The hospital building as project and matter of concern: the role of representations in negotiating patient room designs and bodies

Mock-ups, scale models and drawings are ubiquitous in building design processes, circulating between various stakeholders. They contribute to the gradual evolution of design, but what else can specific material forms of representations do for the building design and project? The full-scale model of a hospital single-bed room can be different in terms of detail and medium, but in what sense might it perform different and similar functions? The mobilization of multiple forms of representations and visualizations suggest that design materialization might have several important roles to play in negotiating the building design and project, including the exposition and resolution of controversy concerning size of spaces and bodies. The paper compares the use of two different forms of representation of the same imagined space—a single-bed room in a hospital, and produced for similar purposes—to ascertain what the optimum (or minimum) spatial requirements should be to allow effective care of patients. The first representations are physical mock-ups of a single-bed room for Danish hospitals where actual medical and logistical procedures are simulated using real equipment and real people. The second is a three-dimensional augmented reality model of a single-bed room for a new hospital in the UK, using a Cave Automatic Virtual Environment where the room is reproduced virtually at one-to-one scale, and which can be explored or navigated using head-tracker technology and a joystick controller. Drawing on Latour's concepts of matters of concern and matters of fact, we compare these two cases to provide insights into the way different media produce specific senses of the design or imagined space, with consequences for on-going design work, and for the settling of controversy over the sizes of spaces and bodies

Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

<b>Background</b> In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.<p></p> <b>Discussion</b> As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.<p></p> <b>Summary</b> Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts