The Third Caregiver: Why Healthcare Design Must Move Beyond Function

Author: Kaja Hellman-Hayes

Space is never neutral.

Every one of us has walked into a room and felt something immediately long before we consciously understand why, be it comfort, tension, calm, or unease. These subconscious reactions shape how we think, behave, and even how our bodies respond. But what happens when we apply this idea to healthcare?

Rethinking Care Beyond People

When we talk about caregiving, we typically focus on two key factors: the clinician and the patient’s immediate support network. Yet this overlooks a powerful and often invisible influence: the environment.

In my research, The Third Caregiver: How Does Spatial Design Impact Patient and Staff Experiences in Healthcare Settings?, I argue that the built environment is not a passive backdrop to care but an active participant.

Healthcare spaces shape wellbeing, dignity, and recovery. They influence how patients experience vulnerability and how staff sustain resilience. In short, they care, whether intentionally or not.

When Design Undermines Care

Having conducted a series of interviews with healthcare professionals working in NHS hospitals, a consistent and concerning theme emerged: the physical environment often works against the very care it is meant to support.

Staff described break rooms without windows, positioned at the centre of wards, offering no mental escape from the clinical setting. The absence of natural light and visual connection to the outside world contributed to feelings of isolation and anxiety.

Patients, meanwhile, were frequently exposed to overwhelming sensory conditions like constant noise, harsh lighting, and disorienting layouts. For individuals already in distress, these environments can heighten confusion and emotional strain.

Privacy, too, was revealed as an illusion. As one nurse put it:

“It’s a big misconception that you get privacy behind a curtain. The only thing you get is that people don’t see-but they hear everything.”

These insights highlight a critical disconnect: environments designed for efficiency and capacity often neglect the human experience at their core.

Adaptation in the Absence of Design

Even within these constraints, staff find ways to cope.

One participant described walking hospital corridors, not because they were restorative, but because they offered a temporary escape from a windowless break room. The act of movement became a substitute for meaningful rest.

This is not a success of design, but a workaround. It reflects a deeper issue: when environments fail to support wellbeing, individuals are left to create their own moments of recovery.

By contrast, participants working in newer facilities with dedicated respite spaces told a different story. Access to outdoor areas, balconies, and even a short walk to a staff canteen – physically separated from clinical zones – made a profound difference. That short distance mattered. It enabled a mental reset.

These insights reveal something important: wellbeing in healthcare is deeply special.

Lessons from the Past and Present

The idea that environment plays a role in healing is not new.

Over 2,000 years ago, Ancient Greek healing sanctuaries – Asklepieia – were designed with the human experience at their centre. Located in natural landscapes, they integrated fresh air, water, social interaction, and rest as essential components of care.

Today, science confirms what these early societies understood intuitively. Research in neuroscience and biophilic design shows that access to nature, daylight, and social connection significantly improves mental and physical health outcomes.

We see a modern interpretation of this philosophy in Maggie’s Centres – spaces designed to support people living with cancer. These environments prioritise warmth, dignity, and agency. Kitchens replace reception desks. Light-filled spaces encourage movement and conversation. They are not clinical. They are human.

And importantly, they complement medical care rather than replace it – addressing the emotional and psychological dimensions of health that hospitals often struggle to accommodate.

From Institution to Individual

This shift toward human-centred care aligns with broader healthcare transformation.

The NHS 10-Year Health Plan calls for a move from institutional, reactive models to preventative, community-based care. If we are serious about this transition, we must recognise the role of the built environment.

Hospitals are exceptional at acute care – but they are not designed for everyday wellbeing. When healthcare is confined to institutional settings, it risks becoming something people engage with only in moments of crisis.

Community health infrastructure offers a powerful alternative.

Imagine neighbourhood health hubs that integrate gardens, social kitchens, and flexible spaces for activity and connection. Environments that are intuitive, welcoming, and embedded in daily life, where healthcare is not hidden behind corridors, but woven into the fabric of the community.

Designing for the Full Spectrum of Health

There are already signs of progress.

At St Bartholomew’s Hospital in London, the restoration of the historic North Wing has created a dedicated wellbeing hub for staff. By separating restorative spaces from clinical environments and reconnecting them with light, art, and heritage, the project acknowledges a simple but vital truth: caring for caregivers is essential.

The goal is not to turn every hospital into a Maggie’s Centre, nor to remove clinical function from healthcare spaces. Rather, it is to design with a broader understanding of health – one that includes physical, mental, and social wellbeing.

What Comes Next?

Future healthcare environments must do more than contain care – they must actively contribute to it.

This begins with legibility: spaces that are intuitive and reduce anxiety from the moment someone enters.

It requires a commitment to biophilic design: integrating natural light and meaningful connections to nature to support both physiological and psychological health.

And it demands a focus on social connection: creating shared, human-scale spaces that make seeking help feel less clinical and more accessible.

If the future of healthcare is moving from institution to individual, then architecture has a critical role to play.

The spaces we design influence how safe people feel asking for help, how confident they are in managing their wellbeing, and how connected they feel to their communities.

Designing the Third Caregiver

When we create spaces that respect dignity, encourage agency, and foster connection, we are not simply improving aesthetics-we are strengthening the foundations of public health.

The challenge ahead is not only financial or technological. It is cultural and spatial.

We must ask: what kinds of environments make people feel capable, supported, and hopeful?

And how can we embed those qualities into the everyday spaces of our cities?

The built environment is already present in every healthcare interaction – the question is whether we choose to design it consciously.

See: https://www.lee-evans.co.uk/project-cat/health-care/