For queries on the status of this document contact info@whe.wales.nhs.uk or telephone 029 2031 5512

Status Note amended March 2013

IMPROVING THE PATIENT EXPERIENCE

Welcoming entrances and reception areas

2004

STATUS IN WALES

INFORMATION

Improvingthe patientexperience

Welcomingentrances and receptionareas

With the biggest building programme inthe NHS under way, designing healthcarefacilities that positively enhance thepatients’ experience and treatment iscentral to our policy. This meansaddressing such issues as privacy anddignity, communication, entertainment,nutrition, cleanliness, comfort, controland the supply of information. To meetthe standards expected by today’s - andtomorrow’s - patients, we need to ensurethat the design of hospitals and healthcarefacilities embodies sound principles fromthe outset.

‘Improving the Patient Experience’ isa series of publications designed tostimulate and inspire all those involvedin designing, procuring, developing andmaintaining healthcare buildings to lookfor new and inventive ways to improvethe environments for patients and staffalike. They contain best practice casestudies, advice and guidance on howbest to implement and manageprogrammes for change in both newbuildings and areas for refurbishment. It isnot expected that the principles outlinedshould be applied retrospectively toexisitng stock.

Other titles currently in development are:

• Friendly healthcare environments forchildren and young people

• The art of good health

• Cleanliness in hospitals

• Food service at ward level

• Ward layouts with privacy and dignity

Improvingthe patientexperience

Welcomingentrances and receptionareas

London: TSO

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© Crown copyright 2004

Published with the permission of NHS Estates, an Executive Agency of the Department of Health, on behalf of the Controller of Her Majesty’s Stationery Office.

Applications for reproduction should be made in writing to:

The Copyright Unit,Her Majesty’s Stationery Office,St Clements House,2–16 Colegate,Norwich NR3 1BQ.

ISBN 0-11-322485-0

First published 2004

Printed in the United Kingdom for The Stationery Office

Cover photographs: Main: Royal Berkshire & Battle Hospital

Inset: Hillingdon Hospital

Reverse: Hove Polyclinic

This guidance has been authorised by the Department of HealthGateway number: 2415

Queen Elizabeth Hospital, Gateshead

Executive summary

‘Welcoming entrances and reception areas’ provides best practiceguidance on how to enhance the experience of those visiting acuteand community hospitals – from the point at which they approachthe hospital site and building entrance, to their first impressions ofthe inside of the building (the entrance and reception area itself*). It is aimed at directors of facilities, designers, architects and projectmanagers.

As well as offering advice on how to make the design of theentrance and reception area both functional and aestheticallypleasing, this document describes the basic facilities that should beassociated with this area to meet the needs of patients, visitors andstaff. It also suggests additional facilities that may be provided tofurther enhance users’ enjoyment of the area.

It suggests the same principles are applied to external areas of ahospital site – through the implementation of well-designed andmaintained hard and soft landscaping.

This document stresses the importance of employing friendly,professional staff – including the use of volunteer teams – at theentrance and reception area to meet, greet and assist patients andvisitors, and to ensure the entrance and reception area is kept cleanand tidy.

It also emphasises the impact that an effective wayfinding strategyand signage system has in reducing stress levels among patientsand visitors and the positive contribution this makes to their overallexperience of visiting a hospital.

The principles outlined in this document should be applied to newbuildings and areas for refurbishment. It is not expected that theyshould be applied retrospectively to existing stock.

* Many hospitals have several different entrances (for example out-patients, rehabilitation,day care etc) even though only one is known as the “main entrance”. The principlesoutlined in this document apply equally to all public entrances.

Acknowledgements

NHS Estates gratefully acknowledges allcontributions to this publication, withparticular thanks to the following:

Bill Davidson, representative of PatientFood Group

Pauline Mason, sister (out-patientsdepartment), Seacroft Hospital, Leeds

David Preece, hotel services manager,Nottingham City Hospital

Peter Scher, architect and freelancejournalist

Addenbrookes Hospital, Cambridge

Conquest Hospital, Hastings

Hillingdon Hospital, Uxbridge

Homerton Hospital, London

Lambeth Community Care Centre & MinnieKidd House, London

Leeds General Infirmary

Norfolk & Norwich University Hospital

Northampton General Hospital

Nottingham City Hospital

Royal Bolton Hospital

Royal Oldham Hospital

Royal Preston Hospital

University Hospital Lewisham, LondonWaiting area at Royal Bolton Hospital

Contents

1 Improving the patient environment2

2 Scope 4

3 The user’s journey 6

The approach to the site

The approach to the building

Transition – from outside to inside thehospital

The way in

The draught lobby

The reception area

Onwards

Waiting

Associated facilities

The way out

4 Operational management 18

Staffing

Cleaning and maintenance

Other housekeeping issues

Monitoring, evaluation and survey

Closure of the main entrance

5 Wayfinding 22

Signage system

Essential facilities

Unauthorised, ad hoc and temporarydirection signs

Controls and prohibitions

6 Information 26

Essential information

Information at reception

Other information

7 Food and refreshments and otherretail services 28

Cafeteria/lounge

Retail services

Mobile and temporary activities

8 Interior design, lighting and seating32

Lighting

Seating

Reception desk

Storage

Smoking

Retail and temporary facilities

9 Hard and soft landscaping, externallighting 38

Hard and soft landscaping

Parking

External lighting

Temporary works

10 Art projects 42

Funding, professional input andparticipation

Landmarks

Heritage and history

Entrance areas

TV, video and broadcast sound

Performances

Appendix I: References 46

1

The Government’s vision of the NHS – asoutlined in the NHS Plan – is for a patient-focused service that treats patients andstaff as individuals.

The realisation of such a vision willencourage:

1. patients to feel confident andreassured that they will receive aconsistent, high-quality level of individualcare;

2. staff to feel valued;

3. society to recognise that the NHS isbeing modernised.

People judge the NHS by the quality of itsstaff – clinical and non-clinical – and itsbuildings. A well-designed healthcarebuilding, run by well-trained staff, will reducestress levels in patients, visitors and staffand will enhance their experiences andperceptions of the NHS.

A good environment is well-functioning,safe, warm, attractive and welcoming. Allhealthcare buildings need to meet theserequirements if they are to meet the

Government’s vision of an NHS fit for the21st century.

The entrance and reception area is the firstaspect of a hospital building that most usersencounter and is also the natural hub of the hospital. It is particularly important,therefore, that it is both functional andaesthetically pleasing. Whilst the design ofthis area will play a vital part in ensuringpatients feel welcome, the availability ofprofessional, friendly staff to meet, greet andassist patients and visitors is even moreimportant.

The entrance and reception area isassociated with the following:

• arrivals and departures (for many differentdepartments);

• waiting;

• meeting and socialising;

• obtaining information and assistance.

When all these functions are deliveredeffectively they contribute significantly to theuser’s whole experience of hospital care.

2

Improving the patientenvironment1

3

Main entrance at Darent Valley Hospital

Welcome flooring, Hillingdon Hospital

This document provides best practiceguidance on how to enhance users’experiences of visiting acute and communityhospitals, including PFI schemes – from thepoint at which they approach the hospitalsite and building entrance, to their firstimpressions of the inside of the building (theentrance and reception area itself). It isaimed at directors of facilities, designers,architects and project managers.

Note: “Users” include patients, visitors andstaff arriving by ambulance, public or privatetransport or on foot. Some will use walkingaids or wheelchairs; others will be ontrolleys. Some will have physicalimpairments and/or difficulties reading orspeaking English. Some will be lost.]

Many hospitals have several differententrances (for example out-patients,

rehabilitation, day care etc) even thoughonly one is known as the “main entrance”.The principles outlined in this documentapply equally to all public entrances.

Section 3 describes the user’s journey, fromtheir approach to the site to the entranceand reception area. Following sectionsconsider specific issues in more detail. Eachissue is related to the quality of the physical,operational and social environment in:

1. large acute hospitals;

2. smaller acute hospitals includingspecialist hospitals;

3. community hospitals.

See Appendix I for additional NHS guidanceon detailed aspects of hospital entrance andreception areas.

