Healthcare buildings as supportive environments

  • International Academy for Design and Health
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Why should hospital buildings be regarded as special buildings in society? Why do the big hospitals look like permanent building sites? How does the staff experience their environment and how often do they have thoughts about their working places? How do health care buildings function as supportive environments for care? This paper will seek to analyse these questions from the viewpoint of historical architectural development of the hospital and the issue of the local environment, namely the hospital ward, which occupies the largest part in surface area of all hospitals and effectively constitutes the primary 'living' area for staff and patients and the place in which the staff conduct their major tasks. Much of that discussed and observed with regard to the hospital ward, is also valid and may be applied to other hospital units. Finally, the question on the criteria and requirements involved in planning large hospitals as applied in the RIT 2000 international programme recently conducted in Scandinavia are addressed and the article concludes by highlighting the principles of design theory the applications of which would serve to unify the various requirements with which to draw up good designs for healthcare buildings.

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... Architect Alan Dilani (2000) adopts Antonovsky's (1996) principles for designing healthcare facilities. Dilani designed the PSD approach. ...
... Dilani designed the PSD approach. It is presented as a useful framework used by designers who study how the physical environment affects wellness (Dilani, 2000). Thus, he listed design features based on Antonovsky's sense of coherence factors (Table 1). ...
... Thus, he listed design features based on Antonovsky's sense of coherence factors (Table 1). He also reinforces the coherence model in healthcare facilities as a means to enhance patients' psychological healing (Dilani, 2000(Dilani, , 2009. Ulrich (1997) maintains that promoting health in healthcare facilities is enhanced through stress management. ...
Purpose: The purpose of this study is to develop a practical framework that combines the psychological supportive design features in hospitals’ healing environments, also, to examine the implementation of these features in a Jordanian public hospital. Background: Positive psychological feelings are the hidden powerful treatment in hospitals. Although that Jordan represents a third-world country, it is counted as one of the most sought-after healthcare locations in the Middle East for its distinguished healthcare serveries (Private Hospitals Association, 2019). Nevertheless, the architectural and interior design of the healthcare facilities in Jordan usually ignores the inpatients’ psychological needs. Also, there is an absence of practicing a set of psychological supportive design features to guide the hospitals’ design in Jordan. Method: Design features are obtained from the main theories in the field of supportive healing environments. A large Jordanian public hospital was selected to be assessed in terms of these features within the developed practical framework. This study adopts a mixed methodology; data are collected using different methods, mainly literature review, site inventory, and inpatients’ questionnaire. Results: The studied hospital remains moderately considerable in terms of the psychologically supportive design features. However, the nature connectivity aspect is not satisfactorily considered in the studied hospital design. Conclusion: This study suggests a responsive design that fosters interaction and integration with surrounding nature in order to increase levels of connectivity with nature. The studied design features in this study could work as guiding principles for Jordanian hospitals’ designers.
... 112 and 115). The resulting large block hospitals have been said to represent care factories and these hospitals reflect the development of health care in the direction of productivity and depersonalization (Dilani 2000). The interior design of hospitals was at the time of construction influenced by demands for hygiene and cost-effectiveness; it had to be possible to keep the hospitals meticulously clean with the least possible effort, and minimum design kept costs down (Birch-Lindgren 1934 p. 211;Fridell 1998 p. 115). ...
... Studies focusing on aspects of environments in relation to human health are also to be found within the field of architecture/design and environmental psychology, where the terms "supportive environments" and "supportive design" are used. Dilani (2000; suggests that environments reflect the ideology under which they were constructed, and that hospitals built during the 1940−1960 era often express dehumanizing industrial production. It has been said that supportive environments of care are small-scale, with a familiar and non-institutional atmosphere and harmonious colours as well as access to daylight and nature − aspects that have been shown to reduce stress among patients (Ulrich 1991). ...
... In line with previous suggestions that health care environments convey different messages of care and the humans in them (Dilani 2000; this study contributes with empirically derived understandings of how patients, significant others and staff experience symbolic messages of worth and worthlessness, and caring and uncaring in settings. This study further provides support to the assumptions that environments in which people can make sense of what is going on, in which they feel they are listened to, involved and needed, in which there are places for them to meet others but still find privacy, and which offer natural scenery strongly influence experiences of being in these settings (cf. ...
