Jamie Brewster, architect at MJ Medical, has spent the last 25 years designing clinical spaces for hospitals around the world. When he was diagnosed with leukaemia in 2020, a three-week stint in hospital isolation for stem-cell transplantation led him to question every room he had ever designed. He is now on a mission to understand others’ experience of clinical isolation and to figure out how, through better UK design standards, we can improve them. In this piece, he shares his own experience of isolation and what his initial research has taught him.
What is an inpatient isolation bedroom? Is it not essentially the same as any inpatient bedroom, but with a small lobby attached to regulate air quality? In reality this is not the case — a conventional bedroom and an isolation bedroom are, in fact, very different.
Dealing with infection risk
Isolating patients has been a method of treating disease for many years. Since Old Testament times and the establishment of leper colonies, isolation has been seen as an effective means of dealing with infection risk. Sometimes, patients are subject to ‘source isolation’ because they present a hazard to others, for example because they carry a highly infectious disease such as Ebola virus or because they present a radiation risk due to iodine 131 treatment for thyroid problems. In other cases, the patient may be severely immunocompromised and needs protective isolation from all sources of infection. In either case, the term ‘isolation’ is key and perhaps indicates the main difference between this type of inpatient room and other more conventional types.
Isolation demands removing the patient from almost all human contact, often for a considerable period of time. It is true that there are numerous examples of patients remaining in hospital bedrooms for extended periods. The difference with isolation is that the patient is confined. Here, regardless as to whether the patient feels well or extremely ill, they must remain within the room for the duration of their treatment. Unlike a patient in a standard bedroom, their choice to vacate the room for a period is not available. It is common for an isolated patient to have to spend many weeks residing in a single small bedroom, very often with relatively minimal social contact with others.
An architect/patient perspective
In 2020, I was admitted to an isolation bedroom after being diagnosed with leukaemia. Spending three weeks in isolation receiving a stem-cell transplant highlighted just how different it was from the typical inpatient experience. The combination of a gruelling treatment burden with fear and social separation created a unique set of factors that maybe are not fully considered by designers.
My combined experience as both a healthcare architect and a patient led me to review the design of this type of hospital room and also the guidance used by designers. How have designers tackled this type of space in recent hospital developments, and how has NHS design guidance helped and informed them? Following my time as an inpatient, the word experience has emerged as the most important factor and one which I now realise has been somewhat absent in my own and other designers’ approach to healthcare design. While ergonomic, technical, and aesthetic matters are important, I now realise that understanding human sensory and experiential factors is also critical. My patient experience taught me that in the context of ‘person-centred care’, where clinicians might now be encouraged to ask, ‘what matters to you?’ rather than ‘what is the matter with you?’, there is an equal need for designers to adopt a more ‘person-centred’ approach. The question ‘what will it feel like to live in this space?’ is now just as important as asking ‘what will the space look like and how will it perform?’. The drive to address these issues has motivated me to undertake a PhD research project to understand the experiential needs of the immunocompromised inpatient and to explore how they might be addressed through design. Finding solutions to these issues may have the potential to influence future design guidance and, through tackling the needs of a unique and complex patient group, also provide some answers for other patients whose needs are perhaps not as acute but whose experiential response to space is just as important.
Practicalities of isolation — the design guidance
The most common need for patient isolation is related to treatment for blood cancers and the transplant of stem-cells. The pre-conditioning, chemotherapy-induced neutropenia and the wait for neutrophils to return to safe levels creates an extended period — typically three to four weeks — where the patient is at risk of harmful infection as their immune function resets. During this time, it is critical that patients are protected against infection risks through air, water, people, food, and drink.
A key feature of any isolation bedroom is the mechanism to achieve a pressure differential to adjacent spaces and the provision of HEPA filtration to regulate the air quality within the room and eradicate potential airborne pathogens. The NHS provides design guidance on isolation bedrooms within Health Building Note (HBN) 04:01 Supplement 1: Special ventilated isolation facilities for patients in acute settings.1 The focus in the guidance is maintaining safe air quality, and it states that a positive pressure differential of +5 Pa between bedroom and adjacent corridor must be achieved via the provision of an ‘airlock’ lobby arrangement.
With the focus on technical engineering matters to maintain pressure differentials and ventilation rates, little is said in the guidance about countering the challenge faced by a confined occupant. The guidance does recognise the challenge in clause 4.19, where it says ‘…patients who are already vulnerable, but not necessarily severely physically incapacitated, may be confined to the room for sometimes several weeks and can experience long periods of boredom’. Clauses 4.20 and 4.25 in the HBN also make passing reference to the challenge with mention of the need for accommodation to be ‘stimulating and as comfortable as possible’ and also through the provision of ‘outside views and using windows with low cills’. It also states that ‘internet access for the patient should be provided.’