4

Scope2

5

Main entrance at Royal Bolton Hospital

The way in which hospitals and theirsurroundings are maintained will create animmediate impression on users, especiallyfirst-time users. A negative initial experienceis unlikely to be forgotten even if,subsequently, other elements make a betterimpression. Users may judge the quality ofclinical care on the basis of a hospital’sappearance so it is essential that hospitalsites are well and attractively maintained.

The approach to the site

If there is more than one way onto thehospital site, clear directions to the mainentrance should be immediately obvious ateach site entrance. Separate signs shouldbe provided for drivers and those on foot.Both should express welcome in theirdesign and wording. Getting lost orconfused, or having to ask directions orretrace a path is not a good experience inpreparation for a hospital visit.

Hospitals that have a number of entrancesshould aim to avoid confusion among users.Patients with appointments should receiveclear written instructions, before visiting thehospital, over which entrance to use.

Prohibition notices about routes andparking, with threats of penalties for non-compliance, communicate the very oppositeof welcome and add to the stress of visitinga hospital. Such notices should only be

used where absolutely vital and in caseswhere penalties will be applied (that is, notmerely as scare tactics). Signs should makeclear that non-compliance will be monitoredand penalties enforced.

A significant architectural feature or artworkthat is visible from a distance in severaldirections can become a memorablelandmark for orientation and judgingdistance. However, its meaning should notbe unexplained or obscure.

It may be necessary to form a covered wayor some other form of shelter from the siteentrance to the building entrance for thoseon foot, especially on a very exposed site.Landscape features, including shrubs andtrees, may also be used to enhance theapproach.

The approach to the building

Ideally, the main entrance should beidentifiable as soon as the front of thebuilding comes into view. At an urban sitethis is likely to be indicated by a prominentand permanent architectural feature; in asuburban or country setting an avenue oftrees may indicate the way.

The route to the main entrance should alsobe identifiable as soon as the front of thebuilding comes into view and should be wellsignposted, especially for drivers. When the

6

The user’s journey3

7

main entrance is not in sight, clearsignposting should indicate the directionand distance to the entrance.

Clear signage, appropriate for pedestrians,from parking areas to the main entrance isessential.

A pedestrian crossing, controlled whereappropriate, should be used where awalkway crosses a road within the site.Clear signs are essential, advising drivers togive priority to those crossing.

Transition – from outside toinside the hospital

The transition from outside to inside thebuilding should be simple and convenient.

The space outside the main entrance is not“no man’s land” but an area of keysignificance. Its design should take intoaccount a large range of functions and itshould be a specific operationalresponsibility to maintain the space properly24 hours a day.

A covered “set down and pick up” area forvehicles should be provided close to themain entrance. The area should not beimmediately in front of the main entrance asthis will obscure key views of the entranceand signs for other users. Once passengershave entered the hospital in safety andcomfort, authorised staff should ensurevehicles are driven away.

A secure cycle stand should also beprovided reasonably near to the entrance.

The distinctive and prominent entrance atBirmingham Children’s Hospital

(Architect Powell Moya Ltd; photographer David Grandorge)

The “set down and pick up” area should besufficient for the maximum number ofvehicles at any one time.

Special considerations will apply todesignated parking areas at the entrance fordisabled badge holders and, whereappropriate, for those with babies andtoddlers.

The size and layout of the area outside themain entrance should be appropriate for thepeak number of users (including those onfoot and those who have parked vehicles incar parks) to come and go conveniently andwithout congestion.

An estimate of the number of users enteringand leaving the main entrance – and theirmode of transport – should ensure this isthe case and will also inform operationalmanagement.

The design of the main entrance shouldinclude a canopy or other form of shelter.The area it covers will vary depending onlocal circumstances. A roof or canopy ofstorey height is the minimum requirement.

The way in

The doors of the main entrance should befully glazed (down to floor level) and, wherepossible, have fully-glazed fixed panelsbeside them to enable users to see throughthem from either side. Here users will gaintheir all-important first impression of theinside of the hospital, which should be awelcoming one.

It is important that large glazed areas areclearly identified as such for safetypurposes, without obscuring the line ofsight. Safety glass in windows and doorsmust be to BS 6206 standards (BritishStandards Institution 1981).

The size and number of doors should besufficient for the expected number of usersto pass comfortably and safely throughthem, without delay or congestion.

Where conventional side-hung doors areused, they should open both inwards andoutwards. Automatic sliding doors andrevolving doors, suitably large, may also beappropriate, but the latter may cause

8

THE USER’S JOURNEY

The road layout and short-stay parking at Conquest Hospital’smain entrance creates an efficient and convenient drop-off zone

The memorable and eye-catching canopy at Homerton Hospital’s main entrance

distress to some users, especially the frailand anxious and those in wheelchairs orwith pushchairs. If revolving doors are used,side-hung doors should also be available.

The draught lobby

The space immediately inside the entrancedoors – the draught lobby – provides theuser with their first experience of the interiorof the hospital. The transition from outsideto inside the draught lobby should not betoo abrupt (for example, changes in airtemperature and lighting intensity should notbe too great).

The prime function of the draught lobby isto control loss of heat from the building andprevent wind and rain from entering. Inexceptionally exposed locations, a secondset of doors is provided to form a modifyingdraught lobby. These should be fully glazed.

The lobby enclosure needs to be fullyglazed to enable users to proceed safelyand confidently.

The lobby area should have absorbent anddirt-retaining flooring, over a sufficientlylarge area, to minimise damp and dirt beingtaken into the hospital.

The size and shape of the lobby should:

• allow the smooth flow of users into andout of the building;

• allow for the fact that users maycongregate there;

• ensure that by the time the second doorsare reached, the first are closed;

• provide a “modifying” environmentbetween the outside and inside of thehospital.

If other facilities are provided within thedraught lobby, such as seats andpayphones, they should not obstruct thepassage of users.

Where revolving doors are used, a draughtlobby is not necessary as revolving doorsare more effective in keeping the buildingsealed from adverse weather.

The reception area

Once inside the building the various userswill proceed in different directions. Thosewho have visited the hospital before may gostraight to their required destination. Others,including newcomers, will go to the mainreception desk. The main reception area is,therefore, an all-important place. Hospitalsthat have multiple receptions should ensureusers are directed to the appropriate one.

The reception area should be comfortablywarm, well lit and free from unwelcomesmells. It may be very busy at times butshould be sufficiently spacious never to becrowded or excessively noisy. The size ofthe reception area and facilities in this areashould cater for the peak number of usersand their requirements. All elements of thereception area should reflect the needs ofusers and communicate a welcomingmessage.

Information will be available from a staffed-reception base. Toilets, facilities for nappy-changing, bottle-feeding and breast-feeding(of infants), seating and a water dispensershould all be immediately obvious andlocated reasonably close to the receptionarea.

The most important feature of the receptionarea is the reception desk. This should beimmediately recognisable and not placed soclose to the entrance doors as to interferewith the flow of people. An open counter,with a feature or sign at high level, is ideal.A clock should be plainly visible at the desk.The size of the desk and the number of staffmanning it should be appropriate for peakusage so that any waiting is brief andqueues never form.

Able, approachable and experienced stafflocated at the reception desk – rather thaninside an office or behind glass – will beable to welcome, direct and give generalinformation. For hesitant, anxious,vulnerable patients – some of whom mayhave difficulties with mobility, language,vision or hearing – this is the most importantelement of their arrival. Reception staff

10

THE USER’S JOURNEY

The light and airy draught lobby at Birmingham Children’s Hospital(Architect Powell Moya Ltd; photographer David Grandorge)

Norfolk & Norwich (N&N) University Hospitalis a brand new PFI hospital. It opened inJanuary 2002, although some areas are yetto be completed.

Like the older hospital that it has replaced,N&N has multiple entrances rather thanone main entrance. The decision toincorporate multiple entrances into the newbuilding was based on the fact that theaverage age of patients being seen in theold hospital was over 70 and, therefore, itwas felt to be important to ensure patientswould be able to park close to theparticular area of the hospital that theywould be visiting.

Although the vast majority of patients arrivein cars or ambulances and there is aregular bus service from town, the fact thatthe new hospital is further out of town hasproved unpopular with some.

A key difference with the new building isthat all reception desks are manned – afactor that has proved very important to thesuccess of the scheme.

