be the patients themselves.
"The most important thing was the patient's perspective, to make sure it was what they required to aid their recovery. It was very much clinically driven," says Tweedie.
"I met with all the patients that had been recently through IPCU and asked them for their wish list," continues Tweedie.
Tweedie pulled all these wish lists together and eventually came up with a presentation that would inform the design and build teams bidding for the contract.
Design and Build
What finally emerged in May 2016, following a year long construction, was a new 1200 sqm single-storey eight-bed facility that sits to the northeast of the hospital grounds. A Scottish larch rainscreen cladding affords the building a softness and site sympathetic solution within its rural setting.
In terms of accommodation the design provides significant clinical benefits supporting recovery, with patient access to an art and music room, a group therapy room, gym and a relaxation area.
The unit is built around a secure central outdoor courtyard providing space to relax, exercise and enjoy some fresh air, which was lacking in the previous unit. Additional features installed for patient and staff security include bio-dynamic lighting, nurse call systems, video linked access control and CCTV.
"Once we came on board, we did a tour of health buildings in Scotland with Lesley. We got a good indication from her about what she was hoping to achieve and what the stakeholders wanted from the building."- Project Architect Paul Gilligan of Oberlanders Architects healthcare team.
In addition to the building's safety and security features, internal finishes were
also a key consideration in terms of patient comfort.
"On such a tight budget we needed to really understand where we’re going to spend the money, what are the non negotiables. The emphasis was on robust solutions that would last. In terms of the finishes we have used a reinforced wallboard for partition walls, which have a really robust finish. It’s not a standard plasterboard finish because they are liable to get bashed and knocked," explains Gilligan.
The courtyard flooring is a self- draining 'Playtop' (playground material) surface, which means that drains aren’t necessary. Elements such as metal grills and drains and those kind of things are a risk as a lot of service users may want to pick at those things, and these elements could cause harm.
"The concept that we brought to the table was the idea of a courtyard and how that not only relates to the function to the building but also the positive effect it can have on the way people feel," explains Gilligan about the final plan featuring three courtyards.
Since its first patients arrived in June 2016 Gilligan believes the positive results of
the patient-centred design of the building are palpable, particularly in the central courtyard. "The way that the main courtyard is so active within the whole unit itself is so good to see, it's such an important part of the experience of the building. When I visited people were sitting out in the main courtyard, enjoying the sunshine."
This is a view very much shared with visitors and staff. "The new building is a massive change in terms of its environment," says Tanya Lonergan. “The patients now have the space to move around, and they have their own rooms, so they don't all need to be in one area at the same time."
"The patients now have the space to move around, and they have their own rooms, so they don't all need to be in one area at the same time. Access to outdoor space in the courtyard and fresh air, as well as the gym, pool table, kitchen, laundry...all of these facilities have made a huge difference to the patients."
- Tanya Lonergan, Senior Charge Nurse, Stratheden IPCU
"And for the staff, it's a totally different culture than it was before. Everyone’s so much more relaxed. The morale is much higher. There’s not the feeling that we’re coming in and waiting for something to happen, we’re not walking on eggshells as we were in the old ward when incidents were happening due to the fact that everyone was living on top of one other and patients were becoming bored and agitated. The new unit is the other extreme, the opposite experience where there’s hardly any incidents. Staff stress levels have really reduced in the new building."
The transformation has greatly affected the clinical outcome, according to Lesley Tweedie. “Looking at our incident reports and the monitoring that we carry out as part of the Scottish Patient Safety Programme, in the old ward we were sitting at around 70% a month in term of incidents involving control, restraint and violence and aggression. These numbers have come right down, and we’re at less than 10%. It’s the space, the freedom of movement. That’s so important. Patients aren’t restricted any more.”
"The new building is all about the patients. It's not just about having a fancy new building. It’s about making it right for patients. And in the end we got everything that we asked for," says Lesley Tweedie.
Read the full case study of the Stratheden IPCU here.
A&DS would like to thank the following for their time and candour:
Lesley Tweedie, Clinical Service Manager - NHS Fife
Paul Gilligan, Associate - Oberlanders Architects LLP
Tanya Lonergan, Senior Charge Nurse - Stratheden IPCU
Images Courtesy of:
Nigel Rigden and Oberlanders.