Whether such references are enough to provoke a designer to properly respond to the design challenge of extended isolation is questioned. Is reference to windows and internet access enough and do these provisions make a difference to patients? The inadequacy of the response through guidance is further highlighted when one considers the guidance regarding area provision. The template schedule of accommodation in HBN 04:01: Adult in-patient facilities2 suggests the size of a standard inpatient bedroom should be 19m2. It further states that the size of an isolation bedroom should also be 19m2. Given the unique nature of isolation, might one expect the size of the space to be different and possibly larger? The need for guidance to be refreshed to better recognise the unique challenges of a confined patient seems to be clear.
What does current research literature say about these matters?
The unique set of circumstances faced by confined patients — a combination of social isolation and arduous physical treatment — elevates their response to and decreases their tolerance of environmental factors such as noise, smell, and temperature, ultimately impacting their wellbeing. Useful research on these topics is provided by Hsu et al,3 who has studied the impact of noise in patient environments. Also, Eusbio et al4 provide useful research findings about the impact of odour and the adequacy of ventilation systems in quickly releasing odour from within the patient room.
Similarly, much has been written about the emotional challenges of isolation. Documented accounts by Annibali et al5 describe the emotional experience of inpatients, where extreme boredom, high anxiety, anger, despair, frustration, and even escape behaviour and suicide ideation are recorded. In some cases, this has resulted in symptoms of post-traumatic stress following discharge. Powerful quotations from participants in studies by Biagioli et al6 have also been recorded:
“I was looking at the ceiling and counting the tiles. It’s very bad to be confined in a room. You are sealed in there and you cannot move or talk with anyone. It was like being imprisoned with a strict sentence.”
Similar research carried out by Coolbrandt et al7 and Digby et al8 refer to patient reported outcomes and patients’ efforts to remain courageous throughout the process. Research exploring the difficulties faced by patients during isolation is extensive, therefore, but little is said about the design of the isolation room itself and how this may have impacted patient experience either positively or negatively.
Introducing an auto-ethnographic aspect
Combining my own patient and professional experience has prompted me to consider some questions which perhaps have not yet been posed in research. Questions which do not tend to be asked specifically about life within an isolation room include ‘what could the patient see, what could they do, or not do, in the room, how did sound travel within and into the room, how much connection with the outdoors did the room allow, could conditions within the room be controlled or adjusted’? These queries are relevant in almost any healthcare context but somehow have added significance in the context of strict confinement. There is clearly an opportunity to address a gap in the research context and to explore the need for new solutions and how these might be delivered.
Going beyond a simple auto-ethnographic account of my own experience, the study has received NHS ethical approval to engage with staff and former patients. The study focuses on three hospital environments typical of the UK healthcare estate — an old facility suffering from extensive back-log maintenance (University Hospital of Wales, Cardiff) a refurbished facility (The Haematology and Oncology Centre, Bristol), and a new facility (The Grafton Way Building, UCLH London). Patients who have experienced time receiving an allogeneic stem-cell transplant in an isolation setting are being interviewed to obtain their recollections and opinions about their isolation experience. Similarly, clinical staff are also being interviewed to obtain their views about how the isolation room might impact their ability to treat and engage with patients. The intention is to refocus the view of isolation using a more forensic lens with an emphasis on daily patient and staff activity throughout the period of treatment.
Using my own experience as both patient and architect provides a unique blend of insight and empathy. Indeed, to support engagement I have analysed my own time in isolation by illustrating daily activities within the space. Consideration of what I did, using which items or ‘things’ in which part of the space, at different times throughout each day, perhaps illustrates the day-to-day experience of isolation in a more meaningful manner, especially when overlaid with thoughts and emotions which were prevalent at the time. Core daily activities have therefore been ‘mapped’ in the space to understand how I lived in the room and how it may or may not have influenced my response to confinement.
This approach is influenced to some degree by the work of architect Sarah Wigglesworth, who has used the concept of ‘activity mapping’ in analysing how a domestic dining table might be used over the course of an evening and what this might mean for the design of a house and how a designer might approach it. In her paper The Disorder of the Dining Table9 she states the following:
Accepting the accidents, embracing the unexpected, and learning to admire ‘the dirt’ that results, is part of acknowledging that life isn’t always as we expected; and this challenges our ability, as architects, to predict and manage the realities of lived experience.
Applying this thinking to an auto-ethnographic account of occupation of a space begins to suggest a number of techniques to analyse this and to inform engagement with study participants.