Approach to the site

The hospital is extremely well signpostedfrom the local road network. On arrival atthe main hospital roundabout there aremultiple signs to direct users to differentdepartments. This signage is clear andeasy to use.

Patients with appointments are sentinformation, prior to their arrival, on whereto park and which entrance to use. Thisinformation is due to change shortlyfollowing feedback that the system doesnot always work successfully. The externalsigns are also being replaced using largersigns with reflective lettering to helpwayfinding at night.

The site has ample car parking. However,some of the paths from the car park to thehospital are too narrow for wheelchairusers.

There are smoking shelters outside someentrances.

Although limited, external landscaping isattractive.

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THE USER’S JOURNEY

Example of a hospital with multiple entrances: Norfolk & Norwich UniversityHospital

13

“Atrium” entrances

Two atria cut through the hospital anddivide it into three sections – east, westand central. These atria then form four‘main’ entrances, two on each side of thehospital.

One atrium contains the hospital restaurant,the other contains the Women’s RoyalVoluntary Service (WRVS) shop.

The entrances to these areas (located atthe back of the hospital) are completelyglazed, making them light and airy. Theyare, however, mostly white and rathersterile. This is being addressed through theaddition of artwork (e.g. the addition ofstained glass, taken from the old hospital).

Both these entrances are spacious andallow free movement of people.

Reception desks in these areas are low andwelcoming, but may not be practical forreception staff as there is little or nostorage space, and little security.

The restaurant is well-stocked andpleasant, and the seating area is large andcomfortable. The only other seating in thisatrium is next to the windows. This is cleanand comfortable and offers a good view,but is laid out in regimented lines.

The two “main” entrances at the front ofthe hospital (near the public transport) arein fact smaller than the other “main”entrances. The draught lobbies in theseentrances are small, and the doors are notautomatic.

At the time of writing this report buildingwork was still under way directly in front ofthese two front entrances, which made itimpossible to judge their effectiveness.

Entrances to out-patients’ units

Work is under way to extend the retail andcatering facilities in the reception areas tothe out-patients’ units.

At the moment there is only a small WRVSsnack bar at both entrances. Seating iscomfortable and includes dining tables.

The overall ambience of the areas is verypleasant and comfortable, and will beimproved further when the building work isfinished.

Entrance to “day attendance unit”

The entrance to this unit is to the centre ofthe front of the hospital, directly underneaththe hospital sign. This suggests it is themain entrance to the hospital, and is in factreferred to as such by taxi drivers etc.

The day attendance unit is not linked to themain hospital, and signs on the door informpeople of this fact. However, anxiouspatients or visitors do not always noticethis, and as a result many people enter thisdoor by mistake and have to be directedelsewhere.

This may be due to the fact that the othertwo “main” entrances on this side of thebuilding are currently obscured by buildingwork. This will not be the case in a fewmonths time when building work iscomplete.

The reception area of this unit is verypleasant, with well arranged, comfortableseating, small tables, up-to-date magazinesand a welcoming, semi-circular receptiondesk.

Conclusion

One of the main issues for the Trust seemsto be how directional information iscommunicated to patients prior to theirarrival. When an appropriate solution isfound to this problem then the correct useof the entrances should be facilitated.

At the moment, the hospital is notsufficiently complete to conclude that itsentrances are “welcoming”. However, wecan conclude that the multiple entrancesystem is a viable alternative to one mainentrance, providing sufficient patientinformation and wayfinding systems are inplace to support it.

3

should have a clear view of the entrancedoors so that they can see people enteringand anticipate their needs by offeringassistance.

Those who are able to proceed unassistedshould be able to obtain clear directions. Insome cases, users may be directed to otherdepartmental reception bases or “Help”desks nearby. It is important that theseshould not, through their location or design,be confused with or take precedence overthe hospital’s main reception desk.

Teams of volunteers are a great asset andcan transform users’ experiences of ahospital. They can be used to meet andgreet patients at the door and ensure thatthey are made welcome. They can direct oraccompany people to the relevant part ofthe hospital, and can provide wheelchairs orspecific information.

The management of the volunteer teamsshould be the responsibility of a senior trustmanager to ensure they are deployedeffectively at points of greatest need.

To deal with enquiries staff at the receptiondesk need immediate access to information

sources (for example telephones, computerterminals, directories etc) without losingvisual contact with users. Staff should alsobe able to come round to the front of thedesk to assist some users.

Reception staff should be able to receiveletters etc, delivered by hand, and arrangefor their internal delivery.

In emergencies reception staff should haveimmediate access to and support fromsecurity personnel.

Onwards

Wayfinding signs in the entrance andreception area should reflect the hospital’soverall wayfinding strategy. For detailedguidance on wayfinding, please refer to‘Wayfinding’, NHS Estates 1999.

From the reception area, any verbaldirections should be quite limited, forexample to the left or the right, or followthat clear route, or to the lifts. Beyond thesedirections, the route should be made clearby means of uncomplicated signs. Whereroutes meet, users should not be presented

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THE USER’S JOURNEY

A redesigned main reception area atConquest Hospital in Hastings, encouragedthe associate director of facilities and theteam to introduce a “meet and greet”service at the front entrance to providevisitors with an immediate point of contactfor help and advice.

A full time member of staff manages thisfunction, and a rota of volunteers deliversthe service. The hospital has over 300volunteers to call upon, and aims to provide the meet and greet service from8:30–20:00 Monday–Friday and 14:00–17:00 Saturday–Sunday.

When a visitor or patient comes throughthe front door, a member of the meet andgreet team (wearing a coloured tabard witha logo) approaches them, and asks if theyneed any assistance.

Many people are directed to the mainreception desk to be dealt with by thereception and appointments team. Somemay need directions to areas in thehospital, and for those who are uncertain oranxious, the volunteers offer to accompanythe visitor or patient to their destination.Others may need to access a wheelchairfor a relative in a car outside. For some, thevery act of being welcomed will be enoughto make them feel more comfortable.

The benefit of this service is that everyonewho enters the hospital is greeted with asmile and an offer of assistance, whichhelps to alleviate the frequent stress, nervesand anxiety that for many people areassociated with hospitals.

Good practice example of volunteer services: Conquest Hospital, Hastings

15

with more than three choices. Users shouldbe able to see the first place to which theyare given directions.

Displayed plans or “you-are-here” maps andlists or directories of departments are usefulto a limited degree but hospitals should notrely on this method alone for wayfindingpurposes.

On long or complex routes users needfrequent signs reassuring them that they areon the right track. If they have taken thewrong route, signs should make this quicklyapparent to allow them to retrace their stepsand take the correct route.

Waiting

Some users will need, or wish, to wait in thereception area. A specific seating areashould be provided for this purpose, nearbyand within sight of the reception desk. Itsposition should not hinder the flow of usersto and from the reception desk. Visual

contact with reception staff is essential aspeople requested to wait need continuousreassurance that they have not beenforgotten. Non-verbal contact with receptionstaff is important for the deaf and those withpartial hearing who may lip-read. A clockshould also be plainly in view.

Others users will be waiting to meet othersor for transport to arrive. Instead of needingto see the reception desk, these users willneed a clear view of the entrance doorsand, through the glazing, of the transitionspace in front of the hospital’s mainentrance. In larger and busier hospitals thiswaiting area will be separate from that forusers waiting by request of reception staff.

Part of the waiting area may be designatedand appropriately designed for patients atdischarge and/or awaiting booked transport.Reception staff will monitor these patients toensure that they are met without difficulty ordelay.

3Homerton Hospital has a light and spaciousmain reception area encompassing a smartcoffee shop and newsagent and well-organised outlet offering patient informationservices (including Patient AdvocacyLiaison Service).

Large windows to the front of the buildingprovide lots of natural light and aid peoplewaiting for transport. A glass roof providesadditional light, together with attractive“downlighting” in the coffee shop andabove the reception desk.

On entering the area through the draughtlobby, the reception desk is immediatelynoticeable on the left-hand wall. Colouredglass bricks behind the receptionist and asemi-circular reception desk both help tocreate a welcoming effect. The desk has alowered section for wheelchair users andan accurate clock is on display.

