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UNI VERSI TYOFNI COSI A DEPARTMENT OF ARCHI TECTURE ARCH-402 AdvancedAr chi tect uralSt udi o 13 R ese arc h c otb oe 0 ...



ARCH-402 Adv anc edAr c hi t ec t ur al St udi o

R e s e ar c h By :THEODOROSZARKAS

o c t o b e r2 0 1 3




Sustainable Design Unit


Design for Healing…a place of birth (maternity clinic)

theodoros zarkas 22-Apr-14 12:34:39 I 131004b DESIGN FOR HEALING

october 2013 1


DESIGN FOR HEALING What sort of hospitals do we want in the twenty first century, how might they differ from those of the recent past and why do we need to change them? What is the true purpose of hospitals? And how can we reconceptualise our understanding of this purpose to give greater meaning for better healing?

‘..we are seeking to define architectural principles that are less about achievement of the individual and more about man as part of community..’

‘Architecture occupies a curious yet crucial position in human history. In effect, it is the most resonant manifestation of what it really means to be human, embodying how we conduct our relationship with each other and the planet. Architecture crystallises the essence of human civilization in ways of art, literature, music and science do not. It gives us physical structure and colour to our existence.’

Until the end of the 19th century the average human life expectancy was between 35 and 45 years. This number is increasing with the development of health care. Health care since the moment we are born until the day we die, and this care means Hospital!!! Hospital design represents a big challenge. It addresses the human dimension from BIRTH to DEATH. Birth and death are the two events at the start and the end of a chain of events involving hospital use. The architect must create a building exclusively for people, but one in such a form that follows specialist medical function in variety of very particular ways. In general, hospitals as we know them from experience are buildings with depressing environment, and negative atmosphere. These negative issues alone with hospital phobia can influence someone’s recovery. On the other hand, hospitals should not only provide medical treatment but also healing environment. A healing environment for the mind, the body and the Soul, a place where Respect and Dignity are waven into everything. A place where Life, Death, Illness and Healing define the moment.

22-Apr-14 12:34:39 I 131004b DESIGN FOR HEALING


SDU A key issue in designing Hospitals is to ensure that efficiency of services is enhanced by the ‘building envelope’ and the technology that is necessary for the function and the run of it. The technology changes more frequently, and across a greater range of areas, than it does in many other business environments, the task of designing for anticipated change, but without knowing quite what that change might be. A pleasant environment, helps patients recover more quickly, using fewer drugs and treatments. The Physical environment of every patient has an effect on the way they feel. These feelings have an effect on your state of both Mind and Health. Another challenge, is the provision for extension to accommodate increasing demands or new technologies in the future without interruption to the existing facilities and minimum abortive work. As all very well said that every patient should have their own room, with an exclusive nurse on call, twenty-four hours a day. Life is not like that. But how close would it be possible to come to such a civilized environment, for patients, staff and visitor (as one of the important elements) without increasing the cost disproportionate, to improvements for better ‘living’ environment, exploring the dimensions of environmental and the social sustainability? A series of elements which, in combination, would produced a building which is:     

safer, patient-focused, family friendly, cost-sensitive, energy consuming (as Hospital are if fact very energy costly buildings)

high level of staff amenity and comfort.  single or double rooms with dedicates space for in-room procedures, and  Maximized Day Light exposure.  Friendly headwall, eliminating the need to move patients as their conditions change. are some of the important aspect for a hospital.

        

Air quality, Thermal and noise comfort, Light, privacy, Views of nature, Visual serenity, Access to nature, Positive diversions, Social and Welfare Support

In respect of softer environmental issues, hospital must include peaceful environments with artwork displays, space to listen music, and gardens with fountains and benches. Noise - reduction measure with sound absorbing floors, walls and ceilings, wireless communication, and patient education center giving the opportunity to patients and relatives of a greater understanding of illness. Equally difficult is the creation of architecture that will provide the sort of sustainable work place which help to attract and retain good medical staff. This challenge does not end with the provision of a building that is fit for the purpose merely from the point of view of the health service provided. 22-Apr-14 12:34:39 I 131004b DESIGN FOR HEALING


SDU On the other hand staff support facilities such as staff only cafeteria, windowed break room with outside access and a health club, are some of the non medical facilities that staff need for more pleasant working environment.