An exercise in overlaying all the various activities, personal items, equipment, and furniture provides an interesting analysis of the space — something which has rarely been done in normal design practice. Much effort and time is often spent in locating all fittings and furniture within a space, as part of the traditional detail design process in healthcare. The focus is on ergonomic fit, function, and compliance, and yet analysis of activity, movement, and use of space is rarely illustrated and analysed. This is surprising, especially in the context of initiatives such as the government’s New Hospital Project, where prototyping and optimisation figures highly in settling upon finalised layouts. The patient voice (the way they behave, the things they use, the space that they need) seems to be diminished somewhat in the face of pure function and clinical efficiency.
Initial research findings
In 2025, I commenced ‘pilot’ interviewing with a number of clinicians and former patients. The full interview phase of the study commenced in March 2026, and is expected to complete in October. A full analysis of interview data is not yet available, therefore, but some useful feedback is already available, with two common themes emerging.
Firstly, the room size needs to be larger, recognising the length of time the occupant must spend in the space and the activities that would ideally be possible given that patients might not feel unwell for the entire duration of the process. This points to the need to refresh guidance and reference to recommended area allowances in particular.
Secondly, early clinician feedback confirms that the room environment and its impact on patient well-being does have a direct physiological consequence. According to initial discussions with some clinicians, there is a high likelihood that a patient whose wellbeing is low will take longer to recover and will need more post-treatment care and rehabilitation. As has been highlighted many times by Roger Ullrich and others,10 there is a correlation between a patient’s response to the environment and physical wellbeing. The impact upon revenue and staff resource seems to be clear and perhaps supports the idea that some increased short term capital spend (which increasing the size of isolation facilities would likely entail) would have demonstrable benefits in reduced post-treatment rehabilitation and revenue costs.
Closing remarks
Recent advances in medical treatment have introduced some alternatives to conventional isolation treatment for blood cancers. Chimeric Antigen Receptor T-Cell (Car T-Cell) therapy has emerged as an alternative to stem-cell transplant for some patients. Here, isolation may not be routinely required for treatment. There is also now an increasing prevalence for some stem-cell transplant patients to be treated on an ambulatory basis, with care taking place either at home or in a hotel close to the hospital. However, almost all UK hospitals still use inpatient isolation as a means of protective care for some cancer patients and, based on current clinical thinking, this need is certain to continue. It is also worth remembering that the use of isolation facilities is not restricted to patients with blood cancers. Isolation can be needed for other types of inpatient, too.
The use of isolation in clinical treatment is an unfortunate necessity. Sometimes it is the only way to manage risks during treatment. So, designers and the guidance that inform their work need to better recognise the unique circumstances faced by the confined inpatient. Not only are there some important technical and ergonomic issues to address, but also some more affective and experiential matters to recognise. This study represents a significant opportunity to address a gap in the research and to suggest some improvements which while small in nature will be of enormous benefit to both patients and the staff who engage with them.
Jamie Brewster
Jamie Brewster, architect at MJ Medical, thought he had amassed all the knowledge needed after 25 years in healthcare design. Only through experience in an isolation room receiving treatment for leukaemia did he begin to question his approach. His PhD research seeks to understand the inpatients’ experience of isolation and, through a refresh of design standards, whether there might be new solutions.
References
1 HBN 04-01 Supplement 1 https://www.england.nhs.uk/wp-content/uploads/2009/12/health-building-note-04- 01-supplement-1-july-2025.pdf
2 HBN Note 04-01 https://www.england.nhs.uk/publication/adult-in-patient-facilities-planning-and-design-hbn-04-01/
3 Hsu T, Ryherd E, Persson Waye K. Noise pollution in hospitals: impact on patients. Journal of clinical outcomes management: JCOM. 2012;19:301-9
4 Eusebio L, Derudi M, Capelli L, Nano G, Sironi S. Assessment of the Indoor odour impact in a naturally ventilated room. Sensors (Basel). 2017;17(4)
5 Annibali O, Pensieri C, Tomarchio V, Biagioli V, Pennacchini M, Tendas A, et al. Protective isolation for patients with haematological malignancies: a pilot study investigating patients’ distress and use of time. Int J Hematol Oncol Stem Cell Res. 2017;11(4):313-8
6 Biagioli V, Piredda M, Alvaro R, de Marinis MG. The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis. Eur J Cancer Care (Engl). 2017;26(5)
7 Coolbrandt A, Grypdonck MH. Keeping courage during stem cell transplantation: a qualitative research. Eur J Oncol Nurs. 2010;14(3):218-23
8 Digby R, Kramer S, Yuan V, Ozavci G, Bucknall TK. Patients in isolation, their physical, environmental and mental health: An exploratory study. J Clin Nurs. 2024;33(9):3526-38
9 Wigglesworth S. The Disorder of the Dining Table. UOU Scientific Journal. 2022;4:122-7
10 Ulrich RS. Effects of interior design on wellness: theory and recent scientific research. J Health Care Inter Des. 1991;3:97-109