Franchises were chosen for both the coffeeshop and the newsagent. A Café Rittazza islocated immediately ahead and to the rightof the main entrance, while a United Newsshop is straight ahead.

The lease period for both shops is sevenyears, with rents based on turnover (with aguaranteed minimum rent) and index-linked. Utilities are metered and servicecharges are based on space occupied.Café Rittazza has 44 seats inside and 24seats on the courtyard outside.

Each tenant was provided with a shell andwas responsible for their own shop-fit.

Plants and artwork enhance theappearance of the overall area.

Other noticeable features include afreephone taxi service and effective signageusing pictorial, multi-lingual and aural signs.

Good practice example of a reception area and franchised facilities: Homerton Hospital, London

Associated facilities

A number of different facilities may beassociated with the entrance and receptionarea. The following are considered essential:

• toilets;

• nappy-changing, breast-feeding and well-equipped bottle-feeding facilities;

• phones (including internal and publicphones, text phones for deaf users, and afree phone for taxis) and informationdisplays (health information, notices ofevents, access and travel information,local advertising);

• a cafeteria/lounge offering refreshments;

• an outlet for purchasing magazines,stamps, phonecards etc;

• parking ticket/change machine;

• a water dispenser;

• a card dispenser for bedsidecommunication services (TV andtelephone).

Many other facilities, some permanent,some temporary, may also be desirable. Thelarger the hospital and the greater thenumber of users the greater the number,size and scale of associated facilities. Suchfacilities can greatly enhance the user’sexperience of visiting a hospital.

Where these facilities are located within theentrance and reception area, their locationand design should not make entering thehospital more difficult.

More extensive facilities may include thefollowing:

• provision for the Patient Advice andLiaison Service (PALS);

• restaurants (including take-aways);

• shops (selling flowers, magazines andnewspapers, greeting cards, stationery,books, confectionery etc);

• art exhibitions, displays andperformances;

• fund-raising and support bases forvolunteers, Friends of the Hospital andpatient groups;

• recruitment facilities for NHS staff andvolunteers;

• occasional special events such as opendays and anniversary celebrations;

• a postal collection, by arrangement withthe Post Office.

Not every hospital will consider all thesefacilities or group them together. In largehospitals, the provision of sufficient space ina concourse, or a suitably-designedenlargement of the hospital street or maincorridor, will greatly enhance both the user’sexperience of the hospital and the hospital’slocal reputation.

A separate concourse near the entranceand reception area is the most convenientand effective option for locating extensivefacilities. The provision of these facilities issecondary to the hospital’s main functions;the design and operation of the concourseshould reflect this and avoid imitating ashopping mall, art gallery or music venue.

In smaller hospitals, associated facilities willnot be part of a separate space but willoccupy accommodation in, or next to, theentrance and reception area. Such facilitiescan be convenient and attractive withoutdominating the hospital or interfering withusers as they enter the hospital.

The way out

The main entrance is also, of course, themain exit; with about the same number ofpeople leaving as arriving (via all the areasdescribed above). It is important to ensurethat those leaving neither impede, nor areimpeded by, those arriving, and that waitingspaces and toilet facilities are sufficient forthe total number of users.

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17

3

Oasis reception area, Derbyshire Children’s Hospital.Designers: Trent Architecture and Design Limited.Interior designers: Potter and Holmes

Courtesy of Graham Gaunt Photography

The operational management of theentrance and reception area should usuallybe the responsibility of one designatedsenior manager, accountable directly to theboard nominee for the patient environment.It is important to ensure that this extends toall parts of the entrance and reception area,including external areas.

Staffing

Staff have by far the most significant effecton patients’ and visitors’ experiences ofhospitals. It is important that those staffingthe entrance and reception area areprofessional, friendly and competent tocarry out their tasks.

Many volunteers, as individuals or fromorganisations such as WRVS, Friends of the Hospital or local groups, makesignificant contributions to the smoothoperation of entrance and receptionservices. By meeting and greeting thoseentering the hospital, in guiding them towards and other departments, in staffingrefreshment, information and retail facilities,they may contribute significantly to patients’and visitors’ experiences of hospitals.

Volunteer teams should be under thedirection of a senior manager to ensure themost effective use of their time and skills.

Staff and volunteers may carry out varioustasks at the entrance and reception areaincluding:

• assisting drivers with setting-down andpicking-up patients and parking outsidethe entrance;

• assisting patients on trolleys and inwheelchairs;

• helping with luggage;

• acting as translators;

• liaising with ambulance staff;

• staffing associated facilities (see section 7).

As well as being competent to carry outtheir jobs, staff and volunteers should befriendly and welcoming to patients andvisitors at all times. This means they require:

• training, briefing, back-up and support atpeak times;

• provision of uniforms and name badges tocreate a professional and approachableimage;

• the ability to deal immediately withindividuals’ difficulties and complaints orrefer to the designated senior manager;

• the ability to follow hospital procedures foremergencies, security, fire and fire drill,especially evacuation procedures forentrance and reception areas.

Cleaning and maintenance

The appearance of a hospital will make animmediate impression on users. If the

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Operational management4

19

hospital is dirty, users will assume it isuncared for and that, in turn, the care theyreceive may not be of a high standard. Thedesignated manager should ensure that theentrance and reception area (including theoutside area) is kept clean and in gooddecorative and working order.

Other housekeeping issues

As well as overseeing maintenance andcleaning tasks, the designated managershould ensure that the entrance andreception area is kept neat and tidy.

Monitoring, evaluation andsurvey

To maintain high standards the designatedmanager should monitor staff and patientsand make changes where necessary.

Closure of the main entrance

NHS hospital services are provided 24hours a day. Users may, therefore, need touse the main entrance at any time.

If the main entrance is to be closed eitherregularly, at less busy times (for example

during part of the night, weekends,holidays), or temporarily, wherecircumstances require it, an alternativeshould be provided. The alternative entranceshould meet all the requirements describedin section 3, although the scale and rangeof facilities provided may be much reduced.

Clear signs and guidance should beprovided to indicate the alternative entrance.In addition to providing signs outside thebuilding, it is important to inform thoseinside of the times of closure of the mainentrance and of the alternative entrance touse.

Large acute hospitals

Large acute hospitals may comprise severaldifferent buildings. Larger buildings are alsolikely to have several entrances. Theprinciples outlined in this document applywhether there is one main entrance or anumber of “main entrances”.

The operational management of all publicentrances to a hospital, excluding the A&Edepartment, should be the responsibility of one designated senior manager.Consideration should be given to extendingthis area of responsibility to include thegeneral circulation, including lifts and stairs

The concierge at Royal Preston Hospital directs andassists patients, visitors and staff

and, externally, between separate hospitalbuildings. This would eliminate areas of “no man's land”, outside departmentalresponsibility, where good housekeepingmay be neglected.

Smaller acute hospitals includingspecialist hospitals

Smaller acute hospitals may have more thanone public entrance. For these, too, it isrecommended that a designated seniormanager is responsible for the operationalmanagement of all entrance and receptionareas, including the general circulation.

Patients of specialist hospitals may needfacilities at the entrance and reception area

that differ in some way to those for generalacute hospitals (for example maternity,women and children’s hospitals, eyehospitals, burns). Specialist hospitals shouldensure entrance and reception facilitiesmeet the needs of their patients.

Community hospitals

Most community hospitals are quite small insize and service provision and all elementsof the entrance and reception area will beappropriately small in scale. For the majority,the operational management of the entranceand reception area will be included withinthe administration function of the hospital.

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OPERATIONAL MANAGEMENT

University Hospital Lewisham has a lightand spacious main reception areaencompassing a smart coffee shop and anewsagent.

Large windows to the front of the buildingprovide lots of natural light and aid peoplewaiting for transport. This is complementedby attractive “downlighting” in the coffeeshop and above the reception desk, and“uplighting” in the roof area.

A high ceiling with visible rafters and tiledflooring adds to the aesthetic quality of thespace.

A large semi-circular reception desk isimmediately noticeable on entering themain entrance. The desk features boldcolourways of red and blue. It has alowered section for wheelchair users and isfitted with an induction loop. An accurateclock is on display.