Another important aspect, sometimes not taken into consideration is the way that hospitals deal with death. Patients and relatives need more calming environment (not only a good functional design). The behavior of the staff and the training they receive, are crucial in this area, but design has important part to play in giving comfort to the individual patient, and to more general consideration of where facilities are located, such as mortuary, viewing room, bereavement counseling spaces. In hospital communities, specialisms rules as it must be. But in creation of a new Healing Place (hospital), there is always the risk that one set of the specialists conflict with another. This exclusion affect patients, visitors and staff.

22-Apr-14 12:34:39 I 131004b DESIGN FOR HEALING


SDU Design for Healing must take in to account the spiritual and psychological needs as much as their strictly medical needs, in what can make a lifeenhancing difference. What patients want and need are well-tempered environment where they can suffer and recover in peace and quiet, where sleep in regarded as important rather than an interference with meal delivery regimes and accessible facilities for visitors on the other.





Environmentally sound

Economically Viable

Socially Responsible The Healing Environment Where policy meets sustainable design Facility Care Magazine, Vol. 5 Sep. 2010

‘The physical environment is vital to healing and well-being’ – Planetree

Research will be based on Green Hospital, and especially on a place of birth (maternity clinic). ‘The Green Hospital is defined as a hospital that has taken the initiative to do the one or more of the following: choose an environmentally friendly site, utilizes sustainable and efficient designs, uses green building materials and products, thinks green during construction and keeps the greening process going. A Green Hospital is constructed around a facility that i recycles, reuses materials, reduces waste, and produces cleaner air.


Hospital 2020 is a mission to promote and advocate for the transformation of hospitals worldwide. Established in 2009 as a compassionate mission of visionary physicians, administrators and hospital staff that saw the immediate need for change in hospitals worldwide. They researched successful programs and best practices and produced four needed initiatives for the hospital of the future.

22-Apr-14 12:34:39 I 131004b DESIGN FOR HEALING




22-Apr-14 12:35:06 I What is a healing environment-FINAL


SDU WHAT IS A HEALING ENVIRONMENT? When you think of a healing environment, what comes to mind? A spa, a Japanese garden, perhaps a corner of our house? Few of us would immediately think of their local health clinic or a hospital. But that is beginning to change as healthcare organizations pay attention to a growing body of research that clearly demonstrates the benefits of a healing environment.

WHAT IS HEALING? The word healing comes from the Anglo-Saxon word haelen, which means to make whole. One way to look at it is as harmony of mind, body, and spirit. Healing is not the same as curing (which is more about fixing problems, eradicating disease, and decreasing symptoms). People can be healed even if they are not cured. For example, those with a chronic disease can learn to live in peace with their condition. Conversely, people may be cured but not healed. What factors create our environment? It begins with our interior living spaces and their elements:  Light  Space  Color  Shape  Texture  Artwork Our experience of our living spaces also includes sounds (music), aromas, and sensations (walking on soft carpet or smooth hardwood). In addition, our experience is also affected by the:    

Larger physical environment: Building design: the buildings that surround us in our day-to-day encounters-our homes, the bank, the hospital, and so on. Urban design: (if you live in a town or city): the layout and elements of streets and neighborhoods. Social environment: the people with whom we share the interior space and all the factors associated with them-mood, behavior, and relationship. This also extends out to the various communities of people we belong to. Natural environment: the natural surroundings, air, water, earth. And perhaps most importantly, our experience is influenced by our own interior environment-our memories, as well as our attitudes, beliefs, values, and intentions.

22-Apr-14 12:35:06 I What is a healing environment-FINAL


SDU HOW DOES THIS APPLY TO HEALTHCARE ENVIRONMENTS? What factors contribute to a healing environment in healthcare? One answer comes from the Samueli Institute, a non-profit organization dedicated to researching the science of healing. In partnership with experts from around the world, the Samueli Institute developed a model that includes all the factors that surround the patient, family, healthcare practitioner, and community.