... Mintz 1972 also studied the effects of aesthetic surroundings by prolonged and repeated experience in "beautiful" and "ugly" room [31]. Similar studies have been made in hospital environments [7,12,13,44]. Dilani [13,14] studied work environment´s influence on hospital staff, and Caspari et al (8] studied patient's opinion of healthy hospital environments. * Recent studies on aesthetics on other workplaces are rare. ...
... Similar studies have been made in hospital environments [7,12,13,44]. Dilani [13,14] studied work environment´s influence on hospital staff, and Caspari et al (8] studied patient's opinion of healthy hospital environments. * Recent studies on aesthetics on other workplaces are rare. ...
... The aesthetic and ergonomic needs for improvements were outcome variables. The definition of workplace aesthetics varies [10,11,13,19,40]. In this survey we asked for the subjectively perceived needs to obtain data for future more detailed studies. ...
Associations between self-reported needs for aesthetic and ergonomic improvements were studied to analyse a possible impact of aesthetic needs on job performance as compared to ergonomic needs in 11 occupational groups. Employees at Swedish broadcasting company were invited to participate in a cross sectional study. 74% (n = 1961/2641) fulfilled the inclusion criteria. Demographic data from company files and a pre-validated questionnaire were used. 'High rank' and 'low rank' aesthetic and ergonomic needs were compared. The perceived needs for aesthetic and ergonomic improvements showed significantly different distributions (p<0.001). Aesthetic needs were more frequently reported. No gender related differences were observed. Differences between occupational groups were shown (p=0.006, 0.003). 'High rank' needs for aesthetic and ergonomic improvements were similarly associated to psychological demands, stress, pain and age. 16/24 factors showed significant differences between 'high and low rank' aesthetic needs, whereas 21/24 between ergonomic needs. Sick leave was stronger related to ergonomics. The study results show a relation between not only work place ergonomics but also work place aesthetics to health and well-being. Future work health promotion and prevention may benefit from the inclusion of workplace aesthetics.
... By writing the brief of Maggie's cancer facility (Maggie's 2015), she sparked the creation of Maggie's Centres. These motivated distinguished architects to be involved in healthcare projects and at the same time supported the already brewing patient focused advocates of healthcare architecture (Chrysikou 2018;Dilani 2000) to back compassionate models. ...
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A review of the recent exhibition ‘Living with buildings: health and architecture’, curated by Emily Sargent, at the Wellcome Collection.
... Architectural auditing: data on the physical environment and sense of place of the wards derived from a systematic architecture account for spatial organization, therapeutic regime, salutogenic qualities, i.e., the building qualities that enhance health [63][64][65] such as day lighting, art, natural views, and access to nature based on visits, photographical auditing, and plans. Regarding the plans, architectural blueprints were compared on their analogies of areas per use and user group. ...
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The pluralism that characterized the development of psychiatric services around the world created a variety of policies, care models and building types, and fostered experimental approaches. Increased complexities of care, institutional remnants, stigma, and the limited diagnostic and interventional accuracy of psychiatric treatments resulted in institutional behaviors surviving, even in newly built facilities. is was raised by research on awarded psychiatric buildings. e locus of the research comprised two acute psychiatric wards in London. Each was evaluated using the SCP model, a tool specifically developed for the evaluation of mental health facilities, identifying the relation between policy, care regime, and patient-focused environment. Data were derived from plans, visits, and staff and patient interviews. Findings were juxtaposed to those of an earlier study using the same methodology. Also, a syntactic analysis was conducted, to identify the social logic of ward layouts. ere were potential connections between regimes, spatial configuration, and the social fabric. Methodologies of architectural morphologies indicated areas that would attract people because of the layout rather than function. However, insights into medical architecture outlined institutional undercurrents and provided alternative interpretation to spatial analysis. Comprehending the social fabric of psychiatric facilities could challenge the current surveillance-led model, as psychosocial rehabilitation uses could be encouraged at points of higher integration.
