Designing with Optimism: Ekkist speak to Dame Laura Lee DBE, Chief Executive of Maggie’s

Maggie’s Leeds by Heatherwick Studio
Maggie’s Oldham by dRMM

Maggie’s is a charity providing free cancer support and information through its uniquely designed centres across the UK and internationally, as well as online. Maggie’s centres are known for design excellence, often being shortlisted for architectural awards and even winning the prestigious Stirling Prize.

Because of this reputation for placing the well-being and mental health of people at the heart of every design, we were curious to learn more about their unique approach. Ben Channon, Director at Ekkist, spoke to Laura Lee (Chief Executive of Maggie’s) for an insight into their ethos and what it takes to create such special buildings.

Unique to the organisation is the job title ‘Architecture Co-client’, which Laura explained emphasises the idea that if you want a good end product, the client should not just be part of the team at commissioning or planning stage.


Laura: I think you really only get a good end product when the client is consistent throughout a project, and has a consistent approach in terms of culture and behaviours from the ‘running a business’ perspective. This means when it comes to making decisions about value engineering and so on, we as the client get to make the key decisions about what is important and what is not in terms of creating the right feeling – as opposed to these decisions being made by a finance director or accountant. It’s emphasizing the idea that if you want a good end product, the client need to stay involved throughout the process.


We work with different architects each time, so expect them to come at it from a fresh direction. We give them the freedom to be the investigator of the social challenge that the Maggie’s brief is asking for in terms of helping people with cancer, supporting staff through a good place of work, and challenging those staff in terms of disrupting those traditional ways of working. Because the architect is coming at these problems from a different perspective each time, staying consistent as a client works well.


Ben: It almost feels there’s a sense that as the ‘co-client’, you represent the people using the centres for cancer support – would you say that’s fair?


Laura: Yes absolutely! And in a way, our brief is both a functional brief – we need X number of rooms, storage space, toilets and so on – but the more important bit of the brief is about how we want the buildings to make people feel, and we’re quite passionate about the fact that you can’t retrofit that. Nice furniture and art can go a long way, but the feeling that a building and its spaces can create is really what we are interested in. If you get too far down the line, you can’t fix the way a space makes people feel. We’re quite explicit about those feelings in our briefs: our buildings have to be inspiring; they have to give people a sense of hope, a sense of control, and make people feel less alone but still be on their own if they want. There is a whole set of quite contradictory ‘feelings’ within that brief, but that’s what we’re the guardians of.


Ben: Having looked at your brief, I think it’s one of the strongest and most interesting I’ve ever read as an architect. As you say, it’s very specific in some ways but then very loose and open to the architects’ interpretation in others, so I found it fascinating.


Now, Maggie’s have been going for around twenty-five years now, and during that time have produced undoubtedly some of the most health-focused architecture not just in the UK but worldwide. Why do you put so much emphasis on design as an organisation?


Laura made the interesting analogy that in the business world – Apple, for example – there is a strong focus on behavioural questions such as: ‘How can we get more customers in our store to buy our products while not feeling like we’re queuing and waiting?’ For such companies, there’s a profit in thinking like this.

Laura argued though that when we look at healthcare, social care or civic buildings, profit should perhaps be viewed in a different way. ‘Profit’, she says, is generally understood in terms of savings – getting the lowest price or the highest shareholder returns, but for Maggie’s profit is more to do with social well-being and mental health benefits.


Laura: Most people who are visiting the centre don’t know who the architect or landscape architect is, so it’s much more about how they feel within those spaces. We interview quite a lot of architects, and often it’s just a feeling we get from a conversation about whether they are in the right place in their careers or development for us or in the right place emotionally. For us it’s about choosing an architect who’s right for what we want to do, who has strong emotional intelligence, and put the brief ahead of the ‘object’.


Ben: It’s clear that one of the core fundamentals of your buildings is trying to make people feel good, and you’ve obviously delivered a lot of buildings that really achieve this goal.


