Universal design: Putting people first

A young boy enters an emergency department with his mother.

The boy has autism and the busy department is overwhelming. Fluorescent lighting flickers overhead, creating a constant hum. Loud announcements ring out over the speakers. There are overwhelming signs everywhere full of information aimed at adults. The surfaces are all steel and plastic, and everything has a ‘medical’ smell. The young boy is overloaded with sensory information, making his first trip to the emergency department anxiety-inducing.

But imagine how different this boy’s experience might be if the emergency department was built with his needs in mind? Enter universal design.

Michael Walker is the Principal Advisor for Universal Design at the Victorian Health Building Authority (VHBA). As he explains, 'People are diverse and everyone has the same rights to access and participation in society. And all people, regardless of ability, should have equal opportunity to take part in society. Diversity comprises acceptance and respect.'

Universal design is about inclusivity. As Michael points out, it’s also a human right. It means designing something so that it’s accessible to as many people as possible. Whether that’s a building, product or service, an environment or a program, universal design thinks about the people who will be using something and puts their needs first.

'Universal design builds on a concept of accessible design, but going further than meeting just minimum legislative standards by accommodating not just some people, but all the people to the greatest extent possible, all the time,' Michael explains.

When we use universal design, we’re designing for everyone. In health infrastructure, universal design means building hospitals, mental health facilities and aged care homes that everyone can use. It considers whether someone is young or old. Whether they have different physical, cognitive or sensory needs. It considers gender, sexuality and religion. And it considers the cultural backgrounds of users, such as Aboriginal and Torres Strait Islanders, and what would make them feel safe.

The concept of universal design emerged in the nineties and was included in the Convention on the Rights of Persons with Disabilities in 2006. But it goes beyond making facilities merely accessible to, say, someone in a wheelchair. Universal design acknowledges that good design is good for everyone. A door that opens automatically is helpful to someone who uses a wheelchair. But it’s also helpful to a parent pushing a pram, or someone who has broken their leg and is temporarily using crutches.

As Michael Walker explains, when we create environments that everyone can use, it has benefits right across the community.

When a building follows universal design principles, it is accessible, flexible and welcoming to as many people as possible. Here we consider how our built environments might impact people with different physical, sensory, cognitive and other needs.

Designing for a child with autism

Visiting hospitals can often be overwhelming, for everyone. Visiting a hospital as a small child – and a child with autism, for example – can add a whole new layer of sensory overload to the mix.

Children with autism have different sensory needs, because they process information taken in through the senses differently. They may be over-sensitive to certain sensations, such as sounds, smells, tastes sights and textures. And they may also be under-sensitive to certain sensations.

If we imagine the constant noise of machines beeping and announcements being made, the fluorescent lighting and strong smells from medical solutions and cleaning products, it’s no surprise that an emergency department would not feel like a safe place.

So how can we design emergency departments that are calmer and less distressing?

By making them a welcoming place for all children – whether neurotypical or neurodiverse. This might involve using natural light as much as possible and avoiding fluorescents. Sounds can be minimised by, for example, locating air conditioning units where they won’t contribute to ambient noise. We can choose calming, muted tones when thinking about colour and design. Even small considerations like providing private spaces to wait in can go a long way. The result? An environment that is less clinical, less overwhelming, and where every child can feel safe.

The recently completed Sunshine’s Hospital’s emergency department redevelopment is a good example. The redevelopment includes a dedicated kid’s-only area. Designed with all children in mind, the purpose-built space provides a calmer, more compassionate environment to receive emergency care in. Children are treated in kids-only treatment spaces decorated with mountain scenes, and painful or invasive procedures are undertaken in private rooms where children feel like they’re in a safe space.

Designing for an older person with dementia

For people with dementia, their physical and social environments become difficult to navigate with changes in cognitive capability. Imagine forgetting where the toilet is because your memory is impaired. Or becoming anxious and confused because there is too much noise. People living with dementia can live with a sense of loss, causing anxiety and insecurity. They need an environment of comfort, and to feel a sense of belonging.

So how can universal design help us make environments that are dementia-friendly?

Creating a home-like environment is key. A home-like environment allows people to go about daily life with choice, independence, familiarity and comfort.

The dementia-friendly unit at Creswick Nursing Home was designed with these elements in mind. The interiors include familiar domestic features to create a comforting space that feels like home. The entry to each room has a deep threshold, helping to create the feeling of a front door, and residents can personalise their space so they feel at home.

Rooms are clustered around a central courtyard that can be sealed off from the rest of the facility, allowing residents to circulate freely and safely. The social spaces look out onto this central courtyard. As well as providing points of conversation, this creates the sense of almost looking out into a backyard. Dining and lounge areas have been broken up into smaller spaces. This means residents are able to cluster into smaller friendship groups, socialise with family or simply sit on their own.

Designing for young people experiencing mental ill health

For someone experiencing mental ill health, the last place they’d want to be treated in is an environment that feels clinical. One way that universal design can help is through the idea of co-creation.

The award-winning Orygen and OYH Poplar Road precinct redevelopment is a clinical and research centre for young people with serious mental illness. The design involved input from more than 140 young people to ensure young voices were heard. They contributed ideas on furniture, the design of consulting rooms, and even on the design of the bathrooms. The result was a space that feels inclusive and safe.

The building was designed to reflect the natural beauty of the surrounding landscape. Natural, laminated timbers and curved, irregular shapes were used throughout. The consulting rooms have access to outside decks so young people have space to debrief, settle and reflect. Young people can access clinical services in a comfortable and safe environment, designed to meet their needs.