Neatly-kept information leaflets and thepresence of plants create an impression ofa well-maintained reception area. This islargely due to the presence of the“telephone manager”, who takes ownershipof the area and ensures it is kept clean andtidy.

Toilets are located straight ahead of themain entrance and are immediatelyobvious.

Other facilities within the entrance/receptionarea include pay phones, a water fountain,litter bins and a post box.

A security camera and CCTV providereassurance to staff and visitors that thearea is being monitored.

Artwork further enhances the appearanceof the overall area.

Good practice example of “ownership” of a reception area: University HospitalLewisham, London

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4

Royal Bolton Hospital: new reception area

Wayfinding is of great importance for userson a first visit to a hospital. It is alsoimportant for users who may havedifficulties even after a first visit, for reasonsof frailty, impairment of vision or for otherreasons.

Wayfinding systems alone cannot eliminateproblems if the hospital site and circulationroutes have become complicated (forexample, there are separate buildings andentrances, long distances to traverse, andentrances on more than one level).

Other difficulties that need to be recognisedinclude users who may not wish to ask theway when “lost”, and those entering thehospital by the “wrong” door and needingdirections to the main entrance andreception area. Such users should receive asympathetic response from all staff.

Signage system

Signs are needed in any building with morethan a few users. They are needed toprovide information, for wayfinding, firesafety etc. They should use a system ofdesign, wording and placement that isunified, clear and consistent.

For further guidance on wayfinding refer to‘Wayfinding’, NHS Estates 1999. Althoughthis guidance provides a thorough andsystematic procedure for creating awayfinding system for an individual hospital,it is recommended that for most major

schemes professional design services areused.

Essential signage

Signs are needed in the entrance andreception area to indicate the following:

• toilets;

• nappy-changing, breast-feeding andbottle-warming facilities;

• telephones;

• the hospital’s smoking policy andprovision;

• cafeteria/lounge facilities (including 24-hour waiting and refreshment facilities,designated to the entrance and receptionarea);

• the alternative entrance. This sign shouldbe displayed outside the main entrancedoors when, and only when, the mainentrance is closed (see section on“Closure of the main entrance” onpage 19).

Unauthorised, ad hoc andtemporary direction signs

These are found in all hospitals and rangefrom the necessary and very useful to theobscure and unsightly. Unauthorised and adhoc signs are frequently symptoms of somedefect in the wayfinding system – for

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Wayfinding5

23

Eye-catching wayfinding signs above the main reception desk at New Liverpool Women’s Hospital

example “This is not the X-ray department!Please take the doors on your right!” or“This way for the Friends' Jumble Sale”. Theformer needs the immediate attention of thedesignated senior manager as it suggeststhat staff feel their department is not wellsigned, which could be rectified byimproving existing signs. The latter needs toobtain authorisation as to both its form andplacement (also from the designated seniormanager).

Controls and prohibitions

Outside the building inconsiderate andunauthorised parking of vehicles is auniversal problem and threatening signs areoften used to counter this. Control ofparking may be essential but signs shouldalso give positive guidance on wherevehicles may park, while expressing awelcoming message to users. It may beappropriate to use signs to indicate off-sitecar parking.

Large acute hospitals

Owing to their size and complexity, the need to simplify wayfinding in large acutehospitals is, perhaps, the overridingobjective. Different building types andarchitectural styles, and distinctive orhistoric names for buildings and placeswithin the hospital site can often beexploited to aid the wayfinding system. Art works may also be successfullyincorporated.

There is a strong tendency to put plenty ofwayfinding signs within the entrance and

reception area of large hospitals on theassumption that this is the place where theyare most needed. The same assumptionunderlies the decision to locate multi-lingualinformation, directional guidance by patientsupport groups and voluntary organisations,and food and magazine outlets etc here.The effect may be not only confusing butalso distressing to some users. Thedesignated manager, following expertadvice, should ensure that the signagesystem is useful and comprehensible to allusers.

Signs in the entrance and reception area forassociated facilities and other informationshould not be excessive and should notobscure or compete with essentialwayfinding signs.

Smaller acute hospitals includingspecialist hospitals

The medical terminology used in somedepartments in specialist hospitals may beunusual, incomprehensible or difficult topronounce for some users (for exampleoncology, cardiology, MRI). Where possible,signs should adopt simple and sensitivelanguage.

Community hospitals

Wayfinding is rarely a problem in smallerbuildings; only minimal signage is needed.External directional signs should be welldesigned and especially well illuminatedafter dark. This is important where there ismore than one hospital building on the siteand, particularly, if it is a suburban or ruralsite.

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WAYFINDING

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Temporary sign, ACAD, Central Middlesex Hospital(Avanti Architects; photographer Nicholas Kane)

5

As the natural “hub” of the hospital, theentrance and reception area is the placewhere users will expect to find information.Essential information should be prominentlydisplayed in a patient-focused and friendlyformat and should take priority over othertypes of useful information.

Essential information

The following is essential:

• routes and car-parking facilities;

• wayfinding and directional signs;

• times of closure of the main entrance, ifany, and alternative provision of entrance,reception and exit facilities;

• locational signs (for example at desks,doors, waiting areas);

• public phones and taxi free phones,internal phones, use of mobile phones;

• local public transport routes andtimetables;

• off-site parking near the hospital;

• hospital and NHS information concerningpatients' rights and responsibilities;

• the Patients' Advice and Liaison Service(PALS) and the administration of theservice;

• “Welcome” board and details of keypersonnel;

• smoking policy (see section on “Smoking”on page 37).

Information at reception

Reception staff will provide essentialinformation to enquirers and will provideassistance, if required, to the following:

• deaf/hard-of-hearing users (usinginduction loop at desk, sign language,visual announcements in waiting areas);

• blind/visually-impaired users (asrecommended by the Royal NationalInstitute for the Blind (RNIB));

• non-English speakers (access totranslations and translators);

• users requiring copies of hospitalinformation (for example wayfinding plans,patients’ guidance notes etc).

Hospitals may use volunteers to provideinformation and act as guides for users, butessential information and guidance shouldcontinue to be provided when no volunteersare present.

Other information

The presentation of information should be under the control of the designatedmanager and all additional forms ofinformation should be subject to approvaland authorisation. The material should bedisplayed in an orderly manner and kept up-to-date. All noticeboards in the area shouldbe “owned” by entrance and reception staffas displays tend to become untidy quickly.Unauthorised material should be promptlyremoved.

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Information6

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Particular care should be taken in usingtouch-screen or other interactive terminals,especially in existing facilities. The spacerequired for the equipment and user issignificant and so should not be locatedwhere it may obstruct or cause congestion.

All types of hospital

Hospitals are important and highly valuedcivic buildings serving a large, ever-changing and all-inclusive population. Forthis reason they are excellent sites fordisseminating information of all kinds,especially the larger hospitals serving a widearea. The opportunity for thiscommunication is very valuable to all

concerned but requires sensible andcontinuous control.

Essential information should be of a highstandard in function and design. Otheradditional information should be presentedin a way that is discreet and does notinterfere with the communication of essentialinformation. Too prominent or too manydistractions will have a negative effect onthe appearance and ambience of theentrance and reception area. Done well, itwill enhance users’ respect for both theservice and the investment in better publicbuildings.

Signage, Dewsbury & District HospitalMultilingual signage, Central Middlesex Hospital

Pulross Intermediate Healthcare Centre

Many patients and visitors spendconsiderable time in hospital and may do so regularly, frequently and sometimes even daily over a long period. It is essentialthat they are able to obtain food andrefreshments without leaving the hospital.

Facilities should be available near to theentrance and reception area to allow usersto purchase drinks and light snacks and toconsume them in a pleasant and relaxingenvironment.

Many large hospitals have a restaurant forboth staff and the public. Small tea bars,staffed by volunteers, are often associatedwith waiting areas in out-patient units and

other clinical departments. These may meetusers’ needs for light snacks and drinks ifthey are well located and signposted butthey are rarely open 24 hours a day.Vending machines for drinks and food arealso commonly provided and can bepermanently available. (See ‘Improving thepatient experience – Restaurant services atward level’, NHS Estates 2002 for furtherguidance on hospital restaurants.)