This model includes the places, people, processes, and principles involved in patient care. As we can see, this model lists factors that impact the inner environment on the left and moves to the right with factors that have a progressively greater impact on the outer environment. Thus healing intention, personal wholeness, and healing relationships are found on the left, healthy lifestyle is in the middle, and collaborative medicine, healing organizations, and healing spaces are on the right. This inclusive view of what is needed to heal is not new. Thousands of years ago, Greek temples were designed to surround patients with nature, music, and art to restore harmony and promote healing.

22-Apr-14 12:35:06 I What is a healing environment-FINAL



COMPONENTS OF A HEALING ENVIRONMENT Lighting components transform clinical facilities that appear rather functional and uninviting into environments that help the patient to relax and to recover. Light elements on the wall or in the ceiling can significantly contribute to easing fear and reducing nervousness. In general, a healing environment can be created by paying attention to three findings:   

Light has a major impact on human well-being and the body´s healing processes. Color is a powerful medium to stimulate positive emotional reactions and thereby promote the conditions for recovery. Interesting views of the outside world help to create pleasant associations and deflect from fear – an effect that is particularly valuable for the treatment of children.

Addressing patient fears In a clinical environment where patients often feel confronted with unknown or anxiety-provoking situations, it is beneficial that healthcare designs convey a feeling of security and safety. Generally, this is better achieved with softer color tones versus loud tones. At the same time, visuals that evoke a light, warm and positive feeling are much more suitable than images with ambiguous, uncertain, provocative or surreal characteristics.

Benefits of a healing environment Stimulating positive emotions can not only foster the patient’s well-being and improve his or her overall hospital experience, but may also shorten the therapeutic process. A healing environment may lead to:    

Less need for strong sedatives Faster and better examination results Better healing conditions Higher patient satisfaction

Another benefit is that a healing environment improves the working conditions for healthcare professionals by reducing stress levels, which in turn may improve productivity

HEALING ENVIRONMENT IN HOSPITAL DESIGN In hospital buildings, where patients seek medical treatment and staff provides continuous support, creating a healing environment with appropriate physical aspects is an imperative to sustainable design. The term ‘Healing Architecture’ is adopted to invoke a sense of a continuous process; in creating an environment physically healthy and psychologically appropriate. A healing environment with appropriate physical aspects would indirectly contribute to patients’ outcome such as shorter length of stay, reduced stress, increased patients satisfaction. One may agree to the idea that sustainable hospital design in the form of healing environment is achieved if these measurable outcomes could be quantified through appropriate design of physical aspects. Most healthcare designers accept the fact that designing a hospital is a complex task: both functional and psychological. Apart from building services, healthcare designers are expected to conform to various requirements provided by the Ministry of Health which includes medical specialist requirements and equipment both for diagnostics and for treatment. In the effort to comply with the explicit requirements, it seems that most healthcare designers pay less attention to the ultimate aim 22-Apr-14 12:35:06 I What is a healing environment-FINAL


SDU of creating a healing environment. This has been well documented in most scientific literature that modern hospitals designed and equipped with technology for diagnostics, curing and treating have contributed to stress, depression and anxiety which have a harmful effect on health to patients and staff. As a response to this, most literature in the healing environment have outlined that noise control,

air quality, thermal comfort, lighting, communication, colour, texture, privacy and view to nature are among the physical factors which have to be thoroughly considered in hospital design. These factors have a more pronounced influence in hospitals than in other buildings especially for patients who are bedridden or have limited freedom of movement.

DAYIGHT AND HEALTH Creating a healing environment is not like building up a garage workshop, where cars are sent for repairs before continuing their journey. It is an imperative for a hospital environment however, where ‘repair’ of the body (i.e. healing) is the concern, to have the optimum level of comfort and care physically, socially and symbolically. For this the luminous environment plays an important role and an integral part of the hospital’s healing environment. As a matter of the fact, natural daylight is often regarded as part of the healthy environment. Therefore, daylight is required in most areas in hospital buildings and is one of the crucial physical aspects to be considered in the healing environment. In the hospital wards indoor environment, appropriate window design would allow the potential benefit of daylight to be experienced by patients and staff. Their physical attributes are intertwined in the healing environment of hospital wards. Numerous studies have indicated that daylight has significant effects on the well-being of humans both physically and psychologically. In fact, it has been recognised for many years that light has a significant effect on our circadian rhythm (i.e. biological cycles that repeat 24 hours). Light is the most important environmental input in controlling bodily function after food. Similarly clearly indicate that access to natural light is one of the crucial factors affecting patients’ recovery. The presence of visible light in an indoor environment does influence the physiological responses, mood as well as

