从建筑学到声学:1948年以来英国国民健康服务体系中“以病人为中心”医院的建立

From Architecture to Acoustics:The Making of Patient-CentredHospitals in the National Health Service since 1948

医院的历史为英国国民健康服务体系中许多健康与医疗历史问题研究提供了背景。然而,已有对NHS医疗保健服务的历史研究,鲜有对物质文化史和环境史给予关注并将其关联起来。本文试图通过探索医院设计的可能性,了解NHS医疗保健服务在实践中是如何运作的,以及不断变化的医疗保健关注点与医院设计实践之间的关系。从广义上说,这种关系包括医院空间是如何为病人的居住体验所建构与重构的。笔者将以“‘以病人为中心’的设计”为例,阐述在20世纪下半叶,英国的医院建筑、内部陈设和医院环境是如何随着医疗原则的演变而变化的。通过考察包括从医院建筑到候诊室声音景观在内的不同类型设计的变化,本文指出医疗环境既是“以病人为中心”思维的产物,也是这一观念的生产者。我们研究NHS的医院设计,可以深入了解认知空间、权力和医疗保健理念之间的相互关系,窥探20世纪后期“以病人为中心”医院设计原则的微妙转变。医院的环境,不仅仅是不断变化的设计理念或经济原则的产物,也是不断演变的护理原则的具体表述和创造者。如能充分认识和理解这一点,历史学家将会从中受益匪浅。

Hospital history forms a backdrop to much history of health and medicine in the British National Health Service.However,histories of NHS healthcare have often been separated from histories of the material culture and environments within which that healthcare took place.This article explores the potential of hospital design for understanding how NHS healthcare operated in practiceand the relationship between changing healthcare concerns and design practices,broadly defined to include how spaces were made(and remade)through theirinhabitation rather than just their construction.It takes patient-centred design asan example of how buildings,interiors and hospital environments evolved in relation to healthcare principles in Britain during the second half of the twentiethcentury.Looking at changes to different types of design,from hospital architecture to waiting room soundscapes,this article shows that healthcare environments were both product and producer of patient-centred thinking.Hospital design under the NHS offers insights into the relationships between space,powerand healthcare philosophies,showing a subtle turn towards patient-centrednessover the course of the late twentieth century.Historians can gain much fromreading hospital environments not only as products of changing design or economic principles,but also as expressions-and creators-of changing care principles.