Cafeteria/lounge

A combined facility where users can obtainfood and refreshments and sit in comfort in

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Food and refreshmentsand other retail services7

The sophisticated and relaxing interior of Café Costa at ACAD, Central Middlesex Hospital(Avanti Architects; photographer Nicholas Kane)

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a quiet, relaxed atmosphere isrecommended. It should be open 24 hoursa day (equipped with vending machines forrefreshments when not staffed) and keptclean and tidy. Food and refreshmentsshould be decent but affordable to mostusers but those who wish or need toconsume their own food and drink shouldbe permitted to do so. It may be desirablefor newspapers and magazines to be onsale, unless they can be purchased nearby.

The cafeteria/lounge should be located near,but not within, the entrance and receptionarea. If possible it should be next to andhave access to an outdoor garden orcourtyard with seating and tables for use ingood weather.

Retail services

Many users will find it convenient topurchase items in hospital, especially in-patients and staff. The financial andmanagerial arrangements for retail servicesare matters for individual hospitals to decidein the light of local circumstances.

There are good reasons for combining retailfacilities with the entrance and receptionarea but it is important that they contributeto the welcoming environment. This meansensuring that the amount of space theyoccupy is not overwhelming and that theirdesign and display does not conflict orcompete with those of the hospital.

Northampton General Hospital previouslyhad a “cabin” facility, run by the WRVS,which sold magazines and confectionery. In1998, following consultation with theWRVS, patients, visitors and staff, it wasdecided to introduce a coffee shop(called Café Royale) into the mainreception area.

The venture was funded fromincome generated by the hotelservices department, and all profitsgo back into the Trust for thebenefit of patient care. The serviceis a stand-alone operation.

The décor of Café Royale is basedon a continental-style coffee shop.It has seating for up to 50 peopleand is open Monday to Friday,9 am until 5 pm. As well as specialitycoffees and freshly-squeezed orange juice,a range of light meals and snacks including

filled rolls, pizzas, pastries, desserts andcontinental dishes are available.

The coffee shop’s prime location next tothe main hospital reception means that it isa focal point for patients, staff and visitors.

It is also used by the local businesscommunity, who either eat-in or use thetakeaway service.

Good practice example of a coffee shop facility: Northampton General Hospital

Royal Oldham Hospital has a well-designedreception desk, which is at a suitableheight for wheelchair users and creates afriendly and welcoming impression.

On entering the main entrance, a“WHSmith” newsagent is located to theleft. High quality, corporate signage and a well-maintained outlet produce aprofessional aspect to the entrance area.

Other noticeable features include afreephone taxi service and a PatientLinevending machine where patients/visitorscan buy tokens for TV and telephoneservices at the bedside. (Note: PatientLineis only one of a number of companies thatholds a licence to deliver telephone and TVservices at patients’ bedsides.)

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FOOD AND REFRESHMENTS AND OTHER RETAIL SERVICES

Good practice example of a reception desk and retail facility: Royal OldhamHospital

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Mobile and temporaryactivities

A busy entrance and reception area may bea good location for activities that supportthe hospital and its users, good causes, thelocal community etc. Such activitiesoperate, usually over limited hours, fromtrolleys, barrows, tables etc and they needsuitable space for setting up.

While they may make the entrance andreception area more welcoming, they alsorequire sensible control. Each activity needsoperating space and, possibly, some localstorage; for new and refurbishment projectsconsideration should be given to planningsome extra space to accommodate these.

All these activities need to be properlyplanned for and supervised so that they donot cause obstruction, create fire or securityhazards or, by their appearance and noiselevel, affect negatively the operation andquality of the entrance and reception area.

Large acute hospitals

Large acute hospitals need to provide all thefacilities described here. Pressures on spaceand the demands of supervision needcontinuous attention.

A 24-hour cafeteria/lounge will be greatlyappreciated in hospitals with hundreds of in-patients. Providing this facility near theentrance and reception area may simplifyexisting services in other parts of thehospital.

If a hospital is to provide extensive retailservices, they should be grouped in an area

that is reasonably accessible from thehospital entrance, but does not impinge onthe space needed there. An alternative is toplace individual retail services inaccommodation along the hospital street ormain corridor. This may be less convenientfor users and less effective for retailers.Wherever they are located, the need forcontrol and supervision will apply.

Smaller acute hospitals includingspecialist hospitals

Local circumstances will determine whatlevel of provision is made for the servicesdescribed here. A 24-hour cafeteria/loungewill be needed. Suitable space for retail,mobile and temporary services will be morelimited in the entrance and reception area.

Community hospitals

Community hospitals admit many elderly,frail patients and those with chronicdegenerative conditions at the end of theirlives. It is not unusual, therefore, to findpatients' relatives in community hospitals atall hours. Consideration should be given toproviding a 24-hour cafeteria/lounge. Ifvending machines are found to benecessary, they should be carefully placedas their great size and typically ugly designmay be damaging to the appearance andatmosphere of the entrance and receptionarea.

A significant number of users are needed tojustify providing a retail outlet and this isunlikely at the smaller community hospitals.A modest general service staffed byvolunteers may be quite satisfactory.

7

Interior spaces should be sufficiently sizedand functionally suitable for the purposeintended and comfortable to be in.

In addition, the design of interior spaces –through the use of materials, finishes,colours and contrasts for building elements,furniture and art work – can greatly enhancethe hospital environment. This requires askilled and experienced interior designteam, selected by the hospital on the basisof similar projects successfully completed.

Each hospital is unique and the opportunityshould be taken to celebrate local themes,materials and skills. The followingparagraphs are reminders of some of thespecific issues related to the entrance andreception area.

Lighting

The following factors should be consideredwith regard to lighting at the entrance andreception area:

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The decorative glass ceiling enhances the appearance of the draught lobbyat Leeds General Infirmary

(Architect Llewelyn Davies; ceiling design Sasha Ward)

Interior design, lightingand seating8

Effective use of lighting in the main reception area at Hove Polyclinic(Architect Nightingale Associates; photographer Charlotte Wood)

• the transition from outside to insideshould not involve a sudden change in thelevel of lighting either at night (when thereis external lighting) or day;

• the reception desk should be wellilluminated so that its position andpurpose is instantly recognised from theentrance doors. Good illumination at thedesk is needed for reading documentsand for the benefit of the visually impaired;

• wayfinding and other signs and landmarksneed illumination enabling them to beseen and read from a distance;

• good lighting is essential for usingtelephones;

• waiting areas require a comfortable ratherthan a brilliant level of illumination, butusers often read while waiting and local orspot lighting should be considered.

The design of the general lighting at theentrance and reception area should be co-ordinated with these and any other quitespecific requirements. Opportunities shouldbe considered for imaginative lighting tocreate an interior that users will rememberwith pleasure. Replacing burnt-out lampsand keeping light fittings clean is veryimportant in maintaining the lighting qualityas well as the appearance of a well-designed scheme.

Seating

A considerable amount of seating isrequired in waiting areas at the entranceand reception and in any associatedcafeteria/lounge. Insufficient seats at anytime will cause considerable userdissatisfaction.

34

INTERIOR DESIGN, LIGHTING AND SEATING

The comfortable and relaxing waiting area atHillingdon Hospital (photographer Martin Bennett)

35

Fixed seating in rigid rows is negative andunsociable since it determines the wayusers face and limits opportunities to talk.Movable seats enable users to choose whatsuits them. Staff should help users torearrange seats if required.

Seats should be of different heights andsome should have high backs and armrestsfor patients who are physically less mobile.Occupational therapists can advise onappropriate types of seating. All seatingshould be comfortable and pleasant totouch as well as to look at. It is veryimportant that seating is easy to clean, ingood repair and regularly maintained.

Reception desk

As the visual focus for users entering ahospital, the reception desk needs to bewell illuminated at all times. The appearanceand quality of the desk makes an importantcontribution to users’ first impressions ofattending the hospital. The design, choice ofmaterials, colours and finishes and thequality of manufacture should recognisethis.

Although an open reception deskcommunicates a welcoming message, thedesign of the desk should enable staff tocarry out their tasks in safety. This can be

achieved by ensuring that the width of thedesk prevents assaults.