... There are parallel, overlapping, theoretical approaches that focus on the research and implementation of evidence-based eco-psychosocial interventions aiming to support the mechanisms that generate health or help combat disease. These are known as therapeutic architecture (Chrysikou, 2014), generative space (Ruga, 2008) or salutogenic design (Dilani, 2000); terms having close links to the theory of salutogenesis from the field of Medical Sociology. Salutogenesis refers to the possible impact from interventions to increase individual well-being and sense of social coherence. ...
The built environment is essential for well-being at old age. The theory of salutogenesis, focusing on health, rather than the disease itself, provides evidence that space contributes to health and well-being. This has influenced healthcare architecture through facilities designed to support well-being. So, increasingly healthcare facilities aim to look like hotels to improve user experience. This retains conceptual and usage gaps between hospitality and healthcare but supports cross-fertilization of best practice. This paper explores possibilities of synergies between healthcare facilities and hospitality industry. Appropriate services and well-being across the lifespan is the ultimate objective, and the physical environment is critical in that provision. Examining the architectural typology of the dementia village as case study, it explores healthcare–hospitality hybrids. Learning from both domains can contribute to silver economy while providing the aging population with enhanced environment. Aging population and stakeholders in this ecosystem can benefit from these synergies.
... The multidisciplinary and the intercultural application of the " Sense of Coherence, " an essential element of the salutogenic theory [13], has influenced a growing body of research based design framework of the built environment, creating a platform for a creative dialogue between healthcare and architecture [14][15][16]. Although Antonovsky did not aim directly at the spatial elements, which are considered part of the physical pillar [17] that lead to increase somebody's " Sense of Coherence " [18], his theories has prompted the generation of a variety of fields, including practitioners of medical architecture, salutogenic design or design and health field [19][20][21], and Healing Gardens [22]. The work of Zeisel on Alzheimer's [23] is a paradigmatic example of the three pillars of Salutogenesis connecting health, space, and society and stresses the benefits deriving from their synergy, as depicted in Figure 1. ...
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Research has demonstrated that enabling societal and physical infrastructure and personal accommodations enhance healthy and active aging throughout the lifespan. Yet, there is a paucity of research on how to bring together the various disciplines involved in a multidomain synergistic collaboration to create new living environments for aging. This paper aims to explore the key domains of skills and knowledge that need to be considered for a conceptual prototype of an enabling educational process and environments where healthcare professionals, architects, planners, and entrepreneurs may establish a shared theoretical and experiential knowledge base, vocabulary, and implementation strategies, for the creation of the next generation of living communities of active healthy adults, for persons with disabilities and chronic disease conditions. We focus on synergistic, paradigmatic, simple, and practical issues that can be easily upscaled through market mechanisms.This practical and physically concrete approach may also become linked with more elaborate neuroscientific and technologically sophisticated interventions. We examine the domains of knowledge to be included in establishing a learning model that focuses on the still-understudied impact of the benefits toward active and healthy aging, where architects, urban planners, clinicians, and healthcare facility managers are educated toward a synergistic approach at the operational level.
... The concept of ''servicescape'' has been used in marketing and health care marketing to emphasize the impact of physical environments on employees in service settings through emotional, affective, cognitive, and psychological states and perceptions (Bitner, 1992;Hutton & Richardson, 1995). In a similar vein, other researchers have studied constructs from the pathogenic perspective, including the reduction of exposure risks to diseases, in addition to the psychological, social, and spiritual needs according to the salutogenic perspective, which focuses on health promotion processes in health care facilities (Dilani, 2000). ...
