The Surprising Science Behind Evidence-based Hospital Design
The article was originally posted in Healthy Debate: Unbiased Facts. Informed Options. An excerpt of this article is reprinted here with permission. The full article may be accessed at http://healthydebate.ca/2014/07/topic/evidence-based-hospital-design
Written by Vanessa Milne, Sachin Pendharkar & Gord Winkel
Rahel Yetbarek sits with her feet up, looking out onto the city and the large swath of treed land that surrounds the freeway below her. The nurse is taking in the view over her lunch break, from the 10th floor rooftop garden at Bridgepoint, a Toronto hospital. Nearby, a few patients do the same. The drone of the highway in the background doesn’t detract from the peacefulness she gets from coming up here.
“I love the view, especially the bridge,” she says, referring to the Bloor Street viaduct. “It’s quiet, relaxing. Most of the time I come here, to read, to eat lunch. At night the view is excellent too.”
Downstairs in the foyer, John Hill, a patient, agrees with her analysis. “It’s a beautiful building – a real Taj Mahal,” he says.
Like many new hospitals, Bridgepoint is building off of 30 years of research into how design can make patients less likely to get infections, have falls, or be stressed while in hospitals. This evidence-based design has changed everything from the amount of airflow in operating rooms to the view out the window, melding the art of design with the science of medicine. And it has played a key role in how new hospitals like Bridgepoint, Calgary’s South Health Campus and Mississauga’s Trillium Health Centre function for patients and staff.
Evidence-based design
In 1984, Roger Ulrich released a study that looked at patients recovering from gallbladder surgery. Half of them had been assigned to a room with a view of nature, and the other half looked out at a brick wall. It found patients whose windows faced a natural view recovered faster and needed less painkillers. “That’s when the notion of evidence-based design really started to take hold,” says Ellen Taylor, director of research at The Centre for Health Design, a California-based organization that promotes research-driven health-care design. “These are things that maybe we intuitively have known before … but this was the first study that generated that notion that you can document some of these outcomes.”
It has taken a while to get there. Florence Nightingale observed in 1860 that placing patients where they can see out of a window or read by natural light was “quite perceptible in promoting recovery.”
The term evidence-based design was defined in 2003 by Kirk Hamilton, an architect and advocate for evidence-informed health-care buildings. “Over my 30 year career, I’ve designed 15,000 patient rooms,” says Hamilton. “[In the beginning,] I knew an awful lot about those rooms: the size of the window, where the air conditioning system was, the artwork on the walls…but I didn’t know which of those rooms had the lowest rate of patient falls, medication error, infection rates.”
Now more than 1,200 studies have been done on everything from sound muffling to sink design. They’ve formed a framework for thinking about evidence-based design, and some hospital design firms have responded by hiring directors of research and tracking metrics. “Hospitals are just designed differently now than they were 20 years ago,” says Taylor. “It’s pretty much expected at this point that your design team is bringing that level of knowledge.”
Reducing stress to boost healing
Ulrich’s legacy is evident in newer hospitals’ focus on what’s outside patients’ windows.
“The first thing patients mention is the view,” says Celeste Alvaro, researcher at the Bridgepoint Collaboratory for Research and Innovation, which is studying the impact of the new building. “It’s increasing their comfort level, but it’s also increasing their sense that they’re in a place of wellness.” Alvaro’s team has found that any meaningful view – including one of the cityscape – is beneficial, not just those of nature. And it’s not just patients that are helped: “what’s good for the patient is good for the staff,” says Gregory Colucci, the architectural lead on Bridgepoint. To continue reading this article, click
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