“Evidence-based design” of hospitals has been credited with laudable improvements in patient care: faster recovery, reduced medication errors, improved staff safety and lower stress levels for everyone. The proponents of this design approach aren’t radicals. They are architects whose design reflects scientific research that proves certain environmental characteristics can create impressive results.
In the last decade, leading researchers proposed the idea that hospital design decisions should be based on documented results. From that point forward, rather than make assumptions about how to design a better functioning hospital, the
profession took the position, “We need to prove it.”
Most of us have first-hand knowledge of the annoying aspects of hospitals—the disruptive noises, harsh lighting, stark décor, uncomfortable furniture, lack of privacy and more. And the staff can cite many design features that make it difficult to deliver the best medical treatment. Thanks to the ongoing compilation and quantification of hundreds of studies on the affects of certain environmental factors, architects know much more about how to improve outcomes.
Let’s take a tour of a model evidenced-based designed hospital to understand the environmental changes (underlined) it incorporates.
Starting at the entrance … visitors and patients find their destinations easily because proper wayfinding is integrated into the design, not just added as a layer of signage or colored arrows on the floor. One study estimated the cost of confusion in a large hospital complex to be about $220,000 and equated it to about 4,500 hours of staff time in giving directions.
The furniture in public areas is arranged in smaller, homier groupings to allow conversation and interaction.
In patient treatment areas you notice it is quieter, calmer. Thanks to decentralized organization of patient areas, the staff is spending less time walking through the corridors to access patients, charts and supplies and equipment traffic is lower. Many of the loud paging systems and alarms are replaced by quieter but equally effective communications. To the extent possible, sound-absorbing materials are part of the furnishings. The data confirmed that ample rest and sleep are essential to recuperation.
The equipment and furniture is ergonomically designed to lessen staff fatigue and injury and add to patient and visitor comfort.
There is only one patient per room and it has comfortable space for visitors. While single rooms could be perceived as increasing costs, in reality, they are a good investment. (See chart.)
Natural light comes in through the window which looks out to a garden area. Among the many advantages of exposure to natural light and pleasant artificial light levels is the tendency to take less pain medication, have fewer complications, less stress, and quicker recovery. Access to nature via healing gardens and window views is also calming and restorative.
Out of view is a well-designed ventilation system equipped with air filters to reduce the risk of hospital-acquired infections. You will see many hand-washing stations. The goal is to do much better than the shocking statistics: “Up to 2 million US hospital patients—1 in 20 of all those admitted—contract dangerous infections every year during their hospital stays” (Evidence-Based Hospital Design Improves Healthcare Outcomes for Patients, Family and Staff, June 7, 2004, the Robert Wood Johnson Foundation website.)
In the nurses’ area, appropriate task lighting supports accurate charting and reduces glare on computer monitors. Studies found that the combination of fatigue, stress, cramped work spaces and poor lighting increases the likelihood of staff errors in recording or reading patient information.
Throughout the patient area you see various positive distractions that de-institutionalize the environment. Certain types of music, nature-inspired artwork, even visits by animal companions lighten patients’ moods and reduce stress.
Evidence-based design is a valuable means of justifying the expense of modifying existing buildings or developing budgets for new construction. And now, the designer can point to proof that healing gardens do help heal and that hospital environments as a whole are part of the solution for improving our healthcare system.