Laura: Rather than always making people feel good, it’s often actually about making people feel that their curiosity is stimulated, and that they can really be themselves. We have a strapline at Maggie’s: ‘Everyone’s home of cancer care’, and while we’re obviously not creating homes, they do have domestic tropes and it’s often about this question of ‘what does home represent to people?’ It’s where you feel safe, where you can let yourself go, where you can face some of your darker issues – so it’s not just ‘good’, it’s about being hopeful and aspirational as well as being challenged.


If you take the West London one for example – Dan Pearson (landscape architect) has designed a slightly gritty pathway as you come off the road, so your feet are aware that you’ve changed surface, while you’re walking into a nature-filled space. All of that is just starting to create a shift in the brain, that the subconscious is busy processing. That’s what we’re really interested in – how those built elements can start to help us to do our work. So as people are approaching the centre for the first time, they’re maybe feeling anxious or apprehensive, perhaps worrying about talking about cancer, yet distractions like nature, specially curated views, colour, materials – even if people aren’t quite aware of them – help to reduce that sense of apprehension and give people courage.


I was intrigued by these ‘magical things’, so wanted to ask Laura whether Maggie’s have a list of conditions or characteristics that every centre must have to support health and well-being. Laura emphasised that a sense of freedom and autonomy is integral to each scheme’s design, with a large part of their approach based on giving people more of a sense of control over their environment, ensuring they feel more at home. It’s important to them, for example, that you can make your own cup of tea and one for somebody else without having to ask permission.


Ben: One of the things we get asked about most is this idea of ‘added value’, and how we can demonstrate that spending money on a better building or on something like WELL Building Certification will add ‘value’. For you I suppose added value doesn’t really relate too much to financial gain, but it’s probably more connected to what we’d call social value?


Laura: The added value comes from us being able to do our business more effectively, because people want to come back, people feel supported by the building, our staff turn up for work and we retain those staff, even though they’re often dealing with difficult stories every day. We’re all aware of the issues around workforce retention in the NHS, and it’s interesting to think about the role of buildings in that. At the Cleveland Clinic for example, they apparently reduced the number of beds in order to improve the staff and patient experience and create more of a feeling of empathy. This is the kind of decision that will probably lead to profit because those patients will likely have a better experience and come back…


…I think we really need to reassess the idea of short-term profit over longer-term gains in their many forms. There are obvious gains around maintenance costs. If you build with good materials – you can actually get a building that looks more beautiful when it’s been open for twenty years instead of one that looks sad and is degenerating. If you invest in these things up-front there’s a good chance you can achieve that.


Ben: Have you looked into ways of measuring those less tangible elements like user experience or patient outcomes at Maggie’s?


Laura: Yes it’s definitely something we’ve been exploring. We’re lucky as we’ve had a good start with Maggie and Charles Jencks knowing that architecture really mattered, and we also knew that we didn’t want to feel like ‘The NHS’ – instead we wanted to create buildings that people truly wanted to visit. That doesn’t mean that over the years we haven’t had to debate with donors and fight for good design or how much we’re spending per square foot, but we’ve had to make the business case for good design.


We’re often building on very challenging sites, so having a bit more investment in the building is even more important. With our focus on good materials, good light, good views and nature – those magical things – we have managed to convert many people to ‘contemporary design’ which is often considered negatively in a more general sense.


Laura: Another example is that we never have signs showing where the toilets are – so if somebody has to ask someone else “do you know where the toilet is?”, there’s an interaction there. It’s all about creating moments of reciprocity. We know that people feel better through the giving and receiving of kindness, however small those interactions are.


The right to be able to move the chairs around, to be able to pull up a chair that is comfortable for you, or to move them into a private room, it makes for a better experience, and helps people not to feel like they’re simply being ‘processed’. Similarly, not having a formal reception desk means that the person visitors first speak to is a cancer support specialist, so they are immediately speaking to the right person. By giving people control, choice, and acknowledgement by a relevant person upon arrival, we can make the experience much more pleasant and personal.