The desk is also an important item ofworking equipment and should beprofessionally designed to suit the specificrequirements of the hospital. Somerequirements are described in the sectionon “The reception area” on page 10. It hasto function as a workstation for staff dealingwith and storing documents and referencedirectories, using telephones and computerterminals. Sections of the desk need to beof different heights for users seated inwheelchairs and those who wish or need tosit, some nursing babies or with smallchildren. Other requirements includeappropriate desk lighting, public address,emergency call and fire alarms. Somelockable storage within the desk may alsobe necessary.

Storage

Inadequate storage space results in itemsbeing left in unsuitable places, whichproduces an untidy and uncared forimpression of the hospital. Large items leftabout give the impression that the hospitalis disorganised. As well as being unsightly,they may obstruct the movement of people,wheelchairs and trolleys and interfere withroutine cleaning.

8

The reception desk at Norfolk and Norwich Hospital makes a welcoming impression on patients and visitors

Royal Bolton Hospital provides an outdoor smoking shelterin pleasant surroundings

37

An area for parking hospital trolleys andwheelchairs should be available near thehospital entrance for users entering orleaving the hospital who need such items.The area should be strictly maintained andcontrolled by staff.

A separate area for users to park prams and pushchairs may also be required,providing users feel that these items will bereasonably safe. In small facilities this areamay be associated with the entrance but inlarger hospitals a better place may be at theentrance to the department visited. Any areafor this purpose should not obstruct accessto the entrance and reception area.

Food and other retail services also needadequate storage space close to whereitems are needed but out of sight and notobstructing other activities.

Smoking

Many users of hospitals are non-smokersand find an environment where smokingevidently takes places very disagreeable,stressful and even intolerable.

National policy is to make NHS premisessmoke-free but to provide some facilities forusers who cannot give it up, especiallywhen events surrounding hospitalisation,treatment and care are stressful. While it isimpossible to reconcile the requirements ofsmokers and non-smokers it is largely left totrusts to implement the NHS policy. (See‘The health of the nation: a strategy forhealth in England’, Department of Health1992, Health Service Guidelines (92)41 –‘Towards smoke-free NHS premises’, NHSExecutive 1992 and ‘Smoking kills: a whitepaper on tobacco’, Department of Health1998 for further details on national smokingpolicy.)

This document recommends that allentrance and reception areas should benon-smoking. Clear signs informing users ofthis, together with suitable disposal facilities,should be placed in advance of entering thebuilding as well as within. In the entranceand reception area, signs should describethe location of smoking rooms (if any) withinthe building and areas outdoors.

It is particularly important to make clear thatsmoking is not permitted immediatelyoutside the hospital’s entrance or nearby.Smoking in the open air is less disagreeableto non-smokers but should not be permittednear open windows or doors.

Whatever provision is made for smokers,both indoors and outdoors, there should beproper arrangements for dealing withsmokers’ litter. Special containers should beobvious but discreet in appearance, and, ifpossible, smoking areas should bedeodorised. Containers should be clearedfrequently, cleaned and maintained in goodorder. Cigarette ends, matches and otherlitter should be removed

Retail and temporary facilities

Arrangements with retailers and othersusing the entrance and reception area forvarious activities should ensure that thehospital has control of the design andappearance of their facilities. An ill-considered or intrusive display, inappropriatelighting or careless wording can spoil users’impressions of the hospital.

Large acute hospitals

Large acute hospitals offer considerablescope for designs that reflect theirwelcoming, patient-focused aims as well astheir civic importance. Imaginative interiorsshould be created to give pleasure to userswithout being shocking or too challenging. Ahospital should select a design team with asmuch care and respect for professional skillas it would select a clinician.

Smaller acute, specialist andcommunity hospitals

Although the scope and scale of the interiordesign may be smaller for these hospitals,they should select from the best interiordesign teams available. The size of theproject should not deter even the mostsuccessful professionals from offering theirservices. Community hospitals, in particular,may want to ensure that local design talentis given an equal opportunity to contribute.

8

Most individual hospital buildings are setwithin larger sites. It is important that allexternal areas of the site are well designedand maintained. There may be severaldifferent routes to the hospital’s mainentrance depending on where users enterthe site and their mode of transport. Allroutes should be well signposted to aidwayfinding and create a good impression.

Where the hospital building and its mainentrance open directly onto a public street,the adjacent external area will be a publicresponsibility. The hospital will have a stronginterest in the area being of high quality indesign and maintenance, especially in termsof road safety, security and lighting afterdark. The hospital should use its influencewithin the community to ensure this is thecase.

Hard and soft landscaping

Areas outside hospital buildings shouldnever be neglected; they are integral to thehospital site and should reflect and enhancethe design and operation of hospitalbuildings. Well-designed and maintainedexternal spaces will give a good firstimpression of the hospital site.

Functional requirements for roads andfootways are as critical as internal spaces.Soft landscaping – shrubs and trees,flowerbeds, grassed areas, water features

and so on – also need to meet specificfunctional requirements. External seatingand tables, suitably positioned, can greatlyenhance the hospital environment andusers’ enjoyment of it. They may be inshelters or gardens, visible to usersapproaching the entrance, as well as withininternal courtyards. For further informationon landscaping, refer to Health BuildingNote (HBN) 45 – ‘External works for healthbuildings’, NHS Estates 1992.

Landscaping of external spaces should bethe responsibility of an integrated and multi-skilled design team.

The day-to-day maintenance and qualitycontrol of external spaces should be theresponsibility of one designated seniormanager.

Maintaining the quality of external lightingand illuminated signs requires regularcontrol of vegetation and promptreplacement of burnt-out lamps.

Where an area outside the entrance isdesignated for the use of smokers (see the section on “Smoking” on page 37),provision for placing litter and its regularremoval should ensure an acceptableappearance at all times.

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Hard and softlandscaping, external lighting9

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Leeds General Infirmary has an attractivecircular “courtyard” area outside its mainentrance, which has been designed todraw people into the building. The areafeatures sculptures, raised garden areasand benches.

People approaching the hospital by car aredirected from a mini-roundabout to themain entrance. The road then loops roundthe courtyard and directs traffic back out. Aparking attendant is also present to controltraffic.

The extremely well-designed lobby, which islarge enough to house benches and plantsand to protect the reception area from thecold, is angled for both functional andaesthetic reasons.

On entering the spacious reception areathrough the draught lobby, the receptiondesk is immediately noticeable straightahead. A rounded reception desk helps tocreate a welcoming effect. The desk is at aheight suitable for wheelchair users (asidefrom one raised section).

A general store and pharmacy is located tothe right of the reception area, with an“Upper Crust” sandwich bar to the left.

Plants and artwork, including large woodenreliefs, enhance the appearance of theoverall area. A glass brick wall and acoloured floor feature provide additionalinterest.

Signage is large and clear, and toilets arewell signed.

Good practice example of external landscaping, draught lobby and reception area:Leeds General Infirmary

Attractive external landscaping and lighting creates a good impressionon visitors approaching the main entrance at Leeds General Infirmary

(photographer HBG Construction Ltd)

Parking

All drivers would like to be able to parkclose to their destination, free of charge andfor as long as they choose. However, this isnot always possible. Each hospital has tomake provisions for parking based on therequirements of its users and arrangementsfor public and private transport onto thesite.

In general, patient parking should belocated in the spaces closest to thehospital. There should be adequate andappropriate-sized parking spaces fordisabled users and those with pushchairs.

Car parks require a good even surface toprevent accidents and should be well-lit andsignposted.

Overspill car parks should generally be forstaff use only as they tend to be located attoo great a distance from the hospital to beof benefit to patients and visitors. They canbe costly to provide as they often requireshuttle buses to transport people to thehospital.

Park-and-ride schemes and bus servicesonto hospital sites can ease the demand foron-site parking. Experience shows thatmany patients and visitors who live locally

will take advantage of these options whenthey receive appropriate information andencouragement.

Many NHS organisations charge for carparking to subsidise the provision ofadequate car parks. It also contributestowards patient transport services. Thisoften means that patients and visitors, aswell as staff, pay car parking charges.

Once users have parked their vehicles theroute to the hospital entrance should be assimple and pleasant as possible so as notto add to any frustration and stress causedby parking. A communication system orparking attendant should be available tohelp users that need assistance in getting tothe hospital entrance.

