Informing Healthcare Waiting Area Design Using Transparency Attributes: A Comparative Preference Study

Abstract

Objective:

This study aimed to explore people’s visual preference for waiting areas in general hospital environments designed with transparency attributes that fully integrate nature.

Background:

Waiting can be a tedious and frustrating experience among people seeking healthcare treatments and negatively affect their perception of the quality of care. Positive distractions and supportive designs have gained increasing attraction to improve people’s waiting experience. Nature, which has shown therapeutic effects according to a growing amount of evidence, could be a distinguished positive distraction in waiting areas. Additionally, the theory of transparency was operationalized to indicate a spatial continuity between the external nature and the built interiors in general healthcare waiting area design.

Method:

A survey method was adopted in the study. Twenty-one images of general healthcare waiting areas depicting three design typologies were preselected following a strict procedure, including designs with (a) no window views, (b) limited window views to nature, and (c) transparent spaces with maximum natural views. Ninety-five student participants rated the images based on their visual preference using a Likert-type scale.

Results and Conclusions:

The results showed that transparent waiting areas were significantly preferred. A significant positive relationship existed between the level of transparency and people’s preference scores. The factor analysis indicated additional supportive features that may affect people’s preferences, including daylight, perceived warmth, noninstitutional furniture arrangement, visual orientation, and the use of natural materials for interior design. However, these tentative results need to be furthered tested with the real patient population as the next step of this study.

Keywords

healthcare waiting area transparency nature visual preference survey evidence-based design positive distractions supportive design

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References

Andrade

C. C.

Devlin

A. S.

(2015). Stress reduction in the hospital room: Applying Ulrich’s theory of supportive design. Journal of Environmental Psychology, 41, 125–134.

Arneill

A. B.

Devlin

A. S.

(2002). Perceived quality of care: The influence of the waiting room environment. Journal of Environmental Psychology, 22, 345–360.

Baldwin

A. L.

(2012). How do plants in hospital waiting rooms reduce patient stress? The Journal of Alternative and Complementary Medicine, 18, 309–310.

Becker

Douglass

(2008). The ecology of the patient visit: Physical attractiveness, waiting times, and perceived quality of care. The Journal of Ambulatory Care Management, 31, 128–141.

Behrman

(1997). Art in hospitals: Why is it there and what is it for? Lancet, 350, 584–585.

Beukeboom

C. J.

Langeveld

Tanja-Dijkstra

(2012). Stress-reducing effects of real and artificial nature in a hospital waiting room. The Journal of Alternative and Complementary Medicine, 18, 329–333.

Butler

D. L.

Biner

P. M.

(1989). Effects of setting on window preferences and factors associated with those preferences. Environment and Behavior, 21, 17–31.

Butler

D. L.

Steuerwald

B. L.

(1991). Effects of view and room size on window size preferences made in models. Environment and Behavior, 23, 334–358.

Dijkstra

Pieterse

M. E.

Pruyn

(2008). Stress-reducing effects of indoor plants in the built healthcare environment: The mediating role of perceived attractiveness. Preventive Medicine, 47, 279–283.

10.

DiNardo

(2014, 3 24). Five design ideas for healthcare waiting rooms. Healthcare Design. Retrieved from http://www.healthcaredesignmagazine.com/blogs/anne-dinardo/5-design-ideas-healthcare-waiting-rooms?page=2

11.

Fenko

Loock

(2014). The influence of ambient scent and music on patients’ anxiety in a waiting room of a plastic surgeon. Health Environments Research & Design Journal, 7(3), 38–59.

12.

Fogarty

Cronin

(2008). Waiting for healthcare: A concept analysis. Journal of Advanced Nursing, 61, 463–471.

13.

Hoesli

(1997). Transparent form-organization as an instrument of design. In Rowe

Slutzky

Hoesli

(Eds.), Transparency (pp. 85–97). Basel, Switzerland: Birkhauser.

14.

IBM Corp. (2013). Released 2013. IBM SPSS Statistics for Windows (Version 22.0). Armonk, NY: Author.

15.