22-Apr-14 12:35:06 I What is a healing environment-FINAL


SDU visual needs. Daylight in hospital design should rigorously be pursued as one of the physical aspects in creating a healing environment. However, it is believed that experimental studies of daylighting in hospital design are very few and far in between. Many studies on the subject of daylight focus on schools, offices and commercial buildings but few on hospitals. Therefore, the present study calls for a comprehensive consideration on the physical aspects (i.e. daylighting design) in a healing environment as a strategy for implementation on a sustainable hospital design. Daylight should be incorporated into lighting design in hospital buildings, not only because it is beneficial to patients and staff, but also because it is light delivered at no cost. Adopting and implementing good daylighting will obviate the need for artificial lighting, subsequently lead for energy conservation, contributing to sustainability.

BUILDING ORIENTATION In hospital building, orientation plays a major part in the early process of the design. In fact, it can be argued that is the highest priority in the design decision for achieving sustainable hospital environment. Regrettably, a preliminary finding seems to indicate that most healthcare designers regard physical planning issues as the topmost priority to be sorted out at the early stage of hospital design. This is due to the fact that designing a hospital building is generally accepted a complex task both: functionally and psychologically. In theory, the decision on building orientation will subsequently influence the design of the physical aspects (i.e. shading devices, window opening, placement and profile). Similarly in hospital design, where creating a 22-Apr-14 12:35:06 I What is a healing environment-FINAL


SDU healing environment is the primary concern, orientation of the building does influence the design of the windows directly affecting the quality of daylighting (i.e. glare effect and daylight distribution) and access to outside view (i.e. optimise the surrounding scenery). Hence, it would have a significant impact on the end users’ (i.e. patients, medical staff and visitors) experience and well-being. Providing access to outside view through a window would provide patients in the ward environments with a sense of orientation and connection to the external environment.

WINDOW DESIGN In the research fraternity of healing environment, there is a growing consensus recognising the window as one of the most significant physical aspects for patients and medical staff physically, psychologically and mentally. There are two benefits of windows: one is daylight and the other is view. In an empirical research conducted by keep and others as quoted by Jana et al. (2005); of two groups of individuals in the intensive ward therapy unit: one was unit without windows, and the other with translucent windows; indicates that patients with translucent windows were more oriented during their stay and gain better health outcomes such as avoiding sleep disorders, hallucinations and delusions. Even with translucent windows in this aspect do provide the vital link to the outside world for patients and the feeling of orientation helped to maintain their normalcy.

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SDU ACCESS TO VIEW There is growing research evidence that access to view in the ward environment would provide a positive impact on patients physically, psychologically and mentally. Evidently, research by Ulrich (1984) of surgical patients with a view through a window may provide shorter length of stay. This evidence and findings by others send a clear message to the professionals involved in the healthcare services that coordinated effort must be taken beyond the requirements of the project briefs. Initial investigation on the hospital project briefs proves that there is no requirement explicitly stated emphasising this aspect. On the same tone, the quality of outside view has to be positively promoted in a ward environment for patients and staff psychological well-being: view of a children playground instead of a view of a blank wall. However, in reality of the building design, the availability of view for the users is not always positive quality. In healthcare design, to achieve quality view depends highly on the site selection, building orientation, wards layout, bed positions and windows design.

References 1. 2. 3. 4. 5.

Evidence-Based Healthcare Design, By Rosalyn Cam The role of physical environment in Hospital of the 21st century : once-in-a-life opportunity, By Roger Ulrich et al, report to the Center for Health Design, Sep. 2004. Improving the patients experience – A place to die with dignity: creating a supporting environment, report for NHS Estates, by Richard Burton. The architecture of hospital, by Markus Schaefer Facility Care Magazine, Vol. 5 Sep. 2010

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