There should be no parking spaces outsidethe entrance area, as this space needs tobe available for users to be set down andpicked up by vehicles.

Well designed and securely maintained,sheltered parking for cycles should beprovided. The pedestrian route from thecycle park to the entrance should besheltered.

For further guidance on car parking, refer toHBN 21 – ‘Car parking’, NHS Estates 1996.

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HARD AND SOFT LANDSCAPING, EXTERNAL LIGHTING

The park-and-ride scheme at Nottingham City Hospital eases the pressure on parking spaces

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External lighting

Good external lighting in the evening and atnight is absolutely vital. Entrances onto thesite and into the hospital building, as well asthe building itself and all routes on the site,should be well illuminated to aid navigationand wayfinding. The main entrance inparticular should be well lit so as to bevisible from a distance and easilyrecognisable.

At some hospitals users may have to walksome distance to parked cars. For thesafety and comfort of such users, routes to and from car parks and car parksthemselves should be well lit.

External lighting, including security lightingand floodlighting, should be designed so asnot to shine through windows into areaswhere users may be disturbed.

Temporary works

Where work is being carried out to thebuilding’s exterior or within the hospitalgrounds, especially road and undergroundworks, the affected areas should be

securely fenced or enclosed with hoardings.This is especially important at or near thesite and building entrances and on all routeswithin the site. The enclosures should notlook hazardous but made neat and tidy andwell illuminated after dark.

For major developments enclosed byhoardings for long periods, viewing slotsmay be provided so that the localcommunity can watch progress. Illustrationsand information should be displayed to helpinvolve users in the hospital’s aims forquality improvement. Hoardings may also bedecorated to enhance their appearance.

Where entrance routes are temporarilydiverted or disrupted, all existing signageshould be adapted and new signs installedfor the duration of the change. The hospitalshould ensure that all users, someresponding to emergencies, can follow theproper route without difficulty or possibilityof error.

Guidance in this section applies equally to large acute hospitals, smaller acutehospitals (including specialist hospitals) and community hospitals.

9

The main entrance at Birmingham Children’s Hospital by night(Architect Powell Moya Ltd; photographer David Grandorge)

There is worldwide recognition of the valueof art in healthcare settings. The arts enrichthe environment and, by stimulating interestor providing distraction from anxiety, theycan reduce the burden of stress borne bypatients, visitors and staff.

This has been pioneered in the NHS and abody of expertise is available backed byextensive experience and good research-based evidence of effectiveness.

The basic experience of users entering ahospital can be greatly enhanced by thesight of appropriate artwork. It will enhancetheir first impression of the hospital, giverepeated pleasure and reassurance onsubsequent visits and continuing pleasure tothose waiting and working in entrance andreception areas. Art needs to beincorporated into the planning process of abuilding at the earliest opportunity. (Fordetails on selecting artwork in hospitals thatwill appeal to children and young people,refer to ‘Improving the patient experience –Creating a friendly healthcare environmentfor children and young people’, NHSEstates 2002.)

Funding, professional inputand participation

There are numerous hospital arts projects in the NHS and many long-established,substantial and flourishing ones, which arewell-known and admired. Finding sources of

funds and organising fund-raising activitiesare an essential requirement for any hospitalarts project.

Hospitals should obtain professionalguidance at an early stage when developingarts projects. The leading and mostexperienced source of information is Arts for Health (at Manchester MetropolitanUniversity). The more recently formedNational Network for the Arts in Health(NNAH) is also a useful source ofinformation. Hospitals should also try toinvolve local artists and arts organisationsbut under specialist professional guidanceas they may not have knowledge andexperience of art in healthcare settings.

The need for expert advice and guidance isemphasised, since introducing works thatare inappropriate, of poor quality or badlyinstalled can lead to hostility from staff aswell as other hospital users. In contrast,well-managed patient and staff participationhas produced some of the most successfulhospital arts projects. Work made entirely byamateurs and displayed in prominent publiclocations is rarely acceptable.

Landmarks

Art works, such as sculptures and murals,may become very effective and memorablelandmarks for wayfinding. As such theyneed to be permanently installed and notsubject to deterioration. Externally their

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Arts projects10

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scale, visibility and legibility need to beeffective. Nothing is “vandal-proof” but ifdamaged or abused they should be quicklyrestored. Internally they can mark decisionpoints on main corridors and othercirculation routes.

Heritage and history

Almost every hospital will have valued itemsof heritage from its history, such asfoundation stones and ceremonial objectsfrom earlier buildings or associated sites,documents, photographs, portraits, historicmedical artefacts etc. Displayed well, in anappropriate setting in the entrance and maincirculation areas, these will interest manyusers. They will also demonstrate the

hospital’s strong links with local and widercommunities.

Entrance areas

The entrance and reception area is animportant site for a significant andwelcoming art work. Since this area, andany associated cafeteria/lounge, is used forwaiting and relaxing, it is also an ideallocation for smaller art works and displays,which may be viewed at close quarters.These works may be changed from time totime but these functioning areas should notbe regarded by the hospital as art galleriesor places for holding temporary exhibitionsor sales of art works.

Artwork enhances the waiting areasat Royal Bolton Hospital

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Artwork enhances the waiting areasat Royal Bolton Hospital

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TV, video and broadcastsound

TV and video displays attract attention andinvite users to stand or sit in front of thescreen. Screens need to be placed whereusers may view them comfortably andwithout obstructing or interfering with theproper use of the entrance and receptionarea.

The noise from TV and videos and frombroadcast sources such as backgroundmusic may be unwelcome to some usersand should only be heard by choice. Forusers with hearing difficulties, backgroundnoise can be a serious problem. Broadcastannouncements using a public addresssystem may be necessary in emergencies.

Performances

Arts projects may include live performancesof music and drama. These can be veryeffective and much valued by patients,visitors and staff. It may not be appropriateto hold performances in the entrance,reception and circulation areas as they cancause obstruction.

Large acute hospitals

Professional arts project management isvery important for large acute hospitals.Great opportunities exist for creating artworks to act as readily recognised

landmarks and aid wayfinding. Theirimportance and permanence requires thatthey are designed and made byprofessionals. In many large hospitals, thereare successful examples of speciallycommissioned imaginative works with localand historical allusions, works that providewit, humour and compassion, and worksmade by the local community withprofessional guidance. Significant art worksare excellent for enhancing the hospitalenvironment.

Smaller acute hospitals includingspecialist hospitals

Arts projects for smaller hospitals may beeasily obtained but there is no formula thatfits all. There is great variety, especiallyamong specialist hospitals, and goodopportunities for enhancing the hospitalentrance and reception area throughappropriate art works of high quality.

Community hospitals

Community hospitals with very limited fundsmay be unable to afford a professional artsproject. However, it is highly recommendedthat art is incorporated into the entranceand reception area – particularly if this is theonly way in and out of the building. Evenone special and appropriate art work, or aprofessionally-designed display of thehospital’s heritage and history within itscommunity, can dramatically enhance theappearance and ambience of the area.

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‘Improving the patient experience – Creatinga friendly environment for children andyoung people’, NHS Estates 2002. The Stationery Office

‘Improving the patient experience –Restaurant services at ward level’, NHSEstates 2002. The Stationery Officewww.betterhospitalfood.com

‘Wayfinding: Effective wayfinding andsigning system. Guidance for healthcarefacilities’, NHS Estates 1999. The StationeryOffice

Health Facilities Note 21 – ‘Car parking’,NHS Estates 1996. The Stationery Office

Health Facilities Note 14 – ‘Disabilityaccess’, NHS Estates 1996. The StationeryOffice

‘Design Guide – The design of hospital mainentrances’, NHS Estates 1993. The Stationery Office

Health Building Note 45 – ‘External worksfor health buildings’, NHS Estates 1992.The Stationery Office

Health Service Guidelines (92)41 – ‘Towardssmoke-free NHS premises’, NHS Executive.Department of Health Publications Unit1992

‘Smoking kills: a white paper on tobacco’,Department of Health 1998. The StationeryOffice(http://www.official-documents.co.uk/ document/cm41/4177/4177.htm)

‘The health of the nation: a strategy forhealth in England’, Department of Health1992. The Stationery Office

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