Article Summary
This article forms part of a wider research programme led by Polly Barker, Director at TP Bennett, exploring how healthcare environments perform under real operational and emotional pressure. Through clinician interviews and lived experience mapping, the research examines how design decisions affect outcomes, wellbeing and care delivery. This piece focuses on obstetrics, drawing on conversations with senior clinicians working at the sharpest end of care.
Designing healthcare environments has long been shaped by standards, guidance notes and prescriptive room data sheets. While these frameworks are essential, they rarely capture what it actually feels like to deliver care at three o’clock in the morning, to support a family in crisis, or to work through sustained pressure in an overstretched department. For Polly Barker, Director at TP Bennett, this gap is where healthcare design needs to become more ambitious,
If we want to design hospitals and healthcare spaces that genuinely improve outcomes, we need to look beyond compliance and listen more carefully to the people who use these buildings every day
To explore this further, Polly led a research project exploring healthcare design department by department. The first focus is obstetrics, an area of the hospital that deals directly with both life’s most joyful moments and its most devastating outcomes. To understand what really matters in design of an obstetrics department, Polly spoke with two senior clinicians: Kerry Barham, an ex–Chief Nurse turned Project Manager; and Frances Evans, a former Consultant Obstetrician at a major London hospital. The patient perspective also shaped the discussion, informed by Polly’s own lived experience of obstetrics care.
The conversation was guided by a simple question: “if budget, site and size were no constraint, what would a truly supportive and effective obstetrics department look like?”
Image 1 – waiting area – lets have waiting areas that people will be happy to spend time in
What emerged moved quickly beyond room sizes and adjacencies into experiences, emotions and behaviours. The discussion explored how women (in particular) can be better practitioners and healthier patients when they feel safe; how staff stress is affected by sounds, light and layout; and how dignity can be undermined by environments design for throughout rather than care. As Polly explains, “As architects, our role is to translate these insights into spatial strategies: to interpret clinical needs, anticipate peak flows and design environments that flex between calm and crisis without compromising patient experience.”
From standards to lived experience
What follows is a synthesis of that conversation: part practical, part aspirational, and focused on how rethinking obstetrics environments could help deliver better outcomes for patients, families and staff alike. Rather than attempting to cover every possible design requirement, the research follows the flow of the discussion itself. It offers a perspective on what most affects the people who use and work within these spaces, and what the design and construction industry can do to support more effective care.
The unique complexity of obstetrics
Obstetrics is one of the most emotionally and operationally complex areas of a hospital. People in adjoining rooms can be having the worst or the best day of their lives and things can go from routine to emergency in a moment. That reality creates a clinical environment unlike almost any other. Spaces must be flexible enough to support routine care, emergency intervention, privacy, dignity, family involvement and rapid escalation. They must also hold a wide emotional spectrum. Joy, grief and uncertainty often sit side by side, sometimes within the same space and the same hour. In those conditions, the physical environment matters deeply. It influences how people feel how clearly staff can respond, and how effectively care can adjust when circumstances change.
Healthcare design guidance such as HBNs and HTMs is typically structured around the spatial and environmental requirements of specific activities. These frameworks are important, but they cannot fully reflect how departments operate under pressure. As Polly notes,
Designers need to understand how the department works at peak flow and peak emergency, not average use
That means learning directly from the nurses, doctors and wider clinical teams who use these spaces every day. It means understanding where movement becomes difficult, where visibility matters, where decisions are made, and where the built environment either supports or obstructs care. In obstetrics, adaptability is not a design preference; it is a clinical requirement. Spaces need to support changing levels of acuity and allow care to respond around the patient, rather than forcing the patient to move through a rigid system.
Things that don’t work: design frustrations on the ground
Many of the frustrations identified through the discussion were not dramatic or unusual; they were the everyday design issues that, under pressure, begin to affect both experience and performance. Poor wayfinding was a recurring concern, particularly when patients and families are trying to reach the department from the main hospital entrance. In obstetrics, where people often arrive anxious, distressed or in pain, unclear routes are more than an inconvenience. They can heighten stress before care has even begun.
The same applies to poorly positioned staff bases, hidden corners and fragmented layouts. These create places where people, equipment and information can become lost. They also reduce visibility across the department, making it harder for staff to maintain awareness when activity increases or an emergency develops. Environmental conditions were another important theme. Spaces that overheat in summer or become uncomfortably cold in winter can quickly undermine comfort and sense of control, particularly when staff cannot easily adjust them. Acoustics were equally significant. As Polly explains, “good acoustics need to support privacy and dignity, but they also need to allow staff to communicate clearly and recognise when a patient may be in distress.”
Technology sits within the same wider issue. Clinicians need systems they can trust, particularly at the point of care. When technology is unreliable or disconnected from workflow, it pulls staff away from patients and increases the risk of information being recalled later rather than recorded accurately in the moment. Taken together, these issues reveal a bigger point. The environments that cause the most frustration are often those that make patients feel less safe and less in control, while also making staff work harder to deliver effective care.