We’ve tried to learn from companies like Google too, where they’re trying to create highly appealing workplace environments. In contrast, we’ve faced sites before where a hospital might be in a very remote location, with poor parking facilities and public transport links. If there are no shops or amenities nearby, staff are forced to make another stop on the way home and it becomes very challenging for our teams. So this idea of useability and liveability are very important for us too.


Landscaping and biophilic elements also play a key role in what the Maggie’s Centres are looking to achieve, but as Laura explained to me, this was an area where their understanding has developed over time, improving with each new centre.


Laura: It took us a little while to discover that if you can design the garden with the building at the same time you get a more powerful impact. This was probably compromised in the early days, where we often didn’t have enough landscape budget or realise the importance of this, so the garden was seen as secondary. Those early centres are still great, but when you start to look at the buildings where we really got it right, the (Rogers Stirk Harbour + Partners) building in west London, the Rem (Koolhaas) building in Glasgow, they just work so well. Since those projects, the landscape architect has always been part of the design team from the very beginning, and you’re asking the landscape design to really ‘infiltrate’ the architecture and blur the boundary between building and garden.


Amanda Levete’s centre is a good example. It’s in a sea of car-parking, so she’s just sunk the building down and slightly mounded up the landscape. When you’re inside this means you don’t perceive the cars, and you just get this sense of the surrounding garden coming into the building. And a good landscaper should also be challenging where the windows should be in relation to views and things to capture – these have all been very important learnings for us over the years.


Ben: Hopefully that will be an area that continues to grow over the next few years as we’re seeing such a big focus on biophilia at present.


Laura: Definitely, although the thing about biophilia is to make sure it’s not just used superficially or as a token gesture like a type of green-washing. We need to consider the type of plants, the placing of plants, the views – sometimes it doesn’t need to be very much, but just enough to give your eye somewhere to go.


Ben: There seems to be a crossover developing between the worlds of design and healthcare. As somebody who has entered the world of architecture and design from the world of medicine, do you feel that more buildings and more design teams could benefit from having health professionals or health experts on board?


Laura: Yes, although I don’t suppose there are a huge amount of people within the world of healthcare who have necessarily considered it. It’s certainly one of the things we’ve been thinking about at Maggie’s, whether there’s a possible consultancy role that could exist either helping people with briefings or design reviews from a health perspective.


In healthcare, we still see a lot of projects that are very heavily focused on productivity. Often staff or patients might not get much access to natural light as plans get deeper or privacy takes precedence, so of course their circadian rhythms suffer. We end up with those rooms we all know that are full of plastic chairs and don’t have any views in an already stressful environment. So yes, there’s an opportunity to provide more of those ‘special spaces’ where things can just be a little nicer for the people using them.


If you look at our Dundee centre: 40% of the budget was spent on the ceiling! And people might think that’s bonkers, but then you come in and the ceiling is the thing that creates the joy. We could have just plastered it of course, but it makes the building what it is.


We love creating joy at Maggie’s. And sadly, those elements would often be value engineered out by your typical developer, but they are what create the magic in spaces, and they can be far more important than we give them credit for.


I personally believe the same should be true for all places of work, not just healthcare buildings. What’s to say you shouldn’t feel better when you leave work than when you arrive? As a straightforward mission in a building, you can’t go far wrong with that as a goal.


After my call with Laura, I was left with a sense of excitement and optimism: excitement for what our industry has the potential to achieve, and optimism because clients like Maggie’s are already showing how it can be done with great success. So much of what Laura said resonated with me, from creating buildings that empower people to the importance of this indefinable concept of ‘joy’. But perhaps the biggest lesson to take from this conversation is a re-thinking of how we define value – not as a number on a page or something calculated by an agent, but in terms of the improvements to people’s everyday lives.