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The key difference between designing a public building and a public service: let’s ask Renzo Piano!

Public buildings and public services are funded by … the public! But the underlying values and principles for their design could not be more different. Poetry does not feature in both …. and that might matter for their function.

Renzo Piano is probably one of the best known architects in the world. His early claim to fame was the design for the Centre Pompidou in Paris – a state of the art cultural space that seemed to defy all conventions how museum and cultural centres should look like: it has all structural engineering visible on the outside – escalators, drain pipes, electrical installations. It was designed in bright colours. The design left half of the site empty as a new public space. The Centre Pompidou causes outrage and delight when it was opened and it made the name of the two architects that headed the project: Renzo Piano and Richard Rogers. Since then Renzo has build many large public buildings all over the world including in London, …. Many of them are public commissions: concert halls, museums, libraries.

His work is currently subject to an exhibition at the Royal Academy in London. Though models, photos and short movie clips we are learning about his approach do designing these project.

Renzo started off in his fathers building company. His designs have a theme of using smallish building blocks to create large structure from them. His architecture is characterised by strong external frames that leave variable space inside. Unlike say Sarah Hadids buildings his creations project a strong structural identify. You can see how they are engineered. The structures that hold them together are obvious and very visible. Engineering these structures with blocks that weight 1000s of tons in not without its challenges. Understanding materials and their physical properties is crucial to support the statics of big buildings and make them safe.

Key to all of his work is however the underlying philosophy of supporting citizens and bringing people together. The architecture needs to serve the public and create the space to enable creative interaction. In order to do this buildings need to have a strong sense of context. They need to understand the place where they are and those who will use them. Renzo spends time in the places where he builds. He walks around. He makes drawings. He talks to people. And he then creates first sketches that capture the essence of the project. Poetry is the term that he uses: not something that we would necessarily link to big buildings or indeed public procurement.

One of the natural results is that all buildings are different in the ways that people enter them, use them, in the way that they attract attention or connect those working in them. No two museums look the same and no two libraries function in exactly the same way.

In healthcare we also procure services. And in the end services commission in one area often look very different from services that are commissions in another area, much to the surprise to healthcare scientist. On the whole there is a belief that if the outcomes that services aim to achieve are the same the process should be as much standardised as possible. And while I understand the rational behind I am less clear about the reasons why Renzo Piano builds a new library every time he is being asked and why i get asked to standardise every time I am trying to design a new service.

Should health services not have a sense of location? Should they capture the light, reflect the surrounding buildings, history (or in our case mountains and sea)? Should they capture the essence of those coming with their healthcare problems and the spirit of those working there? We have many staff who are spending all their time off work climbing, cycling or sailing but might spend most of their working day in a room without any national light. And how would we measure that this is a better way to think about how we design buildings and processes in healthcare as opposed to other big public projects.

Interestingly there is quite a body of literature on ‘healthy buildings’. The literature reflects that some building materials give a better vibe, lightening is important for safety critical areas, clear structure of spaces is important to recognise risk, but there is even literature that suggests that if patients can see trees that their length of stay is on average a day shorter. If this would be true not just for the patients with cholecystectomies that were part of this study but also for other conditions then could relate to 10-15% of the overall bed occupancy of a hospital!!! And this reduces risks from reconditioning, hospital acquired infections and other complications of healthcare. Buildings can hence contribute to safety.

Given the increasing body of evidence on user-centred design and individualised shared decision making it is arguable whether our current way of designing health services and the built structures that house them should continue to be created to reduce variation or whether we should ask Renzo to help us and design services that show the structures but allow plenty of creative ‘safe’ space inside the organisations.

What is the area where we need most variation and expression of individuality? Where is reduction of variability inevitable and needed to create safety?

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