A post occupancy evaluation of the Dundee Maggie Centre

Final Report for Sust. March 2007

Dr. Fionn Stevensonwith Professor Mike Humphris

Ecological Design GroupSchool of ArchitectureUniversity of Dundeein association with Bute Medical School,University of St. Andrews and the Maggie’s Centres

Executive Summary 03 Acknowledgements 05

1. Introduction 06 2. Background 07 3. Aims and Objectives 09 4. Methodology 10 5. Programme 12 6. Results and Analysis 13 a) background demographics 13b) environment behaviour 13 c) the building design 15 d) the visit 16 e) comfort issues 17f) sense of wellbeing and health 20g) staff and volunteer perspective 23h) the building process 26 7. Conclusions and Recommendations 31 8. Bibliography 34 I. User Interview Guide 35 II. Technical Interview Guide 37 III. Drawings –plans/sections/elevations 39 IV. Benchmarking for Fuel Costs 41V. Tables 42VI. Architectural Brief 52

Contents

AnevaluationoftheDundeeMaggie’sCentrewascommissionedbySust.TheLighthouseonSustainabilityinOctober2005andcompletedinMarch2007byEDG(EcologicalDesignGroup)attheSchoolofArchitecture,UniversityofDundeeinassociationwithButeMedicalSchool,TheUniversityofSt.AndrewsandtheMaggie’sCentres.TheDundeeMaggie’sCentreisoneoffivecompletedprojectsinScotland,withafurther10projectedforcompletionintheUK.ThefundamentalremitoftheMaggie’sCentres,whichwereinspiredbyMaggieJencks,istoprovideinformationandpsycho-socialsupportforcarersandpeoplewithexperienceofcancer.

Theaimsofpilotstudyweretoevaluate:

• visitorandstaffresponsesas usersofthebuilding• physicalperformanceof thebuilding• designandconstructionprocess

and:

• developacross-evaluativemethodologyforwideruseinsmallscalehealthcarebuildingsinordertoimprovethebriefingprocess.

The evaluation aimed to establish:

a) theeffectivenessofthedesign conceptintermsoftheoriginal briefandcaremodelb) theoverallusersatisfactionwith thebuildingc) theextenttowhichpeopleperceive thebuildingascontributingtotheir senseofcomfort,wellbeingand health,andthereasonsforthisd) thecomparisonoftheease, speed,andcostofconstruction withastandarddomesticscale palliativecarebuildinge) thebuilding’sphysicalperformance andsustainability,including managementandmaintenance issues,andthelevelofenergy costscomparedtonormative measuresf) recommendationsforthefuture MaggieCentrebriefingprocessand furtherdevelopmentofthe evaluationmethodologyforother smallscalehealthcarebuildings.

Semi-structuredinterviewswereundertakenwith4staffand2volunteers,aswellasanarchitectrepresentativeandtheCentreHead.Questionnaireswerecompletedby34visitors.Fuelbillswereobtainedforaoneyearperiodfromtheenergysupplierandcomparedtouserscomments.

Theresultsofthesmallpilotsurveyindicatethatthebuildinghassuccessfullyachievedthefollowingobjectivesofthebrief:

• ahighlyeffectivedesignconcept inrelationtotheMaggieCentre’s caremodel• veryhighusersatisfactionoverall, withfacilitiesprovidingacalmand friendlyspaceandanappropriate degreeofprivacy• highlevelofoverallcomfort• usersperceptionofincreased healthandwellbeingduetovisiting thebuilding• particularappreciationoftheviews outofthebuilding• lowlevelofmaintenancerequired

Thebuildinghasbeenlesssuccessfulinachievingtheremainingobjectives:

• flexibleofficespacewhichis separateyetvisiblefrom welcomearea• adequatestoragefacilitiesforthe officeareaandotheractivities• thermalcomfort

Executive Summary

Evidenceonrunningcostsfromfuelbillsobtainedforafullyearindicatesthatenergyusewaswellwithingovernmentenergytargetsof35-55GJ/100cu.mfornewbuildingsintheNHSEstate(2001-2010),cominginat29.4GJ/100cu.m.Energyrunningcostswere£64perweekfor286kwh/m2.Totalcarbonemissionsforthebuildingwere4.4tonnesfortheyear.

Additionalissueswhichemergedfromthesurveyincluded:

a) adegreeofoverheatingdueto solargain,lackofcross-ventilation andpoorheatingsystemcontrolb) adegreeofglareduetolowangle solarpenetrationinthe kitchenareac) thedifficultyofhavinganoffice areaimmediatelyattheentranced) userdissatisfactionwithseating ergonomicse) lackofadequate car-parkingfacilitiesf) flexibilityofsmallertherapyrooms

Thehighlevelofoverallusersatisfactionvalidatesadesignapproachwhichhasplacedanemphasisonthequalityoftheinternalspace.Gooddesignalsogivesthebuildingahigh“forgiveness”factorinrelationtoissuesofthermalcomfort,ventilation,glareandlackofhumidity.

ThereareanumberofareaswherethebriefingprocessfortheMaggie’sCentrescouldbestrengthenedinordertoimprovetheoverallperformanceoftheirbuildings,includingtherequirementfor:

a) simpletounderstandandeasy touseheatingsystems,controls andprogrammerswhichcan respondtorapidlychanging occupancylevelsb) low-noisemechanicalventilation equipmentinuserenvironmentsc) adequatesolarshadingand provisionofcross-ventilationd) specificstorageareasandfacilities tobemoreclearlyidentifiedor systemforremovingitemse) adequatecirculationinofficeareasf) sustainabledesignand specificationwithincost constraints.

Thefollowingaspectspresentopportunitiesforfurtherresearch:

• awiderstudyofallMaggieCentresusingafurtherrefinementofthemethodologyestablishedinthispilotstudytoascertainspecificoutcomesandresearchquestionswhichexaminekeydesignfeaturesinrelationtouser’sperceptionhealthandwellbeing.

• awiderstudyoftherelationshipbetweenuser’sabilitytocontroltheirenvironmentandtheirperceivedstateofhealthandwellbeing.

• thedesignofventilationandheatingstrategiesinrelationtothepresence,orabsence,ofthermalmassinsmall-scalehealthcarebuildingsandtheeffectthishasonenergyefficiencyandcomfort.

“Maggie’s welcomes the report’s positive and constructive findings. Suggestions for change have been noted and where appropriate incorporated within the management of the Centre whilst at no time compromising the relaxed and non-institutional ethos which underpins the Maggie’s environmental and programme objectives.”

Laura Lee, Chief Executive, Maggie’s Centres

Executive Summary

Theresearchteamforthisprojectwas:

Dr. Fionn Stevenson PrincipalInvestigator,UniversityofDundeeProfessor Gerry Humphris Co-investigator,UniversityofSt.AndrewsLesley Howells ClientRepresentative,CentreHead,Dundee Maggie’sCentreAnita Laidlaw PostdoctoralPsychologist,UniversityofStAndrewsSusanne Monka GraduatePsychologist,UniversityofStAndrews

Theauthorswouldliketoacknowledgethegeneroustimedonatedtothisstudybythefollowingpeople:

Laura Lee ChiefExecutive,Maggie’sCentresGlynn Jarvis ProgrammeDirector,Maggie’sCentresCharles Jencks AuthorandfounderoftheMaggie’sCentresMark O Connor SchoolofArchitecture,UniversityofDundeeMichael Spens SchoolofArchitecture,UniversityofDundeeFred Stephens JamesFStephensArchitectsDoug Reid JamesFStephensArchitects

TheauthorswouldalsoliketothanktheotherstaffandusersofDundeeMaggie’sCentrewhokindlygavetheirtimeforinterviewsorcompletedthequestionnaire–withoutthem,thisworkwouldnotbepossible.

Acknowledgements

1 TheLighthouseCentreforArchitecture,DesignandtheCitybasedinGlasgow,Scotlandaimstodevelopthelinksbetweendesign,architecture,andthecreativeindustries,seeingtheseasinterconnectedsocial,educational,economicandculturalissuesofconcerntoeveryone.Aspartofitspromotionofsustainabledesign,thisstudywasindependentlycommissionedinOctober2005bytheSust.programme,tofillagapintheknowledgeconcerningthedesignandsmallscalehealthcarebuildingsinrelationtotheuserexperienceandbuildingperformanceinScotland.ItwascompletedinJanuary2007byEDG(EcologicalDesignGroup)attheSchoolofArchitecture,UniversityofDundeeinassociationwithButeMedicalSchool,TheUniversityofSt.Andrews,andtheMaggie’sCentres.

2 Itisonlywithinthelastfewyearsthatenvironmentalissues,beyondtheneedforenergyconservation,havebeenconsideredwithinhealthcarebuildingdesignstrategies,butasyetthereislittle“joinedup”thinkingwhichdirectlylinksenvironmentalperformancewithqualityofdesignandusersatisfaction.Thiscasestudy,drawingontheinnovativetypologyoftheMaggie’sCentres,evaluatedboththeseelementsandthencross-validatedtheminordertoprovideauniquelyholisticappraisalofaparticularbuildingsolution.

3 Underlyingasustainabledesignstrategyforsmallscalehealthcareenvironmentsaretwoprerequisites:

• Therecognitionthatenvironmentaldesignisanintrinsicpartofhealthcaredesignandprovidesmultiplebenefitsincluding:economic,psychologicalandsocial.

• Theunderstandingofdesignwithinanecologicalframework,recognisingthatthedesignofbuildingsisfundamentallyaprocessratherthanjustaproduct.

4 Aprimarywayofimprovingthedesignofsmallscalehealthcarebuildingsisbyfocusingonhowusersexperiencethem,bothintermsoforientationandtheirsenses.Therolethattheenvironmentplaysinthiscanbemosteffectivelyassessedthroughanalysiswhich

combinesbothqualitativeandquantitativemethods.

5 ThisstudyintroducesthedevelopmentofapostoccupancyevaluationandbriefingprocessthatcanbeappliedtoallMaggie’sCentres.Thedesignlessonsmaybeextendedtoothersimilarhealthcaretypologies.

1. Introduction

1 TheUKgovernmentresponsetotheneedforgreaterqualityofdesignandsustainabilityinhospitalshasfocusedonseveralinitiatives.TheNHSnowhasspecifictargetsforachievingsustainabilityaswellasanindependentbodytopromotegooddesigninhospitals1.InScotland,theNHScurrentlyusesatoolknownas“Greencode”fortheevaluationofitsestateinrelationtokeyenvironmentalperformanceindicators,whicharereportedonanannualbasis2.AtthesametimeCABEhasprioritisedthedevelopmentofqualitydesigninhealthcareenvironments,mostrecentlywithalimitedcompetitiontoexploreideasaswellasadetailedlookattherelationshipbetweenhealthandthebuiltenvironment3.ArchitectureandDesignScotland,inrelationtoCABE,hastakenasimilarinterestwithitsowncolloquiumonthedesignofhealthcarebuildingsin2006.

2 Postoccupancyevaluation(POE)providesamoredetailedmeansofexaminingtheperformanceoftheNHSestateonabuilding-by-buildingbasis.ThehighlysuccessfulPROBEprogramme,whichcarriedoutPOEonanumberofdifferentbuildingsduringthe1990’s,onlyexaminedonehealthcarebuilding4.TodatetherehasbeennosystematicevaluationandcrosscomparisonofhealthcarebuildingtypologiesintheUK,althoughtherehavebeenanumberofimportantindividualstudieselsewhere5.

3 SeminalPOEworkbyProfessorLawsonandcolleaguesinSheffieldUniversityhasproventhelinkbetweengooddesignandimprovedbed-patientrecoverytimes,demonstratingtheimportanceofpatientsbeingabletoviewnature,gooddaylighting,ventilationandpatient’sabilitytocontroltheirenvironmentalconditions6.ThefindingshaveinformedarevisedversionofAEDET,theNHStoolforauditingdesignqualityinhospitals.Atthesametime,CharlesJencks,anarchitectandcriticwithinternationalstature,haspioneeredanewhealingtypology,TheMaggieCentre,whichaimstoempowercancerday-carepatientsandtheircarers7.

4 TheMaggie’sCentresorganisationhasfourmaingoals:

• Tolowerthestresslevelofapatient• Toprovidepsychologicalsupport• Tohelppatientsnavigatethe

information-explosiononcancer• Toprovidepeacefulandstriking

environmentswithanimportantplaceforartandgardens

5 TherearecurrentlyfiveMaggie’sCentresopeninScotland,withtenmorebeingdevelopedintheUK.Asbespokeanddistinctivehealingenvironments,theyrepresentanalternativeapproachtothetraditionalcost-drivendesignofhealthcarebuildingsbydeliberatelyfore-groundingdesignasakeyfactorinpromotingwellbeing.

2. Background

1TheFutureHealthcareNetworkisalearningnetworktoexploretheshapeofhealthcareandwhatwillberequiredby2010andbeyond;thewebsiteiswww.nhsconfed.org/fhn.TheNHSEnvironmentalAssessmentTool(NEAT,availablefromNHSEstates)setsouttargetsandachecklistforsustainabledesigninhealthbuildings.

2Seehttp://www.show.scot.nhs.uk/pef/guest/forlatestreport.NHSScotlandalsorunaPropertyandEnvironmentForumwhichisbasedatthesamewebsite.

3SeeHealthyHospitalsReport2003http://www.cabe.org.uk/publications/#healthandCABEHealthWeek,Healthyplaces,healthypeople15-19thMay2006,www.cabe.org.uk/events

4See“BuildingandResearchInformation”,Vol29,Number2,March-April2001whichisaSpecialIssueonPost-occupancyEvaluation,andhasanumberofpapersreportingonthePROBEexperience.Vol33,Number4,September2005providesanupdateonthisarea.Seealsowww.usablebuildings.co.ukforanuptodateaccountofPOEstudiesintheUK.

5AnexcellentexampleisBurt-O’Dea.K.(2005)DesignImpactStudy,TheEuropeanHealthPropertyNetwork,whichstudiesfivedifferenthealthcarebuildingsindifferentEuropeancountries.

6Lawson,B.etal(1998-2001)TheArchitecturalHealthcareBuildingandItsEffectsonPatientHealthOutcomes,UniversityofSheffield.

7SeeJenks,C.TheMaggieCentresMovementEightYearsIn…,FourthDoorReview,Nos.7,2005pp.30-33

6 TheDundeeMaggie’sCentre,whichisthesubjectofthisstudy,wasdesignedbyFrankGehryandopenedinSeptember2003.Inresponsetothis,TheUniversityofDundeehostedaonedayinternationalsymposium,“BreathingSpace”,atthesametime,whichgeneratedsignificantdiscussionontherelationshipbetweenarchitecturaldesignandcancercare,includingtheroleofsustainabledesignandmateriality8.Theproposalforthisstudygrewoutofthefindingsofthesymposium.

7 Largescalehospitaltypologieshavereceivedthegreatestattentionintermsofpostoccupancyevaluation,butwiththeshiftingovernmentpolicytowardsdeliveryofhealthcareinsmallscaleenvironmentswherepractical,itwasfelttimelytoexaminesuchtypologies.ThedevelopmentoftheMaggie’sCentresasasmallscaleindependentnewbuildingtypologyaffordedauniqueopportunitytolearnfromhighqualitydesignenvironmentsandprovideabenchmarkfromwhichtomeasurethecombinatoryvaluesofsustainabledesignandhealthpromotingdesigninallsmall-scalehealingenvironments.

8Anumberofthepaperspresentedhavebeensubsequentlypublishedintheinternational“FourthDoorReview”,Nos.7,2005,pp26-50,includingStevenson,F.“Environmentalarchitectureandthehealthbuilding;thematerialityperspective”pp.38-42

1 The overall aim of this study was to provide a detailed post occupancy evaluation of a small scale healthcare environment which can in turn inform the future design of similar typologies within the NHS and other healthcare agencies.

2 The study had four key objectives:

1. Tocarryoutanin-depthqualitativereviewofusersresponsetotheDundeeMaggieCentre

2. Tocarryoutatechnicalreviewofthebuilding’sphysicalperformance

3. Toevaluatethedesignandconstructionprocess

4. Todevelopacross-evaluativemethodologyforwideruseinsmallscalehealthcarebuildingsinordertoimprovethebriefingprocess

3 The study specifically aimed to establish:

a) theeffectivenessofthedesignconceptintermsoftheoriginalbriefandcaremodel

b) theoverallusersatisfactionwiththebuilding

c) theextenttowhichpeopleperceivethebuildingascontributingtotheirsenseofcomfort,wellbeingandhealth,andthepossiblemechanismsforthis

d) thecomparisonoftheease,speed,andcostofconstructionwithastandarddomesticscalepalliativecarebuilding

e) thebuilding’sphysicalperformanceandsustainability,includingmanagementandmaintenanceissues,andthelevelofenergycostscomparedtonormativemeasures

f) recommendationsforthefutureMaggie’sCentresbriefingprocessandfurtherdevelopmentoftheevaluationmethodologyforothersmallscalehealthcarebuildings.

3. Aims and Objectives

1 AsmallSteeringGroup,whichconsistedoftheDundeeMaggie’sCentreHead,aprevioususeroftheCentreaswellasthetwoprincipalresearchcontractors,wasinitiallyformedtoguidetheproject.TheProfessionalAdvisoryGroupfromtheMaggie’sCentrescommentedonthedesignandformatforthepost-occupancyevaluationquestionnaire.

2 AninitialdesktopreviewofexistingliteratureontheevaluationofhealthcareandotherbuildingsintheUKandelsewherewasundertaken.ItwasfeltthatwhiletheAEDETEVOLUTIONandASPECTtoolsfortheNHSprovidedavaluablemeansofauditingthedesignqualityofhealthcarebuildings,thepre-definedstatementsapproachdidnotallowforamoreopenendedformofinquirywhichmightrevealhiddenfactors.Bycontrast,theapproachdevelopedbyBuildingUseStudiesLtd.andadoptedbyPROBEaskstheusertoofferupfactorswhichworkordonotworkwell.Thisprovidesamorefundamentalappraisalofdesignqualityasitisdirectlyexperiencedbytheuser.

3 Asaresultofthedesktopreview,itwasdecidedtoadopta‘mixedmethods’approach,involving6semi-structuredinterviewswith2full-timestaff,2part-timestaffand2volunteers,andaPROBE-stylequestionnaireforvisitors.BothactivitieswerecarriedoutwithinthebuildingovertheperiodofonedayonMarch23rd2006.Astandardquestionnaireonitsownwasrejectedonthegroundsthatitwouldnotyielda“rich”textureofinformation.Theaimofthein-depthsemi-structuredinterviewswastosupplementthequestionnairewiththecollectionofmoredetailedinsightsfromparticipants.

4 AnumberofqualitativequestionsweredevisedwithadvicefromtheMaggie’sCentresChiefExecutive,ProgrammeDirectorandClientRepresentative,toascertainresponsestothedesign(seeappendixIandV).Theseaugmentedtheinitialstandardpost-occupancyevaluationquestionsprovidebyBuildingUseStudiesLtd.whichconcentratedoncomfortissuesandworkconditions.TheadditionalquestionsweredrawnfromAEDETandASPECT,butwererephrasedtoallowforamoreopenendedresponse.Twokeyquestionsonvisitor’ssenseoftheirownhealthandqualityoflifeweredrawnfromtheEORTC9standardisedquestionnaireforoncology.Theinitialquestionnairewasthensuccessfullypilotedwithnomajorchangesrequired.

5 Visitorstothecentrewerediscreetlyapproachedbyaresearchassistantonentryandhandedaquestionnairetocompleteintheirowntimeandpostanonymouslyintoaboxplacedneartheentranceofthebuilding.Staffwereinterviewedusingtheinterviewguideandatapedrecordingwasmadeoftheinterview.Additionally,theinterviewerobservedhowtheusersandstaffinteractedwiththebuildingduringbreaksintheday.Anythingunusualthatmightinfluencetheeffectivenessofthedesignprinciplesinvolvedwasnoted.

6 FuelbillsforaoneyearperiodfortheDundeeMaggieCentrewereobtainedfromTheMaggie’sCentresHQ.ThesewererelatedtothecurrentbenchmarksforenergyefficiencypromotedbytheUKgovernmentfortheNHSEstate.

7 Copiesoftheoriginalbriefandworkingdrawingswereobtainedasreferencepointforusersexperienceandexaminedintermsofhealthcaredesign,energyefficiency,flexibledesign,anduseofsustainableandlocalmaterialsaswellasefficientconstructionprinciples.Thedrawingswereusedasabasisforthetechnicalanalysisundertakenonthedayofthesurveywhichinvolvedtheuseofamulti-modalmetertomeasuretemperature,humidity,lightingandnoiselevelsbothinsideandoutsideofthebuildingatfivestrategicpoints.

4. Methodology 9seehttp://www.eortc.be/home/qol/-accessedMay2006

8 Theinterviewswithstaffandthetechnicalteamwereusedtofurtherestablishiftherewereanysignificantworkissuesarisingfromtheinnovativedesignoftheprojectoverthetwoandahalfyearssinceitscompletion(seeAppendicesIandII).

9 Allfindingsfromtheinterviewswiththetechnicalandstaffteamswerecomparedtothosefromtheuserquestionnairetoestablishpointsofconvergenceanddivergence.Thiswascarriedoutinrecognitionoftheintersubjectivityinvolvedinthestudyandtheneedtounderstandandanalyseallpointsofview.

10Thequalitativefindingsfromalltheinterviewsandquestionnaireswerecross-evaluatedagainsttheobservedenvironmentbehaviour,thebrief/drawings/specificationsandthephysicaldataobtainedontheday,todetermineiftheissuesraisedwerereinforcedorcontradicted.A“walk-through”tourofthebuildingwasconductedwiththeClientRepresentativetohelpclarifycontradictoryfindingsandprovidefurtherinformationonissuesraised.

11Finally,aSWOTanalysiswasusedtoestablishtheoverallefficacyofthedesignandfuturestrategiesinrelationtotheresultsoftheinterviewsandfuelcostassessmentsandtheinitialprojectobjectives.

4.

1 Giventhecomplexityoftheareaunderinvestigation,carefullydefinedparametersweredrawntoproduceamanageableworkloadwithinthetimescaleallowed.Theworkfellinto6distinctivephases:development,survey,analysis,crossevaluation,draftandfinalreport.

Programme for Dundee Maggie’s Centre Pilot Study

1. Developmentofformats Arrangementsforvisits,interviews,

datagathering Gatheringoftechnicaldata

2. Interviews,Survey Questionnaires

3. Useranalysis Technicalanalysis

4.Cross-evaluation

5. DraftReport CommentonDraftReport/meetings

6.FinalReport SteeringGroupmeetingsx3

5. Programme

1 The analysis of the project was broken down into 8 evaluative stages:

A) backgrounddemographicsB) environmentbehaviourC) thebuildingdesignD) thevisitE) comfortissuesF) senseofwellbeingandhealthG)staffandvolunteerperspectiveH) thebuildingprocess

A Background demographics

2 TheusersoftheDundeeMaggieCentrecanbesplitintofourgroups:staff,volunteers,carersandthosecurrentlysufferingfromcancerorinremission.

3 Abasicdemographicdescription

ofthe34visitorswhorespondedtothequestionnaire(Table1inAppendixV)showsthatthetypicalDundeeMaggiecentrevisitorwasover30,likelytobefemaleandsufferingfromcancer,althoughjustunderathirdofvisitorswerecarers.Theoverwhelmingmodeoftransportwasbyprivatecarwithmostvisitorshavingreturned5ormoretimesforvaryinglengthsoftime.Themostcommonvisitinglengthwasoneortwohours.Visitorsgenerallyratedtheirownhealthasbeingaboveaveragewithoverhalfratingtheirqualityoflifeasaboveaveragealso,althoughthelevelofratingsweregenerallylowerthantheaverageforthosesufferingfromcancer(seesection6.f).

4 ThevisitorprofilesuggeststhatthebrieffordesigningMaggie’sCentresneedstostressthevariablelengthofvisitsandtheneedforthebuildingtobeabletocaterforrapidlychangingoccupancylevels.

B Environment behaviour

1 Onthedaywhichtheinterviewsandquestionnairesurveywascarriedout,theinterviewertooktimetoobservevisitors’behaviourinthebuildingatregularintervalsandoveranextendedlunchtimeperiod.Thissectionbrieflydescribesthoseobservationstoprovideapictureofthebuildinginuse.

2 Thebuildingwasopenfrom9a.m.-5p.m,andverybusy,withaTaiChiclassat1.30pm,arelaxationclassat3p.m.,aswellasabenefitsadvicedropinserviceallmorning.Thekitchenwasparticularlybusyatlunchtime,justbeforetheTaiChiclass,butnotovercrowded.Themainroomwasusedprimarilybygroups,whilethesmallerretreatroomdownstairswasusedforthestudyinterviews.Theupperroomwasusedonanintermittentbasis.

3 Theuseoftheopenplanspacedemonstratedarelaxedandsensitiveinteractionbetweenstaffandvisitors,withtheentranceareaactingasapermeablethresholdforarrivals.Oftenstaffappearedfromeitherthekitchenorlibrarytogreetarrivalsattheentrance.Newarrivalsappearedtohoverintheentranceareabythedeskratherthancomedirectlyintothekitchenarea,untiltheyweremet.Atonepointintheafternoonaformalfundraisingmeetingtookplaceinthekitchenarea,whichwasrelativelyquietasotherspaceswereoccupied.Thisseemedtoworkwell,andsuggestedaveryfluidandmobilewayofusingthespace,butonewhichdemandedthatstaffandvisitorsweretolerantofotheractivitieswithinthevicinity.

4 Visitors,bothfirsttimersandregulars,congregatedinthekitchenarea,withsubtlelevelsofinteractionthatsawsomesittingquietlyawayfromthetableconversation,whileothersengagedmoredirectlywitheachother.Withallfacilitiesinthekitchenbeingimmediatelyaccessibleandwithplentyofroom,therewasasenseofeasewithwhichpeopleseemedtonegotiatethespace.Thelibraryappearedlesswellusedandthecommonroomwasusedonlyforthegroupeventsthatday.

6. Results and analysis

Visitors tended to chat in the bright kitchen; the common room was used for group activities

5 Theofficeareawasbusywiththefund-raiser,CentreHead,informationsupportofficeraswellasotherstryingtousetheareaandthephone.Itwasnotedthatduetolackofstoragespace,largeamountsoffilingandotherpaperworkwerestoredinboxesunderthedeskareainthedesignatedfootspace.Additionalitemswerestoredthroughoutthebuilding,includinganumberofitemsintheboilerroom,ontheseatingareabehindtheoffice,andinthegrouproom.

6 Nowindowswereopeninthemorning,butbylunchtimeonewindowinthekitchenareahadbeenopenedaswellasawindowinthecommonroom.Bytheendoftheafternoon,threewindowshadbeenopenedinthekitchenaswellasthedoorleadingontothebalcony.

7 Thewoodstove-effectgasfirewasgenerallyleftonintheupperfloorroom,evenwhennobodywasthere,leadingtoincreasedandunnecessaryheating.Itwasobservedthatthefiretakesconsiderabletimetostartupandthismightexplainageneralreluctancetoswitchitonandoff.

8 Artificiallightingwasgenerallyleftonthroughoutthebuildingapartfromupstairs.Thismightrelatetothecare-modeladoptedandtheintentionforthelightingtoprovideawelcomingsignal,butitalsomightrelatetotheslowresponseofthelow-energylightbulbs.Theblindsonthelowerpartofthewindowsfacingthehospitalwerepulledup,whichwhileprovidingadditionalprivacy,tendedtomakethesenorth-facingroomsslightlydarker.

9 Externally,itwasnotedthatthecarparkwasfullfromearlyon,withpeopleresortingtoparkingonthevergesandthedrivewayapproachingthecarparkasaresult.

Conclusions:

10Thebehaviourofusersinthebuildingsuggeststhatwhiletheyaregenerallyverymuchateaseinthebuilding,thereisadistinctissuewithventilationcontrolwithoccupantstryingtoincreasetheventilationinordertoreduceoverheatingusingwhatmeanstheyhaveavailable.

11Theprincipalmeansofaccessisbycardespitethedirectpublictransportthatisavailableonsite.ItmaybethatfutureMaggie’sCentreswillneedtoconsideralarger,landscapedcarparkfacility,particularlyasruralvisitorsareoftenpoorlyservedbypublictransport.PeoplemayalsotendtouseacarratherthanpublictransportduetothenatureoftheirtreatmentinhospitalbeforeoraftertheirvisittotheMaggie’sCentre.

12Thesmallamountofcirculationspaceintheofficehasledtostaff“choreographing”theiruseofthespace,whichisnotalwaysconducivetoeffectiveworking.

6.

Lack of storage space and cramped office space may hinder effective working

People come to the Dundee Maggie’s Centre mainly by car, leading to parking problems

CThe building design

1 TheDundeeMaggie’sCentreislocatedonthewesternoutskirtsofDundee,withintheNinewellsTeachingHospitalCampus.Itsitstothesouthofseverallargehospitalbuildings,onaraisedgrassyplain,adjacenttothehospital’shelipadandontheedgeofwoodland.ThesitewaschosenforitsspectacularviewsovertheTayEstuary,whichareconsideredsomeofthefinestintheUK.Thebudgetforthebuildingwas£0.97mforafloorareaof225m2,workingoutat£4311perm2whichisaboutoneandhalftimesthecostpersquaremetreforanequivalenthealthcarebuilding.Thejustificationforthisisperceivedtobeintheiconicnatureofthebuilding,thespecificrequirementsofthebrief,andintheinitialhighcapitalinvestmentinordertominimisefuturemaintenancecosts.

2 Thebuilding,whichhasbeenoccupiedforovertwoandhalfyearssinceitopened,consistsoffourmainareas(office,library,kitchen/dining,commonroom)linkedbyacentralentrancelobbyandstairwellrisingtoaretreatspaceonthefirstfloor(seeAppendixIII).

3 Thequestionnairepromptedvisitorstocommentonthebuilding’simage,layout,useofspace,theirneedsandtheviewsbothwithinandlookingoutofthebuilding.Thesewereratedintermsofeffectiveness,withadditionalcommentsmadewherenecessary.

4 Theoverallbuildingdesignwasratedveryhighly(Table2,AppendixV),althoughaboutaquarterofvisitorsexpressedsomedifficultyinunderstandingthelayout.Themostpositiveimpressionofthebuildingwasoftheviewsoutside,whichreceivedthehighestratingofanyaspectofthedesign.Therewereslightlylowerratingsforfunctionalaspectssuchaslayout,useofspaceandmeetingpeople’sneeds.

5 Awidevarietyofimageswereassociatedwiththebuildingbyvisitorsincluding:

“special,qualitynotcheap!,bird,light,comfort,enveloping,home,beautiful,waves…..Ithinktheroundcentralpartislikeaship’sfunnelrisingfromthewaves.Abrilliantconcept!”

Theoverallimpressionwasoneoftranquilityandcalmness.

6 Thelayoutofthebuilding,whilebeinggenerallywellappreciated,presentedparticularchallengesforfirsttimevisitorssuchas:findingthetoiletwhichhadnosignonitsdoor,andthelocationoftheofficearea,summarisedbyonevisitorwhofoundit“protrudesslightlytoofarandlimitstheuseofthecentralspaceinfrontofthedoor”.Thespaceinthebuildingwasgenerallyperceivedtobewellused.

6.

The site for the Dundee Maggie Centre was chosen for its spectacular views

Images of waves, funnels and wings

7 VisitorswereveryimpressedbyboththeinternalviewsthroughtheopenplanbuildingandfromthebuildingacrosstheTayestuary.Forsome,thenaturalviewwasquitetranscendentalwithcommentssuch“verymeditative”and“AbsolutelyspectacularandconducivetocalmreflectionandawarenessofGod.”Othercommentsweremorespecificsuchas“Ilovethelightandthewood”and“Heightoffersausefulperspective”.

Conclusions:

8 Theoveralldesignofthebuildingisverymuchappreciated.Visitorswouldappeartopositively“tradeoff”certaindesignqualitiesofthebuildingsuchastheexploitationofexternalviewsanditsoverallimpressionagainstcertainfunctionalaspectssuchaslayout,useofspaceandpeople’sneeds.Thisleadstothebuildinghavingahigh“forgiveness”factor,wherebypeoplearewillingto“forgive”functionalissuesbecauseoftheirappreciationofotherdesignqualities10.

D The visit

9 ThepurposeofthevisitmadebyvisitorsissummarisedinTable3(AppendixV).Thepurposeforthemajorityofthevisitorsonthedayofthestudyobservationwastoattendgroupactivities.

10Intermsoftheactualvisititself(Table4,AppendixV),visitorsweremostpositiveabouttheirfreedomtousethebuildingandfeltverymuchateaseinit.Theywereslightlylesscomfortableabouttalkingtoothersandslightlylesspositiveaboutthebuildingmeetingtheirspecificneeds,althoughnearly78%thoughtthatthebuildingmettheirneedswellorverywell.

11Inrelationtotheirspecificneeds,visitorsfelthinderedbyalackofcar-parkingspacesandthecoldnessofthecommonroomattimes.Byfarthegreatestnumberofnegativecommentsrelatedtothepracticalityandcomfortofthefurnishings.Thiswassummedupbyonevisitoras“Theseatingcouldbemoreforcomfortratherthanlook–thistheonlythingIwouldsuggest”.

12Commentsabouthindrancesduringavisitwereheavilyoutweighedbypositivecommentsaboutthingswhichworkedwellinthebuilding.Thesefocussedonthekitchenareawhich“encourageseveryonetogatherandchat”,theopenplanlayout,andthe“abundanceofnaturallight”.Despitethequestionsbeingdirectedtowardsthenatureofthebuilding,visitorsconsistentlyreferredtothe“openandencouragingstaff“whichperhapsdemonstratesatendencybyuserstoviewthebuildingandthepeoplewithinitasoneentity.

6.

Visitors particularly appreciated the abundance of natural light and welcoming kitchen

10“Forgiveness”wasfirstidentifiedasafactorinPOEbyAdrianLeamanandBillBordassinthePROBEstudiesfeaturedinBuildingmagazine,UKandtheBuildingResearchInformationresearchjournal.

Conclusions:

13Visitorsclearlyfelt“athome”inthebuildingbutitisunclearhowmuchofthiscanbeattributedtothebuildingitselfandhowmuchtothewelcomeandsupportprovidedbystaff.ThisreflectstheMaggie’sCentresethosofsolvingproblemsbyworkingwithpeopleinanupliftingenvironment.Itsuggestsfuturestudiesconcernedwithvisitorsinhealthcarebuildingswillhavetoeitherbemorecarefully

tailoredtoseparateoutstaff-relatedobservationsfromobservationsaboutthebuilding,oralternativelyacceptahybridmodelofanalysiswhichacknowledgestheinfluenceofstaffonvisitors’perceptionsofthebuilding.ThelattermodelismoreappropriatefortheMaggie’sCentres.

14Thestrengthoffeelingaboutthe

furnishingsexhibitedbyvisitorssuggeststhatfuturebriefingneedstotakegreateraccountofergonomicrequirementsinrelationtoaestheticappearance.

15Theexistingbriefhasbeenparticularlysuccessfulintermsofthekitchenareaandcentralisedkitchenislandunit,whichvisitorscommentonveryfavourably.Visitorsalsofeltverymuchateaseinthebuilding–apositivereflectionontheoriginalbriefrequirementforawelcomingbuilding.

E Comfort issues

1 Amajoraspectofpostoccupancyevaluationisthedegreeofcomfortwhichusersexperienceinabuilding.Thisisparticularlyimportantinhealthcarebuildingswherevisitorsarelikelytobeextrasensitivetoenvironmentalconditionsduetotheirrelativelypoorstateofhealth.

2 Visitorswereaskedtoratetheirperceptionoftemperature,airquality,ventilation,noise,lightingandoverallcomfortinrelationtothebuilding.Noisewasgenerallynotanissueforvisitors;intriguingly,however,overathirdfeltthattherewasnotenoughnoisefromoutside.Althoughthelightingoverallwasfelttobeverypositive,40%ofvisitorsfelttherewastoomuchnaturallightand28%experiencedsomedegreeofglare.Itisunclearwhy66%ofvisitorsexperiencedsomeglarefromartificiallightingaswell,whenoverthreequartersfoundoverallcomfortleveloftheartificiallightingtobejustright.Nearly90%ofvisitorsfeltthebuildingwascomfortableoverall,despiteabouthalfthisnumbercomplainingaboutadegreeofoverheating,excessivenaturallightanddrynessoftheair.

3 Thetopratingsforcomfortweregenerallylowerthanthoseforthebuildingdesignoverall(Table5,AppendixV)againsuggestingthattheremaybeisakinaestheticcompensatoryfactoratworkwithvisitorsalso“tradingoff”theappreciationoftheviews,imageandoverallqualityofdesignagainstcomfortfactors.

4 VisitorscommentsrelatedmainlytotheissueofoverheatingandvariabilityoftemperaturebetweentheNorthandSouthsideofthebuildingwithoneobservingthat“Sometimes(ifthesunisshining!?)someareasbecometoohotbutotherdaysthebigroomwastoochillyforsittingcomfortably”.

6.

The strong contrast in these photos shows the glare factor from the natural light

5 Visitor’scommentsandratingsofcomfortconditionswerecorroboratedbythephysicalreadingstakenontheday(Table10,AppendixV).Indoortemperaturereadingsonthedayofthequestionnaireweresurprisinglyhighandreachedapeakof24.4˚CbymiddayindoorsonacoldMarchday,eventhoughthemainheatingcontrolwassetto22˚C.Humidityreadingswererelativelylowinsidethebuilding,averagingaround30%,comparedtoanoutsidehumiditylevelof50%.Thiswouldaccountforasignificantpercentageofvisitorsexperiencingtheairasbeingdry.Lightinglevelsinthebuildingwererelativelylowapartfromintheupperlevelroomwhichwasfloodedwithlightfromthelargeskylight.Withitbeingasunnydayoutside,thecontrastinglowlevelsofinternallightexacerbatedtheglarefromthesouthfacingwindows.Noiselevels,ontheotherhand,wereatanormalconversationallevelinmostpartsofthebuildingapartfromtheupper

levelspace.Thisareawasrelativelyquietdespiteconversationcarryingonbelow.

6 Visitorswerethenaskedtoconsiderthedegreetowhichtheyhadpersonalcontrolovertheircomfortconditions(Table6,AppendixV).Nearlyhalffelttheyhadabsolutelynocontrolovertheheatingornoiseconditions,witharoundathirdfeelingtheyhadnocontrolovercooling,ventilationandlighting.Interestingly,despitethevariouscomfortissuesraised,theoverwhelmingmajorityofusersstatedthatapersonaldegreeofcontrolovercomfortconditionswasnotimportant.Thissuggeststhateithertheyrelyonthestafftodealwiththeseaspects,orthatotheraspectsofthebuilding,suchastheviewsandwarmthofwelcome,compensatefortheseissues.Aninterestingissuethatwastestedwiththequestionnairedatawasthedegreeoftherelationshipbetweenthesenseofcontrolthatthevisitorshadaboutthecomfortfeaturesofthebuildingandtheirownself-reportedratingsofhealth,wellbeingandqualityoflife(seesection6.f).

7 Intermsofbenchmarking,theDundeeMaggieCentreperformsexceptionallywellwithasignificantnumberofvariablesagainstover50otherbuildingsintheUKthathavebeenevaluatedusingtheBUSquestionnaire(seetable11).Despitetheissuesraisedinrelationtothecontrolofheatingandotherareas,theratingsofthesevariablesarenodifferentfromtheaveragebuilding.Theonlytwovariablesthatwouldappeartofallsignificantlybelowthebenchmarkaretherelativestillnessofairinthebuildingandtheapparentlyexcessiveamountofnaturallight.Thelatterfindingiscurious,giventhatanumberofvisitorscommentedfavourablyontheamountofnaturallightinthebuilding.

6.

The programmer and lack of cross ventilation both contribute to the overheating

2AssociationforEnvironmentallyConsciousBuildersarticleonLightweight.v.Heavyweightconstruction.Vol.11,no.3pp.30-34Winter2001-02

Conclusions:

8 Thereareanumberofcomplexinteractingfactorswhichmayaccountforthemildoverheatingofthebuildingandrecommendationsarerelatedtotheseforfuturebriefinganddesignpurposes:

Open plan layout:Theopenplanlayoutofthebuildingmeansthattheusershavetoheatallthemainareastothesametemperature,regardlessoffunction.Inevitably,thewarmairwillriseandcausetheupperstoreyretreatareatobeevenwarmerthantheotherareasbelow.Thisisbestmitigatedbyadequateventilation.

Thermal mass, heating systems and programmers:Thereismuchdebateonthevirtuesoflightweight.v.heavyweightconstruction11intheUKintermsofheatingstrategies.Lightweightconstructionisseenasbeingmoresuitableforquickresponseheatingsystems,whereasheavyweightconstructioncanworkwellwithaslowresponseheatingsystem,suchasunderfloorheating,inhelpingtoevenoutchangesintemperature.Intheory,theheatingsystemspecifiedforthisbuildingwouldseemtoideallycomplimentthelargeamountofthermalmasspresent.Infact,thesignificanttimelaginrespondingtotemperaturechangesaffordedbytheheatingsystem(2hours)combinedwiththeslowresponseofthethermalmassinthebuildinghasledtoadegreeofconfusionbystaffattemptingtoheatandcoolthespacequicklyinresponsetorapidchangesinoccupancylevels.Thisisnothelpedbytherelativelycomplexityofthemainunderfloorheatingprogrammer(HoneywellHometronicHCU30RemoteSetpointAdjuster)situatedbytheentrance,whichalsoperplexedstaff.Theguidanceforsimplyoperatingtheprogrammeristwentyonepageslong,whichspeaksforitself.Programmerswhicharerelativelyeasytounderstandandoperatebynon-technicalstaffshouldbeselectedinpreferencetomorecomplexones.

Solar Gain and ventilation:Thelackofadequateexternalshadingtothesouthernwindows,combinedwithinadequatecross-ventilation,pointstotheneedforcarefuldesignwhenusingnaturalventilation,ifoverheatingistobeavoided.Onesolutiontothisproblemwouldbetoensurethatthereisadequatecross-ventilationprovidedthroughthelayoutofroomsandthattheneedforexternalsolarshadingistakenfullyintoaccountthroughcarefuldesignanalysis.Shadingneedstotakeaccountoflow-levelaswellashighlevelsunpenetration.Thereareanumberofmechanicalextractfansinthebuildingtohelpwithventilation,buttheseareparticularlynoisyinthekitchenarea,makingstaffreluctanttousethemwhilepeoplearetryingtotalk.

User strategies for heating and ventilating:Itisclearfromtheanalysisthatstaffandusersarenotabletooptimisetheirheatingandventilationsystemsandhaveadoptedthecommonstrategyofoverheatingthebuildingtoensurethatitdoesnotgettoocold.Excessheatmustthenbeventilatedoutofthewindows.Duetothelow-levelplacementofrestrictedwindowopenings,thereisabuildupofheatinthemainvolumeandusershaveresortedtoopeningdoorsinanattempttocompensateforthelackofventilationneededtoclearthisbuildup.Highlevelventilationpointswouldsolvethisissueinfuturebuildings.

The need for user education:Lackofspecifictrainingontheheatingandventilationcontrolsforusersattheoutsetinthisinnovativeproject,andonanongoingbasisfornewstaff,mayalsohavecontributedtotheuseofinappropriatestrategiesforheatingandventilating.Userinductionisavitalaspectofbuildingprocurementandmanagement.

6.

The windows are left open while the heating is on due to its slow response to change

11AssociationforEnvironmentallyConsciousBuildersarticleonLightweight.v.HeavyweightconstructionVol.11,no.3pp.30-34Winter2001-02

Choice of heating system:Thesolerelianceonanunderfloorheatingsystemofthetypespecified,whichisrelativelyunresponsivetochange,mustbequestionedforfuturecentresofthiskindunlessthereisanadequatetopupsystemandgoodventilationoptions.Theheatingsystemispredicatedonasteadystatescenarioanddoesnotrespondquicklytotherapidchangesintemperaturewhichoccurwithvaryingnumbersofusersandactivities.Theheatingmanualrecommendsatwohourlead-intimetoobtainthedesiredheatlevelfromthesystem.Thestaffmustthereforeattempttopredicttemperaturesaheadoftimeandthiscanleadtothesystemfailingtoprovideadequatetemperatures,iftheweatheroroccupancylevelchangessuddenly.Thesupplementaryair-blownheatingsysteminthekitchenandgrouproomappearsnottobeusedtogreateffect.Therelianceongasasafossilfuel,withoutthebenefitofrenewableenergytechnologieswillinevitablyleadtoarelativelyhighcarbondioxideoutput.Thiscouldberelativelyeasilyaddressediftherequirementforrenewableenergywerebuiltintothebrieffromtheoutset.

9 Althoughtheoveralllevelofnaturallightingisclearlyappreciatedbyanumberofvisitorsthroughtheircomments,asignificantnumberfelttherewasaglareissueandtoomuchnaturallight.Thelatterfindingisunusualinstudiesofthiskindandmaybeattributabletovisitors’stateofhealth.Itwarrantsfurtherinvestigationinordertoestablishappropriatenaturallightlevelsinbuildingsforcancersufferers.Glarecouldbecausedbyexcessiveamountsofunshadedlow-levelsunlightorfromtheskylights.

10Thequalityofdesignwouldseemtosuggestthatvisitorsalsohaveahighdegreeof“forgiveness”forlowercomfortratings.Atthesametime,althoughthebuildingperformswellagainsttheBUSbenchmarkforallbuildingtypes,itshouldberememberedthatvisitorsusingthisbuildingdonotoccupyitforanygreatlengthoftimeandareinaparticularstateofmindduetotheirhealthsituation.Boththesefactorsmaytendtoresultinmorepositivereportingthanusualandmaskunderlyingissuesgenerallyexperiencedbythosewhousethebuildingforgreaterperiodsoftime.

F Sense of wellbeing and health

1 ThequestionnairecontainedtwoquestionstakenfromtheEuropeanOrganisationfortheRecognitionandTreatmentofCancerQualityofLifeCoreQuestionnaire(30Itemversion).ThetwoquestionsadoptedfromtheCoreQuestionnairewerechosenastheyassesssimpleglobalratingsbytherespondentthemselves(asopposedtotheclinician)oftheirhealthandhealth-relatedqualityoflife.Theratingsaregiveninresponseto7pointLikertscales.Theanswerstothesetwoquestionscanbecomparedtonumerousotherstudiesthathaveemployedtheseitemsintheirassessments.

2 Theoverallself-reportedratingofglobalhealth(overpastweek)demonstratedthattheirviewwasmoderateonlyforthesevisitors.TypicallytheEORTCnormforcancersurvivorsforthisratingisaround75%(thatisthosescoring5to7onthe1-7ratingscale)andforthesampleincludedinthesurveywefoundthatthispercentwas64.Thegeneralhealthratingthereforewassomewhatlessthanexpected.

3 Likewisethequalityoflife(overthepastweek)ratingforthevisitorswas57%(i.e.scoring5,6or7)whichisalsolowerthanmighthavebeenexpectedincancersurvivors.

4 Overallqualityoflifeoverthepastweekwasfoundtopositivelyrelatesignificantlytothelengthofvisit(rs=0.45,p<.05).Thiswouldappeartoshowthatthelongerthevisitorspendsinthecentrethegreaterthelikelihoodthattheirratingofqualityoflifewillbehigh.Thiseffectisrelativelyweak.Howeverwitharelativelysmallsampleitissuggestivethattheexperienceofvisitingthebuildinghasadose-responseeffect(testforlinearity:F=4.22,df(1,19),p=.05).Thatis,thelongerthepersonreportsthattheyspendinthebuildingthemorepositivetheyregardtheirqualityoflife.Suchafindingrequiresreplicationasthiswouldbesupportiveevidencefortheeffortspentonprovidingasconsiderateanenvironmentaspossibleforthevisitor.Cautionthereforeshouldbeexpressednottoover-stressthispositiverelationship.

6.

5 Theywerethenaskedtoratethedegreetowhichtheyperceivedthebuildingitselfimpactingontheirsenseofwellbeingandhealth.

6 Althoughthestudydidnotaimtoproveadirectconnectionbetweendesignandhealthbenefits,itwasfeltimportanttoascertainwhetherornotvisitorsthemselvesperceivedsuchalinkandwhetherthisrelatedinanywaytotheirperceivedqualityoflifeandhealthstatusatthetimeofthequestionnaire.Threesetsofassociationswereinspectedandtheresultsarediscussedinthenextthreesections.

7 Correlationswerecalculatedbetweentheself-reportedratingsofqualityoflifeandhealth(overthepastweek),andtheperceptionofthefeaturesofthebuilding.Inadditiontheratingsforhowthebuildinginfluencedtheirwellbeingandhealthwerealsoinspected.Spearman’scorrelationcoefficientswereadoptedastheindexofassociation.Statisticalassumptionssimplyrequiredtheratingstoberankorderscales,whichthisquestionnairedesignsatisfied.Henceinterpretationisstraightforward.Itwaspredictedthatpositiveratingsofthebuildingwouldbeassociatedwithsimilarpositiveratingsofhealth.Onthewholethesepredictionswereconfirmedformanyaspectsofthebuildingandthevisitors’ratingsoftheirwellbeingandhealth(Table6,AppendixV).Onlyonecorrelationwasfoundthatwasclosetosignificanceamongthequalityofliferatingsandthatwastheassociationwiththeabilityto‘talktoothers’.Hencethosewhoratedtheirqualityoflifestronglyalsofeltthattheyregardedthebuildingwasamenableforconversationwithotherpeople.

8 Thelackoffurthersignificantcorrelationsbetweenthehealthandqualityofliferatingsandtheotheraspectsofthebuildingcanbeexplainedbythenatureofthequestions.ThevisitorswereinvitedtogivetheirratingofhealthandqualityoflifeOVERTHEPASTWEEK.Itwouldnotbesurprisingthatvisitorsreferringtotheirhealthstatusoveraweekwouldnotassociatestronglywiththeiropinionofthebuildingduringtheirvisitonthedayofthequestionnairecompletion.Insupportofthisviewwerethestrongcorrelationsbetweenthehealthandwellbeingratingsandthebuildingfeatureperceptions.Thequestionsonhealthandwellbeingare‘state’measuresaskingthevisitortooffertheiropiniononhowtheyfeltabouthowthebuildingwasinfluencingeithertheirhealthorwellbeingatthetimeofansweringthequestionnaire.Hencetherelationshipsbetweenthesetwo‘state’questionitemsandtheperceptionofthebuildingfeaturesshowsignificantrelationships.Howevertheinterpretationoftheseassociationsisnotaltogetherstraightforward.

9 Onfirstglance(Table7,AppendixV)itwouldappearthatpositiveperceptionsofthebuildingfeaturesarelinkedwithhigherratingsofhealthandwellbeing.Thismaywellbethecaseespeciallyasthequestionsonwellbeingandhealthareinvitedwithreferenceinparticulartohowthebuildinginfluencestheirhealthandwellbeing.Itispossiblehoweverthatthepatternofcausalitymaybethereverse.Thatis,thosevisitorswhoratedtheirhealthorwellbeingpositivelymayfeelabletoratethebuildingenthusiastically.Specificpointsfromtheindividualitemsworthnotingare:

a. Firstandlastingimpressionsofthebuildingwerestronglypositivelyrelated.

b. Thevisitors’needsbeingmetwithinthebuildingwasassociatedwiththeirperceptionsofthebuildinginfluencingtheirhealthinapositivemanner.

c. Asignificantrelationshipwasfoundwiththebuildingsettingthepersonateaseandaperceptionofastrongerself-reportedratingofhealth.

d. Surprisinglytheinnerandouterviewswerenotsignificantlyassociatedwithratingsofhealthorwellbeing.Thisresultappearstocontradictthemanypositivecommentsthatvisitorsmadetotheviews.Thisdiscrepancymaybeexplainedbythefactthattherangeofvaluesforthequestionsconcerningtheperceptionofviewswassmall(i.e.positiveandveryfewnegativeratings).Fromatechnicalpointofviewthisrestrictsthesizeofthecorrelation.Inotherwordsthepositivedatacollectedontheperceptionofviewsmayhavepreventedastrongcorrelationwithhealthandwellbeing.Thisisanareaforfurtherinvestigation.

6.

10Thesecondsetofassociationsthatwasinspectedwasthecomfortratingsofthebuildingbythehealthandwellbeingratings(Table8,AppendixV).Wellbeingwasweaklyassociatedwiththecomfortratings.Ofsignificancewastheassociationofnoiseexperiencedinsidethebuildingandthesenseofwellbeingfromthebuilding.Thatis,thosewhoratedtheirwellbeingpositivelyperceivedthenoiselevelastowardsthe‘toolittle’endoftheinteriornoiseratingscale.Allmeasuresof‘overall’comfortsatisfaction(namely:temperature,comfort,noiselevelandlighting)werestronglycorrelatedwiththeratingofhealth.

11Ofparticularinterestistherelationshipofcontrolwithselfperceptionofhealth.Visitorswhoaresurvivingcancermayfindtheabilitytoexertsomecontroloftheenvironmenttheyareincontactwithsatisfyingandlifeconfirming,especiallywhenthediseaseitselfmayhavefosteredtheviewthattheirbodyhasbeen‘out-of-control’.Alternatively,thepsychologicalliteratureontheeffectsoftheenvironmentontheindividualwhoiscompromisedthroughsevereillnessshowsthatwithincreasinglackoffunction,theenvironmentexertsgreatereffectsontheindividual’shealthstatus.Henceitwasimportanttotesttheassociationsbetweenthesenseofcontrolthatthevisitorsindicatedandtheirperceptionofhealth.

12Significantcorrelationswere

foundbetweentheselfreportsof‘wellbeing’inthevisitorsandtheirperceptionofcontrolofthe‘cooling’and‘ventilation’(Table9,AppendixV). It would appear that if control was considered to be available this had a positive effect on wellbeing. Weakeffectswerealsofoundfor‘lighting’and‘heating’.Onlyoneeffect(andthiswasweak)wasfoundfor‘cooling’controlandselfperceived‘health’.

13Thefactthattherewereconsistentpositiverelationshipsfoundacrossthevariouscomfortfeatures,theircontrolandratingsofwellbeingintroducesafascinatingareaofstudy.Itcouldbearguedthattheseresultsreinforcetheviewthatmakinganenvironmenteasy‘toread’byvirtueofofferingsystemstoallowchangingcomfortparameterswillenhancewellbeingandpossiblyselfreportedhealth.Thisinterpretationisspeculativebutwouldbeafascinatingareatoconfirminafurtherinvestigationandcoulddevelopourunderstandingofthisperson-environmentinteraction.

14Positivecommentsfromvisitorsinrelationtohealthandwellbeingincluded:

“Feelings of calm”

“The building is a place where I have moved from ill-health to health by visiting regularly”

“The building/space and light lend themselves to people feeling welcome and safe –safe to explore difficult issues.”

6.

Positiveperceptionsofthebuildingarelinkedwithhealthandwellbeing–butwhichway?

Conclusions:

15GiventheaboveresultsanddiscussionthereareseveralissuesthatshouldbeconsideredinrelationtothefuturebriefinganddesignofMaggie’sCentresandpotentiallyothersimilartypologies.Itisclearfromthestudythatthereisapositivecorrelationbetweenmanydesignaspectsofthebuildingandvisitorssenseofhealthandwellbeingatthetime.Whatisnotcleariswhethervisitors’senseofwellbeingandhealthisinfluencingtheirperceptionofthebuilding’squalities,orwhetherthebuilding’squalitiesareaffectingvisitors’perceptionoftheirhealthandwellbeing.Additionalvisitors’commentswouldseemtosuggestthelatter,butthisisnotprovenandisclearlyanareaforfurtherinvestigation.

16Thefindingsrelatinghealthandwellbeingtovisitors’senseofcontroloverventilationandcoolingareimportantandsuggestthatgreaterattentionneedstobepaidtothedesignandspecificationofheating,ventilatingandcoolingcontrols,ifvisitors’senseofhealthandwellbeingaretobefurtherimproved.Whatisparticularlystriking,isthatwhilevisitorsconsciouslystatedthathavingadegreeofcontrolintheseareaswasnotimportanttothem,thedegreeofcontrolperceivedtobeavailableclearlyaffectedtheirsenseofwellbeingandhealth.Inotherwords,theymayliketofeel“incontrol”ofventilationandcooling(“IcanalwaysopenawindowifIwantto”),butwithoutnecessarilyhavingtoresorttoactuallycontrollingthesethemselves.

17TheabilityforvisitorstobeabletocontroltheirenvironmenttiesincloselywiththeMaggie’sCentresethosofempoweringpeopletobeabletoadapttotheirsurroundingsandtakecontrolratherthanbeingcontrolledaspassiverecipientsinacaresystem.

G Staff and volunteer perspective

1 Theinterviewguideforthestaffandvolunteersdeliberatelyadoptedthesamequestionsasthevisitorquestionnaireforcomparativepurposes,butdivergedinrelationtothenatureofactivityinthebuilding(AppendixI).Manyoftheresponsesechoviewsofthevisitors.

2 OnlytwoMaggie’sCancerCaringTrustfulltimemembersofstafftookpartintheevaluation,inadditionthreesessionalworkersandonevolunteerwereincludedininterview.TheClientRepresentativewasnotincludedinthisinterviewprocessbutparticipatedina“walk-through”discussionatalaterstage.Allstafflivedrelativelylocallyandalmostallcommutedtoworkbycarwithanaveragejourneytime20minutes.Mosthadworkedinthebuildingfortwototwoandhalfyears.Theyhadveryvariableworkpatterns,withrelativelylittleuseofVDUsandtendedtobecontinuouslyonthemoveinthebuilding.

3 Asurprisingvarietyofimageswereassociatedwiththebuildingwiththebuildingbeingseenascontemporary,unique,welcomingandcalminaveinsimilartothevisitorresponses.Thebuildingwasperceivedtobewellusedandinlotsofdifferentways.Generallythebuildingmetthestaffneedsapartfromsomekeyissueswhichareoutlinedintherestofthissection.

4 Levelsofprivacywereperceivedtobegoodforvisitors,butnotsogoodforstaffwhofelttheydidn’thaveaprivatespaceto‘escape’to.PartoftheMaggie’sCentresethos,however,istoensurethatstaffarealwaysawareofvisitors.Thisnecessarilyentailsstaffbeingvisiblemostofthetime.Thelibrarywasnotseenasanidealplaceforconversationwithpeopleindistressasitwasdirectlyoppositethefrontdoor.

5 Thelayoutofthebuildingwasfelttobewelcoming,easytounderstandandopen.Onememberofstaffsuggestedthatthetherapyandretreatroomsshouldbeknockedtogethertocreateamoreusefulspace,becausebothweretoosmallontheirown.Anothervolunteerwasunclearwhatthesesmallroomswerefor.

6.

Theofficemaylooklikeithasenoughspace...

...untiltheworkstationsareinuse.

6 Severalissuesinrelationtotheofficeareawereidentified:visitorstendedtowanderintotheoffice,notknowingquitewhatitwasfor,thedeskareawasawkwardbecauseittendedtosuggestareceptionpoint,whichitwasnotmeanttobe,andtheofficeareawasperceivedtobeabit“weird”–nobodywasclearwhattheseatingatthebackoftheofficewasforandasaresultithadbeenadoptedasatemporarystorageplace.Itwassuggestedthattheofficemightbebetterlocatedupstairs,butthiswasn’tnecessarilyperfecteither,asstaffneededtobeseenbyvisitors.Theofficewasgenerallyfelttobetoosmall,withnotenoughspaceforstorage.Oneintervieweesummedthisup:“Ican’tbearthelackofspaceintheofficearea;thechairsaretoocloseandtherearenofilingcabinetsandnostraightwalls.”

7 Likethevisitors,allintervieweesverymuchappreciatedtheviewswithinthebuilding,withtheheightofroomsgivinganadditionalsenseofspace.TheywereparticularlyfondoftheviewsacrosstheTayEstuarywithonecommentingthat“Ilovetheviews–theychangeallthetimeandraisemyspirits.Theyneverceaseto–thetrees,tide,skyandcolours–theychangeallthetime.Arealjoy”.Viewstothenorthofthebuildingwereseentobenotsoimportantbutcouldbeimprovedpossiblywithtreescaping.

8 Staffcarriedoutaverywidevarietyofworkfunctionswhichthefacilitiesgenerallyprovidefor.Itwasfeltthattheglasswindowinthemaindeskpartitiongavethewrongimpressionandthatpeopletendedtowaitattheentrancearea.Thisviewwasbackedupbythebehaviourofvisitorsindependentlyobservedonthedayoftheinterviews.Therewasasuggestionthatitmightbebettertohavethekitchenarearightnexttotheentrancetohelpencouragepeopletocomeintothebuilding.

9 Likethevisitors,intervieweesthoughtthatsomeofthefurniturewasnotappropriate.Theseatingwasfelttobetoolowanddidn’thavearmrestsforpeopletohelpthemselvesupwith.Thechairswereseentobegoodlookingbutnotalwaysfunctional.Theseatinginthecommonroomwasnotfelttobeconducivetomeetingsandwasdesignedmoreforindividualrelaxation.Theoutwardlycurveddeskintheofficewasfoundtobeawkward.Itwaspointedoutthatthebuildingneedstocaterforthefullspectrumofconditionsandpeopleandthatthereshouldbemorevarietyinthecrockeryprovided(olderpeoplemaypreferacupandsaucer,ratherthanamug).

10Thelackofstoragespaceinthebuildingbroughtoutthestrongestreactionamongstaff,whoendedupstoringthingsintheboilercupboard,creatingapotentialhealthandsafetyissue,andgenerallyspreadingitemsaroundthebuildingasdiscreetlyaspossible.

6.

Themaindeskandfurniturewerefelttobeinappropriateforvisitorsandstaff

Althoughstoragewasaproblemstaffverymuchappreciatedtherelaxingatmosphereinthecentre

11Keythingswhichusuallyworkedwellfortheintervieweesincluded:theatmosphereoftheplaceandfeelingofrelaxation,thekitchenandspecificallythekitchentablewhichwereseentobethebestaspectsofthebuilding,functioningasanautomaticmeetingpointandbeingperfectfortalking.Thecommonroomworkedwellforrelaxationclasses.

12Despitecertainissues,thebuildingdesignoverallwashighlyratedsuggestingthatitsoverridingqualitiesoutweightheissueswithasimilar“forgiveness”factoroperatingforstaffandvolunteersasthatnotedforvisitors.

13Interviewees’viewsoncomfortalsoechoedthoseofthevisitors.Themaincomfortissueswereoverheating,inadequateventilationandsolarglareinthewinterfromlowanglesunlightstreamingintothekitchenarea.Venetianblindsweresuggestedforthekitchentocounteractglareissues.Noisewasnotnormallyaproblemasstaffhadlearnedtolivewithitanditdidn’tgenerallyinterferewiththeirwork.Therewasarealissueofthefrontdoorbanging,especiallywhenitwasleftopeninordertotryandventilatethebuilding.Thequalityofnaturallightwasperceivedtobeverygooddespitetheissueofsolarglareandthekitchenwasfelttobethebrightestarea.Thecommonroomandsmallertherapyroomswerefelttobeabitdark,bycomparison.Thebigspotlightsupstairswerefelttobetoobrightandneededtobere-angled.

14Interviewees,incommonwithvisitors,felttheyhadlittlecontrolovercomfortconditions,withvirtuallyno-oneunderstandinghowtheheatingworked,butrecognizedthatthebuildingwasslowtorespondtochangingconditions,whichledtooverheating.Thewindowventilationwasfelttobeinadequateandthemechanismsforopeningthemratherimpractical.Intervieweeshadresortedtoleavingthefrontandbackdooropentotryandcreatecross-ventilation,butrecognizedthattherewaslittlecontroloverthismeansofventilation.Beingabletopersonallycontroltheheatingwasseentobemoreimportantthancontrollinglightingornoise.

15Despitethesignificantissueofoverheatingandlackofofficespace,staffratedtheoverallcomfortconditionsasbeingverygood,suggestingthatthey,likethevisitors,also“forgave”thebuilding’sparticularcomfortproblemsduetoitsoveralldesignquality.

16Intermsofwellbeing,healthandproductivity,nooverallconclusioncouldbedrawnfrominterviewee’sperceptionsaboutwhetherornottheconditionsofthebuildingactuallyaffectthese,withtwosayingthattheconditionsimprovedboththeirwellbeingsenseofhealthandproductivity,andthereststatingthatitmadenodifference.

Conclusions:

17Fromtheaboveitcanbeseenthattheviewsofthestaffandvolunteersareverysimilartothoseofthevisitors.Additionalissuesraisedbystaffinclude:poorergonomicdesignintheofficeareacombinedwithlackofspace,anambiguousreceptionarea,lackofstorageandunfamiliaritywiththeheatingcontrols.Itcanbeanticipatedfrompreviouspostoccupancyevaluationstudiesthatthelongersomeonehasworkedinabuildingthemoretheybecomeawareofanydeficiencies.Inthissense,itisvitalthatthebriefingprocessandresultantbuildingdesigntakecarefulaccountofstaffrequirementsaswellastheneedsoftheusers.

18RecommendationsforfuturebriefinganddesignofMaggie’sCentresarisingfromtheinterviewfindingsinclude:

a) therequirementfordiscreetandflexiblestoragefacilitiesrelatedtotheoffice.Thesecouldbedesignedtolookdomestic,e.g.builtinshelvingandfilingsystemswithdoorstocloseoffviewsofpaperwork.Baseunitscontainingfilingfacilitiesandotherstorageshouldbedesignedtobemoveabletoenableofficeusetobereconfiguredasnecessaryaccordingtowhoisusingit.

b) therequirementforadequatespaceintheofficeareaforallofficestationstobeusedatthesametimeifnecessary.

6.

c) separatingtheofficeareaofffromtheentrance,whilestillmaintainingadequatesightlines.Sightlinesneedtobecarefullycheckedatdesignstage.

d) providingasound-proofbutmoveablepartitionbetweenthesmallerretreatroomandtherapyroomtoallowthesetobeopenedupformoreflexibleuse.

H The building process

1 AnArchitectrepresentativewasinterviewedseparatelyusingquestionswhichrelatedspecificallytotheconstructionofthebuilding,maintenance,managementandenergyefficiencyinaseparateTechnicalInterviewGuide(AppendixI).Theresultsoftheinterviewwereanalysedinrelationtoacarefulexaminationoftheworkingdrawings,specificationsandheatingbillsforthebuildingtoprovideanoverallappraisalofsustainability.A“walkthrough”withtheClientRepresentativewasusedtofurtherclarifyidentifiedissues.Thebenefitofhindsightwasusedtoestablishwhat,ifany,additionalchangesmightbemadetothefuturebriefing,design,specificationandconstructionofsmall-scalehealthcarebuildingssuchasMaggieCentres.

Construction process

2 Fromthelocalarchitect’spointofview,therehadbeennoproblemsduringtheplanningstageandtheiconicstatusofthebuildinghadverymuchhelpedinthisrespect.Theconstructionhadbeenequallystraightforwardapartfromtheroof,forwhichtheholdingofdesignandconstructionworkshopsbeforegoingonsitehadeasedmatters.Thespecialised“angelhair”finishtothestainlesssteelroofhadtobecarriedoutintheUSAbecausenoonewoulddoitintheUK.Theconstructionprocesshadturnedouttobeslowerbutnotgreatlyso.Thebuildcontracthadbeenfor12monthswhennormallyitwouldhavebeen6-8months.Therehadbeennoparticularproblemsduringthedefectstagebecausepeoplehadtakenarealprideinthejob.

Maintenance

3 Accordingtothelocalarchitectsandstaff,ongoingmaintenancerequirementsforthebuildinghadbeenrelativelylowatthetimeofthisstudyalthough,fromrecordsanalysed,therehadbeenanumberofcalloutsrelatingtothepoorperformanceoftheheatingsystemandthenon-disabledw.c.AnymaintenancerequiredhadbeenarrangedonarelativelyinformalbasisbytheCentreHeadwiththeNHSestatesdepartment,thelocalarchitectsoragentsresponsibleformaintainingtheservices.

4 Thehoodedeffectoftheroofhadhelpedtosheltersomeoftheexposedtimber,althoughitwasthoughtthattheexternaltimberonthesouth/southwestwoulddeteriorateunlessitisregularlymaintained.Theexternaltimberseatingwillbeneedparticularattentioninthisregard.ThedesignarchitectshadspecifiedaverticalgrainimportedDouglasFirforaestheticreasons,evenalthoughthelocalarchitectshadrecommendedamoredurable

hardwoodbecauseofthesevererainfallinScotland.

5 Wallingareaswhichweresubjecttosignificantwearthroughfurnitureabrasionandhandprintshadbeenrepaintedandwerelikelytoneedrepaintingrelativelyfrequently.

6 Generallythefinishestothebuildingwerefelttobeofgoodquality,apartfromtheexternaltimber,anditwasanticipatedthatthehighercapitalcostandinvestmentinbetterqualitymaterialsshouldresultinlessmaintenance.

6.

Theexposedsoftwoodtimberonthesouthsideofthebuildingwillneedmaintenance

7 Atowerwillberequiredtochangetheinternallighting,anditwasrecommendedbythearchitectsthatthelow-energylightbulbswerereplacedallinonegowhenthefirstonegoes.Acherrypickerwillbeneededtoservicetheroofbecauseofitsparticulardesign.Thearchitectdidnotfeelthatmaintenanceexpenditureonthebuildinghadbeenexcessivetodate.

8 Itshouldbeaddedthatnolifecyclecostinghadbeenspecificallycarriedoutonthisdevelopmentatthedesignstagetominimisefuturemaintenancecosts.

Management

9 Accordingtothelocalarchitect,theperformanceofthebuildinghadgenerallyfulfilledthebriefrequirementsapartfromtheofficearea,wheretheergonomicswerenotthoughttobeoperable.TheofficedidnotcomplywiththeDisabilityDiscriminationAct,becauseitwasnotpossibleforawheelchairusertoworkintheoffice.Itwouldbepossible,however,forawheelchairusertobeaccommodatedelsewhere,giventheflexibilityofthebuilding.

10Thebuildingwasperceivedtobeveryflexibleinusebythelocalarchitect,whopointedoutthatalaptopfacilityhadrecentlybeenaddedtothekitchentableareatoenablepeopletouseITwhilehavingacupoftea.Itwassuggestedthattherewaslotsofopportunityforthiskindofflexibility.Storageareas,however,werefelttoberelativelyunprovidedforandthelocalarchitectssuggestedthattheclientwillneedtore-examinetherequirementforthis.

11Generally,althoughthebuildingwasfelttoworkwellandhadacompletelackofinstitutionalfeeling,thelocalarchitectsuggestedthatthebriefwasnotcomprehensiveenough.Neverthelessthedesignwasratedbyhimas“prettyclosetoexcellent”.

12The“walkthrough”revealedthatsightlinesfromthePCinformationstationandthekitchenareastotheentrancedoorwereblockedtoadegree,leadingtostaffhavingtopositionthemselvescarefullyatalltimestoensurethattheycouldhear/seevisitorsarriving.Thiswas,however,viewedpositivelyasitensuredthatstaffremainedattentivetoallpartsofthebuilding.

Energy efficiency

13Theprimarymeansofheatingthebuildingwasbyunderfloorheatingusingadomestic30kWcombinationgasboilerforthegroundfloorwetsystemandelectricityfortheupperfloorunderfloorheating.A6.6kWwoodstove-effectgasfireprovidedadditionalheatingtotheupperlevelareaabovethelibrary.Thewetsystemwasdesignedtoberunataconstanttemperaturesettingofaround18˚Cwithlocalisedheatingelementsinthekitchenareaandlargegrouproomtotopthisupasrequired.Theunderfloorheatingwassplituptoeightdifferentzonesrelatingtodifferentpartsofthebuilding,eachwithaseparatethermostat.Thesecouldonlybeadjustedbyoneortwodegrees,however,fromthemainprogrammesetting.Thelocalarchitectwasnotconvincedbythecontrolmechanismforthelocalisedheatingelementandatthetimeofthisstudytheheatingcoilitselfappearedtobemalfunctioning.

6.

14Serviceengineer’sreportsnotedseveraltimesthattheheatingprogrammerwasonthewrongsettingsandhadtobereset.Therehadalsobeensomepastproblemswiththeheaterunderthebenchunitinthekitchenandintheofficearea.Itisquiteclearfromtheengineer’sreportsthatstaffregularlyreportedproblemswiththeheatingwhichwerelargelyrelatedtothecomplexityoftheprogrammer.Theauthoralsoobservedthecomplexityofusingtheprogrammerduringthe“walkthrough”.

15Thelocalarchitectobservedthattherewasconsiderablesolargaininthebuildingasnotedalsobyusers.Onedesignsuggestionhadbeentousefrittedglassforthelargeskylightovertheconcretefloorinthecentreofthebuildingtopreventexcessiveheatbuildup,butthedesignarchitectshadbeenadamantthattheusersshouldbeabletoseetheskyjustasitwas.Thelocalarchitectalsostressedtheneedtocontinuouslyeducatethestaffonhowtousetheheatingsystemduetotheinevitableturnoverofpersonnel.

16Thebuildingwasdesignedtobenaturallyventilatedapartfromareaswithnooutsidewall,whichwereservedbymechanicalventilation.Thelocalarchitectrecognisedthattheshapeandvolumeofthemainspacestogetherwithnaturalventilationonlyoccurringthroughthelow-levelsashwindows,wasnotaltogetherhelpfulinthisregard.Itwassuggestedthatarapidextractsystemcombinedwithheatrecoverymayhelptoovercomeanyventilationoroverheatingissues.

17Thelevelsofinsulationinstalled(60mmRockwoolHPintheexternalwalls,35mmrigidinsulationinthefloor,and80mmFoamglassintheroof)werethoughttobeinexcessofthebuildingregulationsatthetimeandthelocalarchitectfeltthatthebuildingshouldbeverygoodintermsofenergyefficiency.Bestpracticeinthisareawouldhoweversuggestdoublingtheselevelsofinsulationinfutureprojectsinordertoreducecarbondioxideemissionstoasustainableratewhichwillmitigateclimatechangeinfuture12.

18Evidenceontherunningcostsfromfuelbillsobtainedforafullyear(Table12,AppendixV)indicatesthat,despitetheheatingcontrolissuesidentified,theenergyusewaswellwithinthegovernmentenergytargetof35-55GJ/100cu.mfornewbuildingsintheNHSEstate(2001-10),cominginat29.4GJ/100cu.m.Energyrunningcostswere£64perweekfor286kwh/m2.Totalcarbonemissionsforthebuildingwere4.4tonnesfortheyear.

6. 12Stevenson,F.andWilliams,N.(2000)SustainableHousingDesignGuideforScotlandp.36

Overall sustainability

19 AnappraisaloftheoverallsustainabilityoftheDundeeMaggieCentrebuildinginvolvedanassessmentofanumberofinterrelatedareas:resourceuse,pollution,biodiversity,healthyenvironments,peopleandcommunitiesandthebuildingprocessitselfdrawingontheheadingsinTable1313.Thelimitationofthisstudydidnotpermitafullassessmenttobemade,andwhatfollowsisabriefoverviewfollowingscrutinyofthedrawingsandspecificationtogetherwithvisitstothebuildingandinterviewswithvariousparties.

20 Resource Use: Thedesignofthebuildingitself

hasreducedenvironmentalimpactthroughtheextensiveuseofrenewabletimberinthestructuralframing,windows,doorsandcladding.Howeveritshouldbenotedthatthereislikelytohavebeenasignificantamountofembodiedenergytiedupinthetransportationofcertainelements,suchasthesteelcladdingfortheroof,whichhadtobetransportedtotheUSandbackagainforfinishing,andthetimberstructuralbeamswhichweremanufacturedinFinland.Theextensiveuseofbuildingproductsandmaterialsbondedtogetherbystrongadhesiveswillmakeitdifficulttorecyclethesecomponentsattheendoftheirlife,althoughthemaintimberelementscouldintheorybere-used.

21 Pollution and Biodiversity: Almostalluserswerecommuting

bycar,arelativelypollution-intensiveformoftransport,despiteaccessiblepublictransportfacilitiesonsite.ThesolutiontothisliesbeyondthecontroloftheMaggie’sCentres,possiblyintheformoflesspollutingcars.Thematerialsandproductsusedinthebuildingwererelativelystandardandnoparticularattempthadbeenmadetospecifylowpollutantsbeyondregulatorypractice.Biodiversityonthesiteremainedrelativelyunaffectedbecausethesiteitselfhadnoparticularmerittostartwith.Althoughnoattemptshadbeenmadetoenhancebiodiversitytodate,thepotentialisofferedthroughfuturelandscapinginitiatives.

22 Healthy Environment: Therehadbeensignificant

emphasisoncreatingahealthyenvironmentwithinthebuildingthroughthespecificationoflow-emissionpaintandvarnishfinishes,theextensiveuseofnaturalmaterialsinsidethebuilding,theuseofnaturalventilationanddaylight.Therewas,however,noparticularrequirementinthebrieftominimisetoxicityortooptimisehumiditylevels,bothofwhichhelppreventallergicreactions14.Neverthelesstheperceptionbyuserswasthattheairqualityinthebuildingwasrelativelygood,possiblyduetothegenerousvolumesprovidedbythedesignwhichprovidedadegreeofbufferingintermsofairquality.

6. 13Halliday,S.P.andStevenson,F.(2004)SustainableConstructionandtheRegulatoryFramework:AThinkPiece,GaiaResearch,Edinburgh,http://www.gaiagroup.org/Research/IDS/suc-con-reg/index.html

14Berge,B(2000)Ecologyofbuildingmaterials.ArchitecturalPress,Oxford.Thisbookextensivelydescribesthepropertiesofvariousconstructionmaterialsandishelpfulforspecificationpurposes.

Thedesignofthebuildinghasreducedenvironmentalimpactthroughtheuseoftimber

23 People and Communities: Theoutstandingdesignqualityof

thebuildinghadgreatlybenefitedthelocalcommunityintermsofraisingDundee’sprofileasacity,althoughthedirectbenefitstothelocalconstructionandmanufacturingeconomywererelativelyminimalgiventhatmostproductsforthebuildinghadbeenimportedtotheregion.Therewereno“locallabour”clausesspecifiedinthecontractassuch,tohelppromotethelocaleconomy.

24 Building Process: Thebuildingprocessdidnotutilise

anyparticularsustainabilitytoolsorbenchmarksandpostoccupancyevaluationwasnotspecifiedaspartofthebriefingprocessassuch.Therewas,however,extensivepre-evaluationofthedesignwiththeclientbodyandaverycloseandcontinuousrelationshipwiththearchitect.Futureexpansionofserviceshadbeenconsideredandratherthanexpandthebuilding,theclientwouldconsiderbuildinganotherbuildinginstead.Future-proofingthebuildingintermsoffuturelegislativerequirementsorupgradingelementswasdifficulttoanticipateandpotentiallyexpensive.Althoughthebriefspecificallyrequiredthatthebuildingshouldeconomicaltomaintain,therewasnobriefforthearchitectorcontractortoprovidesustainablemethodsofconstructionthatminimisedwaste,energyuseandaddressedclimatechangebeyondstatutoryrequirements.

Conclusions:

a) Design issues:

1 Thedomesticnatureofthedesignresultedinarelativelystraightforwardconstructionprocessapartfromtheroof.Thecontractlengthwasslightlylongerthanforabuildingofasimilarsize,butthedifferenceisrelativelyinsignificant.

2 Intermsofmaintenance,itisimportanttotakeaccountofthelocalclimatewhendesigningandspecifyingexternaltimberelements.Largeflattimbersurfaces,suchastheseatingonthe“jetty”shouldbeavoidedaswaterwillsitontheseandleadtoprematuredecay.

3 Althoughtheprovisionofanenvironmentallysustainabledevelopmentwasnotaprimaryaimoftheoriginalproject,thedesignhasaddressedtheseonanumberoflevelsincludinggoodlevelsofdaylighting,passivesolargainanddurability.Ithasalsominimisedenvironmentalimpacttoadegreethroughthespecificationofrelativelylowembodiedenergytimberforprimaryandsecondaryelementsofthedevelopment.Incorporatingthebriefingrequirementsrelatedtoresourceuse,pollution,biodiversity,healthyenvironments,peopleandcommunitiesandthebuildingprocess,wouldimproveperformanceinalltheseareas.

4 ThereisalsoscopeforfutureMaggie’sCentrestoreducecarbondioxideemissionstoamoresustainablelevel,forrelativelylittleextracapitaloutlay,byintroducing“quickwins”tothebriefwhichrecognisethecostconstraintsofanorganisationdependentonfundraising.Theseinclude:

• increasedloftinsulation• useofmaterialsandproductswith

recyclateinthem• wasteminimisationprocedures

duringconstruction• minimaluseoftimbertreatments• category“A”boilers.

b) User related issues:

5 Themaintenanceandrunningofthebuildingisrelativelytraightforwardapartfromtheheatingsystem.Atpresentmaintenanceiscarriedoutonarelativelyinformalbasis.ItmaybeusefulfortheMaggie’sCentres,atthisstageofdevelopmentasanorganisation,toconsideremployingapermanentbuildingsmanagerfortheirstock,whowouldbeablehelpstaffunderstandproblemsrelatedtoheating,ventilationandgeneralmaintenanceandensurecontinuinginductionfornewstaffunfamiliarwithhowtoruntheirbuilding.Thispersoncouldalsobechargedwithcyclicalmaintenanceplanningandbroughtinonthebriefingprocessfornewprojectsinordertoprovidetechnicalfeedbackonproposedspecificationsrelatedtotheactualrequirementsofusers.

6.

1 ThelimitedscopeofthisshortstudypresentsasnapshotoftheDundeeMaggie’sCentreandcannotseektoreplicateafullmonitoringexerciseoveralongerperiodoftime.

2 Themethodologyadoptedhashowever,revealedagreatdealofbothsubjectiveandfactualinformationwhichhasprovidedarichpictureofhowwellthebuildingisperformingandcouldbereplicatedforfuturebuildings.

3 Theresultsofthesmallpilotsurveyindicatethatthebuildinghassuccessfullyachievedthefollowingobjectivesofthebrief:

• ahighlyeffectivedesignconceptinrelationtotheMaggie’sCentre’scaremodel

• veryhighusersatisfactionoverall,withfacilitiesprovidingacalmandfriendlyspaceandanappropriatedegreeofprivacy

• highlevelofoverallcomfort• usersperceptionofincreased

healthandwellbeingduetovisitingthebuilding

• particularappreciationoftheviewsoutofthebuilding

• lowlevelofmaintenancerequired

4 Thebuildinghasbeenlesssuccessfulinachievingthefollowingobjectives:

• flexibleofficespacewhichisseparateyetvisiblefromwelcomearea

• adequatestoragefacilitiesfortheofficeareaandotheractivities

• thermalcomfort

5 Evidenceontherunningcostsfromfuelbillsobtainedforafullyear(Table12,AppendixV)indicatesthat,despitetheheatingcontrolissuesidentified,theenergyusewaswellwithinthegovernmentenergytargetof35-55GJ/100cu.mfornewbuildingsintheNHSEstate(2001-10),cominginat29.4GJ/100cu.m.Energyrunningcostswere£64perweekfor286kwh/m2.Totalcarbonemissionsforthebuildingwere4.4tonnesfortheyear.

6 Thehighlevelofoverallusersatisfactionvalidatesadesignapproachwhichhasplacedanemphasisonthequalityandgeneroussizeofinternalspaces.Goodqualityinternaldesignalsogivesthebuildingahigh“forgiveness”factorinrelationtocomfortissuesconcerningoverheating,humidity,ventilationandglare.

7 ThereareanumberofissuesarisingfromtheevaluationinthelightoftheoriginalbriefanddevelopedproposalwhichshouldbeinvestigatedfurthertohelpimprovethedesignqualityofMaggie’sCentresandothersmallscalehealthcarebuildings:

Design Issues:

a) largeareasofsouthfacingglazingcanleadtooverheating,unlessadequateexternalsolarshadingandventilationmeasuresaretaken

b) thesizeoftheofficeshouldtakeaccountoftheneedforflexibility,storageandadequatecirculation

c) thespecificationoftheunderfloorheatingsystemneedsanadequateandinstantaneoustop-upsysteminthelightofthefluctuatingnumberswhichuseaMaggie’sCentre.

d) thespecificationanddesignofwindowsmustallowforadequateventilationathighlevelandshouldbedesignedtoalloweasyopeningbyoneindividual

e) adequatecrossventilationisneededbetweenroomsifthissizeofbuildingistobenaturallyventilated

f) thepossibilityofprovidingasound-proofmoveablepartitionbetweenthesmallerretreatroomandtherapyroomtoallowformoreflexibleuse.

7. Conclusions and Recommendations

User-related issues:

a) userinductionshouldbeaninherentfeatureofanynewbuildingandneedstobecontinuous,especiallyinrelationtoheatingandventilationcontrols,toavoidpotentialmisunderstanding

b) complexheatingprogrammersshouldbeavoided–thedesignteamneedtoensuretheyaresimpletounderstandwithnounnecessaryoptionsforsettings

c) thepositionoftheofficeshouldbeconsideredcarefullyinrelationtostaffrequirementsaswellasuserrequirements,andavoidbeingseenasa“receptionarea”.Thekitchenshouldideallyleadimmediatelyoffthemainentrance,astheprimarysocialspace,toavoidfirsttimevisitors“hovering”attheentrance

d) theuseofchairswithoutarmrestsoradequatebacksupportforconversationalmodeisnotrecommendedforambulantdisabledusers

e) thereisaneedforincreasedcarparkingprovisionatpeaktimes.

8 Positiveoutcomesthatshouldbeadoptedfromthebuildingdesigninfuturebriefingincludetheuseof:

Design principles:

a) emphasisonexternalviewsofnaturefromthebuilding,whicharenaturalandupliftingforusers

b) relativelygenerousspacestandards

andvolumecombinedwithacarefullydesignedabundanceofnaturallighting,whichallowsairtoremainfresh

c) theuseofhighqualitymaterialsandfinishestominimisemaintenancecostsandincreasedurability

d) theuseoftimberforboththeprimaryandsecondaryelementsofconstructiontominimiseenvironmentalimpact.

User-related principles:

a) openplanlayout,whichwhileprovidingasenseofwelcomealsomakescirculationandinternalmanagementrelativelyeasy

b) thegenerous“farmhouse”kitchenastheprimarysocialspace,whichisthekeytothesuccessoftheMaggie’sCentre

c) theinclusionofavarietyofdifferenttypesofspaceswhichallowdifferentactivitiestooccurinthem.

9 ThereareanumberofareaswherethebriefingprocessfortheMaggie’sCentrescouldbestrengthenedinordertoimprovetheoverallperformanceoftheirbuildings,includingtherequirementfor:

a) simpletounderstandandeasytouseheatingsystems,controlsandprogrammerswhichcanrespondtorapidlychangingoccupancylevels

b) low-noisemechanicalventilationequipmentinuserenvironmentswhichdon’tinterferewithquietconversation

c) adequatesolarshadingandprovisionofcross-ventilation

d) specificstorageareasandfacilitiestobemoreclearlyidentifiedorsystemforremovingitems

e) adequatecirculationinofficeareas

f) sustainabledesignandspecificationwhichdrawson“quickwins”withincostconstraints.

10ASWOTanalysisbasedonthestudyfindingstoestablishtheoverallefficiencyofthedesignandfuturestrategiesinrelationtotheinitialprojectobjectivesisshownoverleaf.

7.

Strengths

successfuldesignconceptinrelationtoMaggieCentrecaremodel

qualitativenatureofdesignbrief

outstandingscenicviewsfrombuilding

qualityandabundanceofnaturallight

openplanlayout

welcomingandengagingkitchenarea

flexibilityofdesignfordifferentuses

staffethos

7.

Weaknesses

inadequateventilationdesignandlackofsolarshadingleadingtooverheating

poorthermalcomfortconditionsduetounderfloorheatingsystemandthermalmasswhichcannotrespondquicklytorapidchangesinuseractivitiesandnumbers.

complicatedheatingprogrammer

unergonomicchairsandseating

relativelyundevelopedbriefingdocumentationandfeedbackproceduresforprojects

Opportunities

addmoveablesolarshadingtosouthfacingkitchenwindowstoreduceglare

remodelofficearea

continuoususerinductiontohelpunderstandthebuilding’sheatingandventilationandcontrolitbetter.

improveddesignbrieftotakeaccountofidentifieddesign,sust-ainability,andmaintenanceissues

employmentofbuildingsmanagertoprovidestrategicsupport

Threats

staffdissatisfactionwithworkingconditionsinofficearea

futurelegislativerequirementsinrelationtosustainabledesign

increasingenergybillsforfossilfuels

longtermmaintenanceofexposedtimber

11Thefollowingaspectspresentopportunitiesforfurtherresearch:

• awiderstudyofallMaggieCentresusingafurtherrefinementofthemethodologyestablishedinthispilotstudytoascertainspecificoutcomesandresearchquestionswhichexaminekeydesignfeaturesinrelationtouser’sperceptionhealthandwellbeing.

• awiderstudyoftherelationshipbetweenuser’sabilitytocontroltheirenvironmentandtheirperceivedstateofhealthandwellbeing.

• thedesignofventilationandheatingstrategiesinrelationtothepresence,orabsence,ofthermalmassinsmall-scalehealthcarebuildingsandtheeffectthishasonenergyefficiencyandcomfort

SWOT analysis of Dundee Maggie’s Centre

AssociationforEnvironmentallyConsciousBuildersarticleonLightweight.v.Heavyweightconstruction,Vol.11,no.3pp.30-34Winter2001-02

Berge,B(2000)Ecologyofbuildingmaterials.ArchitecturalPress,Oxford.

BuildingandResearchInformation,Vol29,Number2,March-April2001SpecialIssueonPost-occupancyEvaluation

BuildingandResearchInformation,Vol33,Number4,September2005

Burt-O’Dea,K.(2005)DesignImpactStudy.Plan&Projectpartners,EuropeanHealthPropertyNetwork.

DepartmentoftheEnvironment,TransportandtheRegions(2000)BuildingaBetterQualityofLife:AStrategyformoreSustainableConstruction,HMSO,Norwich

Halliday,S.P.,andStevenson,F.(2004),SustainableConstructionandtheRegulatoryFramework:AThinkPiece,GaiaResearch,Edinburgh,http://www.gaiagroup.org/Research/IDS/suc-con-reg/index.html

Jencks,C.TheMaggieCentresMovementEightYearsIn…,FourthDoorReview,Nos.7,2005pp.30-33

Lawson,B.etal(1998-2001)TheArchitecturalHealthcareBuildingandItsEffectsonPatientHealthOutcomes,UniversityofSheffield

Roaf,S,Fuentes,MandThomas,S.(2001).Ecohouse:ADesignGuide,ArchitecturalPress,Oxford.

Stevenson,F.andWilliams,N.(2000),SustainableHousingDesignGuideforScotland,TheStationeryOffice,Norwich

Stevenson,F.(2005)Environmentalarchitectureandthehealthbuilding;thematerialityperspective,FourthDoorReview,Nos.7,pp.38-42

Wagenaar,C.(ed.)(2006),TheArchitectureofHospitals,NAiPublishers,Rotterdam

AEDETEvolution:DesignEvaluationToolkit,NHSEstatesDept,Londonhttp://knowledge.nhsestates.gov.uk

ASPECT:StaffandPatientEnvironmentCalibrationToolkit,NHSEstatesDept,Londonhttp://knowledge.nhsestates.gov.uk

NHSEnvironmentalAssessmentTool(NEAT),NHSEstatesDept,Londonhttp://www.dh.gov.uk

8. Bibliography

Appendix 1User Interview Guide

Staff Interview Prompt Sheet for Questions

Interviewer:IamcarryingoutthisinterviewaspartofastudytohelpwithfutureplanninganddesignofMaggieCentres.Theinformationcollectedwillbetreatedascompletelyconfidential.Thefinalreportofthestudywillusesummariesoftheinformationandnotrevealtheidentitiesofanyindividuals.Anynotesontheinterviewwillbedestroyedattheendofthestudy.

Theinterviewwilllastaboutanhouranditwouldbehelpfulifyoucouldanswerasmanyquestionsasyoucan.

A Background Questions:

1. Whatisyourage?

2. Whatisyoursex?

3. Whatisyourhomepostcode?

4. Howdidyougethere?

5. Doyousitnexttoawindowatyournormalworkplace?

6. Howlonghaveyouworkedinthisbuilding?

7. Howmanydaysdoyouspendinthebuildinginanormalweek?

8. Howmanyhoursperdaydoyouspendatyourdeskorinyournormalworkareaonanormalworkingday?

9. Howmanyhoursperdaydoyounormallyspendworkingwithacomputerscreen(VDU)?

B The Building Overall

10.Whatimagedoyoufeelthebuildingprojects?

11.Howwouldyoudescribethelevelsofprivacyitprovides?

prompts-foryourwork-forvisitors

12.Howdoyoufindthelayoutofthebuilding?

prompts-howeasytounderstand-howpractical

13.Howwelldothinkthespaceisusedinthebuildingasawhole?

14.Doesthebuildingasawholemeetyourneeds?

15.Howwouldyoudescribetheviewsinsideofthebuilding?

16.Howwouldyoudescribetheviewsfromtheinsidetotheoutside

ofthebuilding?

17.Whatdoyouthinkofthestoragearrangementsinthebuilding?

prompts-foryourwork

18.Allthingsconsidered,howdoratethebuildingdesignoverall?

C Your Work Requirements

19.Pleasebrieflydescribetheworkthatyoucarryoutinthisbuilding

20.Specificallyforthepurposeofyourwork,howwelldothefacilitiesmeetyourneeds?

21.Canyougiveexamplesofthingswhichcanhindereffectiveworking?

22.Canyougiveexamplesofthingswhichusuallyworkwell?

23.Howdoyouratetheusabilityofthefurnitureprovidedatyourdeskornormalworkarea?

24.Doyouhaveenoughspaceatyourdeskornormalworkarea?

D Comfort

25.Howwouldyoudescribethecomfortconditionsinthebuilding?

prompts:-temperature-airquality

26.Howwouldyoudescribenoiseinthebuilding?

prompts: -noisefromotherpeople-othernoisefrominside-noisefromoutside

27.Howwouldyoudescribethequalityoflightinginthebuilding?

prompts-lightingoverall-naturallight-glarefromsunandsky-artificiallight-glarefromlights

E Personal Control

28.Howmuchcontroldoyoupersonallyhaveoverthefollowingaspectsofthebuildingduringyourvisit?

-heating-cooling-ventilation-lighting-noise

29.Howimportantisittobeabletocontrolthesefactors?

30.Allthingsconsidered,howwouldyouratetheoverallcomfortofthebuildingenvironment?

31.Isyouroverallwellbeingincreasedordecreasedbytheenvironmentalconditionsinthisbuilding?

32.Doyoufeelthatthebuildingaffectsyourhealthbymakingyoufeelmoreorlesshealthy?

33.Doyouthinkyourproductivityatworkisdecreasedorincreasedbytheenvironmentalconditionsinthisbuilding?

34.Anyotherscomments?

Thankyouforagreeingtotakepartinthisinterview,whichshouldtakeabout45minutes.CanIassureyouthatnorecordsoftheinterviewwillbekeptwithyournameonthem.IwillbetapingthisinterviewbutthetapewillbedestroyedonceIhavemadeanonymousnotes.Canyoupleasetrytoanswerallquestionsasfullyasyoucan.

Background:

1.Howoftenhaveyouvisitedthebuilding(onceitwascomplete)

2.Whatwasyourinvolvementwiththebuilding?

Section A: Performance Aspects

3.Howdoyouthinkthedevelopmenthasmeasureduptotheoriginalexpectationsofthebrief?

Probes-layout-useofspace-viewsinside-viewsoutside-flexibility-privacy

Appendix II Technical Interview Guide

Section B: Construction

4.Wasconstructioneasierormoredifficultcomparedtostandardsmallscalepalliativecaredesign?

Probes-structure-superstructure-foundations-services-fittings-finishes

5.Wasconstructionfasterorslowercomparedtostandardsmallscalepalliativecaredesign?

Probes-structure-superstructure-foundations-services-fittings-finishes

6.Werethereanyproblemsduringtheplanningstageofthescheme?

7.Werethereanyproblemsduringtheconstructionstageofthescheme?

8.Werethereanyproblemsduringthedefectsstageofthescheme?

9.Howeasyisthebuildingtomaintainandclean?

Probes-maintenancedifficulties-cleaningdifficulties-lifecyclesformaterials,finishes

10.Whatimprovementswouldyoumaketothebuildingintermsofconstructioninhindsight?

Section C: Heating, Ventilation and Lighting

11.Howisthebuildingmeanttobeheated?

Probes-whenduringday/season-usingwhat

12.Howwellhastheheatingsysteminthebuildingperformed?

Probes-comfortlevels-temperaturesinallseasons-easeofuse-responsiveness-qualityofheat-anyproblems

13.Howisthebuildingmeanttobeventilated?

Probes-whenduringday/season-usingwhat

14.Howwellhastheventilationstrategyinthebuildingperformed?

Probes-comfortlevels-easeofuse-responsiveness-airquality-anyproblems

15.Howisthebuildingmeanttobelit?probes-natural-artificial

16.Howwellhasthelightingstrategyperformed?

17.Howenergyefficientisthebuildinginyourview?

18.Whatimprovementswouldyoumaketotheheating,ventilationorlightinginhindsightifany?

Section D: Flexibility

19.Howflexibleisthebuildinginaccommodatinguserneeds?

probesuseofroomsworkspaceacousticprivacy

20.Howwelldoyouthinkthebuildingcouldaccommodatefutureuserneeds?

probes-storage-disability-growinguse-workspace/IT

21.Whatimprovementswouldyoumaketotheschemeintermsofflexibilityinhindsightifany?

Section E: General

22.Pleasegiveexamplesofthingsaboutthebuildingwhichworkwell?

23.Pleasegiveexamplesofthingsaboutthebuildingwhichhinderitseffectiveoperation?

24.Inonewordwhatimagedoyoufeelthebuildingprojects?

25.Allthingsconsidered,howdoyouratethedesignoverall?

26.Arethereanyothercommentsyou’dliketomake?

Appendix IIIDrawings – plans/sections/elevations

Ground Plan

Section looking North

Section looking North

Appendix III

Appendix IV Benchmarking for fuel costs

Table x: Energy/ C02 Benchmarking for Fuel Costs

Building Type Total Volume M3 Kwh/m2/year CO2/tonnes/m2/year NHS EstatesBenchmark (2001-2010) GJ/m3/year

New buildings 35-55

DundeeMaggie’s Centre 785 286 0.07 29.4

Appendix V Tables

1: User Demographics (Questionnaire)

Parameters Age Over30yrs=97% Under30yrs= 3%

Sex Female=69% Male= 29%

Status Sufferingfromcancer=71% Carer= 29%

Travel mode Car=82% Walk= 9%

Nos. of visits 5timesormore=73% firsttime= 12%

Length of visits Variable 1-2hours= 43%

Rating of health in past week 62%aboveaverage 19%underaverage

Rating of quality of life in past week 56%aboveaverage 10%underaverage

2: Visitor Satisfaction (Questionnaire)

Parameters Criteria Nos. of visitors rating this at top of scale (1-7) image verygood 71%

lastingimpression verygood 68%

layout easytounderstand 53%

spaceuse effectively 41%

meetingmyneeds verywell 52%

viewsinside good 76%

viewstotheoutside good 82%

designoverall satisfactory 70%

3: Purpose of visit (Questionnaire)

Reason stated N Counselling/chat 5

Before / after treatment 2

Women’s group 6

Relaxation group 10

Carer’s group 5 Medical student placement 1

Care of plants 1

Volunteer 1

Collect Information 1

Not ascertained 2

Total 34

4: Specific Needs for Visit (Questionnaire)

Parameters Criteria Nos. of visitors rating this at top of scale (1-7) meetingmyneeds verywell 52%

talkingtoothers verycomfortableto 67%

feelingatease atease 72%

freedomtouse alot 76%thebuilding

Appendix V Tables

6: Personal Control

Parameters Criteria Nos. of visitors rating this at top of scale (1-7) Heating nocontrol 46%

Cooling nocontrol 35%

Ventilation nocontrol 35%

Lighting nocontrol 27%

Noise nocontrol 42%

5: Comfort (Questionnaire)

Parameters Criteria Nos. of visitors rating this at top of scale (1-7) Comfortoverall satisfactory 58%

Noiseoverall satisfactory 58%

Lightingoverall satisfactory 58%

Appendix V Tables

7: Relationship of Features with Health Ratings (Questionnaire)

Self Reported Ratings Scales

Overall* Overall Well being* Health* Health QoL Past week Past week

1st Impression + +++ Lasting Impression † ++

Layout -

Space Use ++ +

Needs +++ +++

Views Inside

Views Outside

Visit Needs +++ +++

Talk to others + +

At ease +++ ++

Freedom of use + +

Overall design +++ +

*highScoreispositiverating†lowscoreispositiveratingblankcellrepresentsnoconsistentrelationshipfound- weaknegativerelationship(p<.1)--moderatenegativerelationship(p<.05)---strongnegativerelationship(p<.01)+ weakpositiverelationship(p<.1)++moderatepositiverelationship(p<.05)+++strongpositiverelationship(p<.01)

Appendix V Tables

8: Self Reported Rating Scales

Well being* Health*

Overall Temperature* + ++ Overall Comfort ++

Noise Overall* +++

Noise from Inside† -- -- Noise from Outside† -

Lighting* Overall + +++

* highScoreispositiverating† lowscoredenotes‘toolittle’noise blankcellrepresentsnoconsistentrelationshipfound- weaknegativerelationship(p<.1)-- moderatenegativerelationship(p<.05)--- strongnegativerelationship(p<.01)+ weakpositiverelationship(p<.1)++ moderatepositiverelationship(p<.05)+++ strongpositiverelationship(p<.01)

9: Self Reported Rating Scales

Control of... Well being* Health*

...Heating + … Cooling ++ +

… Ventilation ++

… Lighting +

… Noise

Appendix V Tables

10: Technical Measurements on 24th March 2006 in Dundee Maggie Centre

Outside Reception Kitchen Main room Upstairs Noise levels dB 9 am 65 52 50 32 31 1 pm 65 62 66 32 45

5 pm 53 62 55 31 31

Lux levels dB 9 am 1200 288 269 187 797 1 pm 900 350 218 209 1900

5 pm 271 314 748 (light) 131 (off) 400

Relative Humidity 9 am n/a 33 31 31 30 1 pm 51 46 31 29 31

5 pm n/a n/a 30 29 31

Temp C 9 am 19.7 21 20.5 21.7 1 pm 11.4 23.3 23.8 24.2 24.4

5 pm n/a 22.8 23.4 23.8 22.5

Appendix V Tables

Outside Reception Kitchen Main room Upstairs

Windows open? 9 am no no yes (1) no 1 pm no yes (1) yes (1) no 5 pm no yes (3) no no jetty door

Other things - draughts, smells etc. no smells/draughts

General Comments: Very sunny all day, little wind, average humidity. Snow melting. Tai Chi class at 1.30 Relaxation class at 3 Benefits advisor in morning Busy in kitchen at lunchtime Building open from 9-5pm. Main room unused in morning, but all other rooms used. Need to check boiler room.

Appendix V Tables

11: Variables better than BUS benchmark

Air in Winter: fresh/stuffy

Comfort: overall

Design:

Health (perceived):

Image to visitors:

Lighting: artificiallight,glarefromlights,overall

Needs:

Noise: overall,noisefromotherpeople

Space in the building:

Temperature: overall

Summary: Variables no different from BUS benchmark

Air in Winter: dry/humid Controlovercooling,heating,lighting,noise,ventilation

Lighting: glarefromsunandsky

Noise: othernoisefrominside,noisefromoutside

Temperature: hot/cold,stable/varies

Summary: Variables worse than BUS benchmark

Air in Winter: still/draughty

Lighting: naturallight

Appendix V Tables

12: Heating costs and CO2 emissions

Heating Period Cost Units Energy, CO2 and Carbon Emissions

Oct–Dec2005 Electricity£525 4084 ThesewerecalculatedusingtheEnergy SavingTrust“energycalculator”at

www.est.org.uk

Oct–Dec2005 Gas£320 1357Jan–March2006 Electricity£679 5347

Jan–March2006 Gas£456 1858

April–Sept2006 Electricity£1048 7261April–Sept2006 Gas£281 1003Totalsforyear Electricity£2252 16692 Gas£1057 4218

kwh/pa Electricity 16692kwh 7044kgCO2/pa (1kwh/unit) (60GJ)

Gas 47705kwh 9254kgCO2/pa (11.31kwh/unit) (172GJ) (1kwh=0.0036GJ)Total overall £3309/pa 232GJ/pa 16.3tonnesCO2/paenergy cost and (£64p.w.) 64397kwh/paCO2 emissions/pa

Total carbon 4.4tonnescarbon/paemissions/pa (0.019 tonnes carbon/sq.m/pa)

Overall energy £15/sq.m 1.03GJ/sq.m 0.07tonnesCO2/sq.m/pacostand CO2 (225sq.mtotal (286kwh/sq.m)emissions/pa/sq.m floorarea) Government energy target 225x3.5m Target =35-55GJ/100cu.mfor new build in NHS Estate av.height=(2001-10) 787.5cu.m Actual =232GJ/7.87 =29.4GJ/100cu.m

Appendix V Tables

13: Distilled Parameters for Evaluating Sustainable Construction15

Principle Parameters Factors to consider

1.DesignforEffectiveResourceUse Wasteminimisationinproduction, recyclingandlandfill Conservenon-renewableresources Minimisingrateofuseof renewableresources Designforleanconstruction,repair,re- use,flexibilityanddeconstruction Re-useandimproveexisting builtassets Designwithclimate/microclimate Designforsoilretention 2.MinimisingPollution Minimiseair,waterandlandpollution inrelationtobuildinguseanddesign specification Relateland-useplanningtotransport infrastructureandstrategy Locateappropriately Minimiselightpollution LifeCyclestudies Wasteminimisationandtreatment

3.RespectforPeople,Communities, Designquality andLocalEnvironmen Benefitinglocaleconomyandecology MinimiseFuelpoverty Access/Safetyissues

4.PromotingBiodiversity Globalecologyandproductionof materialsandcomponents Habitatcreationandconservation Waterfeatures/SUDS Locatebuildingsappropriately(local) Preserveandenhanceexisting localbiodiversity

5.CreatingHealthyEnvironments Optimisehumiditylevels Minimisetoxicity Indoorairquality Optimisenaturalventilation Optimiselightquality Optimisepersonalcontrol ofenvironment

6.ManagingtheBuildProcess Contractorrequirements (sustainableconst.) Futureproofing–legislation CriticalPath,toolsandbenchmarks Logbooks Pre-andPostOccupancyEvaluation

Appendix V Tables

15Halliday,S.P.,Stevenson,F.(2004)SustainableConstructionandtheRegulatoryFramework:AThinkpiece,GaiaResearch,Edinburgh

Appendix VIArchitectural brief

Suggestions towards requirements

Appendix VIArchitectural brief

Appendix VIArchitectural brief