Designing for safety, dignity and trust
One of the strongest themes to emerge from the research was the relationship between environment and clinical outcome, as Polly says, “There is a direct relationship between positive labour outcomes and a woman feeling safe within a space that gives her privacy and dignity.” In obstetrics, safety is not only about access to emergency intervention. It is also about whether a patient feels calm, respected and able to communicate openly with caregivers. The design challenge is to create environments that feel welcoming and domestic, while still making clinical support visibly and immediately available.
Acoustics illustrate this tension clearly. Strong acoustic separation can protect privacy and allow women to speak confidently about what is happening and what they need. But clinicians also need to be able to hear if a patient is in distress in a room, as they move through the department. Lighting, temperature, visibility, layout and material choices all contribute to whether a space feels calm or overstimulating, personal or purely clinical. The most effective obstetrics environments are those that support dignity without compromising readiness. This is where design moves beyond technical compliance. Standards can define what a room must contain, but they cannot always define how a space should feel when someone is frightened, exhausted, grieving or about to give birth.
Choreographing care through the hospital
Obstetrics cannot be planned as an isolated department. Its position within the wider hospital directly affects clinical efficiency, emergency response and patient dignity. The department needs strong connections to A&E for emergency admissions, as well as access to pathology and testing so that results can be delivered quickly. If located on an upper floor, dedicated lifts with emergency override become essential. Behind the scenes, segregated back-of-house routes can help staff, patients, equipment and services move efficiently without creating unnecessary conflict in public areas. As Polly notes, “getting the location right can make the day-to-day use of the department significantly better for both patients and staff.”
But hospital choreography is not only about speed; it is also about sensitivity. Obstetrics must support some of the most difficult journeys through a hospital, including stillbirth care and discreet mortuary access. These routes need to protect privacy and dignity at moments of profound distress. This makes adjacency, access and circulation central to the quality of care. They determine not only how quickly people and services can move, but how respectfully and calmly those movements can happen.
Designing spaces that adapt around people
Few areas of healthcare are as unpredictable as obstetrics. A pregnancy or labour can shift from routine to emergency in a matter of moments, and the environment needs to be able to respond accordingly. This raises an important question for design teams and healthcare leaders: should patients be moved through a rigid system, or should the system be able to adapt around them?
One idea explored through the research was the potential for delivery suites that could convert into theatres for emergency caesarean procedures. This would require larger footprints than standard labour, delivery, recovery and post-partum rooms, but it reflects a wider ambition to reduce unnecessary movement during labour and support faster escalation when needed. As Polly puts it, “we should look at spaces that can adapt to the patient rather than the patient being moved during labour.”
That principle also extends to partners and families. Their presence can make a meaningful difference to patient experience, yet their needs are often treated as secondary. Simple interventions such as pull-out beds, washing facilities and better waiting areas can significantly improve comfort during long and uncertain stays.
Image 2 – Spaces for families to work whilst waiting
More ambitious ideas, including overnight pods or lounge-style waiting spaces with access to catering, recognise the reality of obstetrics as an environment where families may need to remain close for many hours. Digital tools can also reduce unnecessary disruption, for example allowing a partner to extend parking without leaving the department. These are not small luxuries; they are ways of keeping support networks close to the patient and reducing friction at moments when people are already under pressure.
Staff experience as part of clinical performance
The research also makes clear that staff experience cannot be separated from the quality of care. Obstetrics is intense, emotionally demanding and operationally complex. Staff need environments that allow them to work efficiently, communicate clearly and recover during difficult shifts. When spaces are poorly designed, technology is unreliable or rest areas are inadequate, the burden falls directly on clinical teams. Polly highlights the importance of technology that works at the point of care. “Getting technology right at the point of care keeps caregivers with the patient,” she explains. “The information entered is more accurate than that recalled later from memory in a separate room.”
Physical space is just as important. Staff need quiet rooms, prayer spaces and proper rest areas within the department, alongside changing facilities, showers, lockers and tea points. In a more ambitious model, obstetrics departments would also include spaces for mentoring, training, professional development and focused administrative work.
Image 3 – Staff rest room – spaces that are a genuine time out from clinical spaces
This matters because healthcare estates influence workforce resilience. In a system facing sustained pressure, staff spaces should not be treated as residual or secondary. They are part of the infrastructure that supports recruitment, retention, wellbeing and safe care.
Beyond compliance
The central message from Polly’s research is not that standards are unimportant. It is that they are only the starting point. HBNs and HTMs help define the physical requirements of clinical activity. But the effectiveness of an obstetrics department also depends on less easily measured factors: whether people feel safe, whether dignity is protected, whether staff can see and respond, whether families can remain close, and whether the environment can flex when care becomes unpredictable.
For Polly, this means continuing to listen to the teams who provide care, asking what works and what does not, and challenging conventions where current models no longer reflect clinical reality. Healthcare environments will need to keep evolving as technology, practice and patient expectations change. The opportunity for designers, estates teams and healthcare leaders is to create spaces that do more than meet guidance. They must support the real conditions of care.
And perhaps, as Frances Evans suggested during the conversation, they should also leave room for moments of joy: “could there be a carousel in reception?” Because, in a department shaped by intensity, uncertainty and emotion, who wouldn’t feel better after a ride on a carousel?
