By Kimberly Nelson Montague, AIA, NCARB

 A healing environment is essential to patient-centered care. Many hospitals, however, still occupy buildings built during the last construction boom of the 1960s and 1970s. As hospitals look to update, they should keep in mind that although enhancing the physical environment is important, a healing environment involves many more aspects than just the “look” of a space.

Privacy
Privacy is one of our basic human needs, and is best maintained when patients are afforded a private room. Studies have shown that patients will reveal more information about their conditions and recovery processes when strangers or neighboring patients are out of earshot.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires confidentiality for patients’ medical information, can have a significant impact on design. In an inpatient setting, confidentiality can be encouraged with the inclusion of private patient rooms versus the previous model of semi-private rooms or wards. Facilities with semi-private rooms can consider adding additional private family consultation rooms and lounges. Private rooms in emergency departments and recovery areas also increase the opportunity for confidential consultations.

Research has linked private patient rooms to improved patient safety in hospitals. Given that falls are a critical safety problem, providing private rooms with decentralized nurse stations supports a safer environment for patients.

Noise Control
Hospitals are notoriously loud environments, with a constant din of conversation, rolling carts and medical equipment. Noise levels can exceed standards set by the World Health Organization, and are comparable to the perceived noise level near a highway. Several environmental improvements can be made to reduce the amount of ambient noise. Some hospitals opt for carpeted corridors; however, this has met with some opposition due to the increased awareness of infection rates. Other options include the usage of acoustic ceiling tiles, rubberized flooring and the reduction or elimination of overhead paging systems.

Views and Access to Nature
It has been researched and well-documented that views to nature can help reduce stress and aid in the healing process. While patients are infirm, their stress level is elevated; in many instances, visitor and staff stress levels are also elevated. Providing a view to the out-of-doors or, at a minimum, artwork with nature scenes, can aid in relieving some of this anxiety. Patient room views in some cases are limited because of location, but creating a foreground view of a rooftop garden or trellis can have a positive effect.

Lighting and Environmental Control
The most common type of light fixture in most hospitals is a two-foot-by-four-foot fluorescent fixture. This fixture, while functional, provides a lighting level that can feel glaring, cold and over-stimulating. Using a variety of lighting types that are adjustable by seasons and times of day provides a combination that is appealing and allows for varying needs. In addition to considerations for artificial lighting, the provision of windows, clerestories and skylights can have a profound affect on patients, staff and visitors. In fact, it has been shown that patients in brightly lit rooms have a shorter length of stay compared to patients in dull rooms. Additionally, exposure to morning light may be more effective than exposure to evening light in reducing depression.*

Another factor for consideration is the room temperature in each patient sleeping area. The most common implementation is to include individual thermostat controls at the bedside or located such that a family member or the staff can adjust it according to the patient’s request.

Therapeutic Enhancements
Patient-centered design embraces the attention to the five senses in the physical environment. The inclusion of healing arts such as music therapy and healthy cooking classes, or quiet meditation gardens, fish tanks and indoor plantscapes, exemplifies this approach to mind, body and spirit healing.

Wayfinding
A clear and direct path for patients and visitors to the health care facility can significantly reduce the amount of stress one feels when entering a hospital campus. Facilities expand and grow beyond their boundaries, and in many cases this contributes to the overall confusion and development of indirect pathways to treatment destinations. The incorporation of an overall master plan that indicates destination points, significant junctures and pathways is a major step in the process for assisting patients and visitors alike in navigation of a hospital or clinic setting. The use of consistent signage, visual cues (such as artwork), and architectural detailing on the floor, in the ceiling plan and on the wall surfaces can provide a cohesive wayfinding scheme.

Patient-centered designs can also provide smaller, decentralized nursing stations that allow the staff to be closer to the patient, yet still provide them with much-needed collaboration space.

Sustainable Environments
Our environment is under stress. According to the Green Guide for Health Care, hospitals represent $16 billion and over 100 million square feet of construction annually. Hospitals are often one of the largest industries in their community and therefore the biggest consumers of utilities and largest creators of waste. Healthcare organizations should raise awareness of their environments, both interior and exterior, and approach the design process with care and concern for product specification, sensitivity to the impact on land and creation of a healthy interior for patients, visitors and staff.

Kimberly Nelson Montague is Director of Design Consultation Services for Planetree. The Connecticut-based nonprofit serves as a catalyst and partner in the development and implementation of patient-directed, value-based health care models that cultivate healing of the mind, body and spirit and support patients’ safety through active involvement in their own care.

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