In health care, architects, interior designers, engineers, and health care administrators need to pay attention to the construction and design of health care facilities. Research is needed to better understand how health professionals and employees perceive their work environment to improve the physical environment in which they work. The purpose of this study was to test the effect of the physical environment of hospital pharmacies on hospital pharmacists' work outcomes. This cross-sectional mailed survey study of individual hospital pharmacists used a structured questionnaire developed to cover perceptions of the ambient conditions and the space/function(s) of pharmacists' work environments. It included aspects such as dispensing areas, pharmaceuticals areas, storage areas, and administrative offices. Work outcomes were job satisfaction, intentions to leave or reduce job working hours, and job-related stress. Hospital pharmacists in Taiwan (n = 182) returned the mailed surveys. Structural equation modeling was performed to validate the construct of the physical environment of a hospital pharmacy and the causal model for testing the effect of the physical environment on pharmacists' work outcomes. For hospital pharmacy workplaces, more favorable perceptions of the workplace's physical environment were positively associated with overall job satisfaction, but such perceptions were also negatively related to intentions to quit employment or to reduce working hours. However, the effect of the physical environment on job stress within the workplace was not supported. The designs of physical environments deserve attention to create more appropriate and healthier environments for hospital pharmacies. Further research should be devoted to trace more psychological responses to the physical environment from a longitudinal perspective.
Associations between self-reported need for aesthetic improvements in the workplace and the need for ergonomic improvement and health factors were investigated to determine the possible impact of aesthetic needs on job performance. The need for aesthetic improvements were compared with the need for ergonomic improvements. All employees at a Swedish broadcasting company were invited to participate in this cross sectional study. Of those who fulfilled the inclusion criteria the participation rate was 74% (1961/2641). Demographic data was obtained from company files and pre-validated questionnaire was used for data collections from the participants. additional questions on needs for improvement were developed, tested for repeatability, and demonstrated to be within acceptable limits. Differences between 'high rank' and 'low rank' aesthetic needs and ergonomic needs were correlated to set ups of demographic, work environmental and organisational and health variables.The perceived needs for aesthetic and ergonomic improvements showed significantly different distributions (p<0.001). Aesthetic needs were more frequently reported than ergonomic needs. There was no significant gender related difference in response distribution of aesthetic or ergonomic needs, whereas differences between occupational groups were shown (0.006 and 0.003). 'High rank' needs for aesthetic improvement were associated to psychologically demanding work, negative work stress, sleep disturbances, problems at work, musculoskeletal pain and lower age. Gender and physical training did not differ between 'high and low rank' responders regarding neither aesthetic nor ergonomic needs. Sick leave was stronger related to ergonomics. The independently tested associations with aesthetic needs were similar to, but fewer than those for ergonomic needs with regard to the variable set ups. Sixteen studied factors out of 24, showed significant difference between 'high and low rank' aesthetic needs, and 21/24 of ergonomic needs, independently tested. The study results show a relation between work place aesthetics and health and well-being. Future work health promotion and prevention may benefit from the inclusion of an assessment of workplace aesthetics.
Midwives providing care as lead maternity caregivers in New Zealand provide continuity of care to women who may give birth in a variety of settings, including home, primary units, and secondary and tertiary level hospitals. The purpose of this study was to compare mode of birth and intrapartum intervention rates for low-risk women planning to give birth in these settings under the care of midwives. Data for a cohort of low-risk women giving birth in 2006 and 2007 were extracted from the Midwifery Maternity Provider Organisation database. Mode of birth, intrapartum interventions, and neonatal outcomes were compared with results adjusted for age, parity, ethnicity, and smoking. Women planning to give birth in secondary and tertiary hospitals had a higher risk of cesarean section, assisted modes of birth, and intrapartum interventions than similar women planning to give birth at home and in primary units. The risk of emergency cesarean section for women planning to give birth in a tertiary unit was 4.62 (95% CI: 3.66-5.84) times that of a woman planning to give birth in a primary unit. Newborns of women planning to give birth in secondary and tertiary hospitals also had a higher risk of admission to a neonatal intensive care unit (RR: 1.40, 95% CI: 1.05-1.87; RR: 1.78, 95% CI: 1.31-2.42) than women planning to give birth in a primary unit. Planned place of birth has a significant influence on mode of birth and rates of intrapartum intervention in childbirth.
As emergency obstetric care (EmOC) services are being upgraded, many health planners are considering structural changes to the health facility. Preparing for a renovation is a long process which involves three phases: assessment, planning and implementation. Input from many sources during the course of this process is important. Some design objectives, simple planning techniques and cost considerations are presented. In this paper we discuss some of the critical aspects (based on published literature) in assessing, planning and implementing renovations at an EmOC facility. The actual in-the-field experience of renovations and repairs will be explored in a second paper in this issue.
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