Jiang

(2015). Encouraging engagement with therapeutic landscapes: Using transparent spaces to optimize stress reduction in urban health facilities. Doctoral dissertation. Available from All Dissertations. (Paper 1495)

16.

Jiang

Verderber

(2016). Landscape therapeutics and the design of salutogenic hospitals: Recent research. World Health Design, 8, 40–51.

17.

Jones

Swain

Cale

(1990). Antecedents of multidimensional competitive state anxiety and self-confidence in elite intercollegiate middle-distance runners. The Sport Psychologist, 4, 107–118.

18.

Kaiser

H. F.

(1974). An index of factorial simplicity. Psychometrika, 29, 31–36.

19.

Kaplan

(1989). The experience of nature: A psychological perspective. Cambridge, MA: CUP Archive.

20.

Kaplan

(1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15, 169–182.

21.

Keep

James

Inman

(1980). Windows in the intensive therapy unit. Anaesthesia, 35, 257–262.

22.

Kepes

(1944). The language of vision. Chicago, IL: Paul Theobald.

23.

Lankston

Cusack

Fremantle

Isles

(2010). Visual art in hospitals: Case studies and review of the evidence. Journal of the Royal Society of Medicine, 103, 490–499.

24.

Locatelli

S. M.

Turcios

LaVela

S. L.

(2015). Optimizing the patient-centered environment results of guided tours with health care providers and employees. Health Environments Research & Design Journal, 8(2), 18–30.

25.

McNaire

D. M.

Lorr

Droppleman

L. F.

(1971). Manual for the profile of mood states. San Diego, CA: Educational and Industrial Testing Service.

26.

McSweeney

Rainham

Johnson

S. A.

Sherry

S. B.

Singleton

(2015). Indoor nature exposure (INE): A health-promotion framework. Health Promotion International, 30, 126–139.

27.

Menegazzi

J. J.

Paris

P. M.

Kersteen

C. H.

Flynn

Trautman

D. E.

(1991). A randomized, controlled trial of the use of music during laceration repair. Annals of Emergency Medicine, 20, 348–350.

28.

Nanda

Eisen

S. L.

Baladandayuthapani

(2008). Undertaking an art survey to compare patient versus student art preferences. Environment and Behavior, 40, 269–301.

29.

Nanda

Eisen

Zadeh

R. S.

Owen

(2011). Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case. Journal of Psychiatric and Mental Health Nursing, 18, 386–393.

30.

Olds

A. R.

(1989). Nature as healer. Children’s Environments Quarterly, 6, 27–32.

31.

Pati

Nanda

(2011). Influence of positive distractions on children in two clinic waiting areas. Health Environments Research & Design Journal, 4(3), 124–140.

32.

Pruyn

Smidts

(1993). Customers’ evaluations of queues: Three exploratory studies. In van Raaij

W. F.

Bamossy

(Eds.), European advances in consumer research (Vol. 1, pp. 371–382). Provo, UT: Association of Consumer Research.

33.

Pruyn

Smidts

(1998). Effects of waiting on the satisfaction with the service: Beyond objective time measures. International Journal of Research in Marketing, 15, 321–334.

34.

Raanaas

R. K.

Patil

G. G.

Hartig

(2010). Effects of an indoor foliage plant intervention on patient well-being during a residential rehabilitation program. HortScience, 45, 387–392.

35.

Raanaas

R. K.

Patil

G. G.

Hartig

(2012). Health benefits of a view of nature through the window: A quasi-experimental study of patients in a residential rehabilitation center. Clinical Rehabilitation, 26, 21–32.

36.

Rowe

Slutzky

(1963). Transparency, literal and phenomenal. Perspecta, 8, 45–54.

37.

Ryan

C. O.

Browning

W. D.

Clancy

J. O.

Andrews

S. L.

Kallianpurkar

N. B.

(2014). Biophilic design patterns: Emerging nature-based parameters for health and well-being in the built environment. International Journal of Architectural Research, 8, 62–76.

38.

Schweitzer

Gilpin

Frampton

(2004). Healing spaces: Elements of environmental design that make an impact on health. Journal of Alternative & Complementary Medicine, 10, S71.

39.

Shepley

M. M.

(2006). The role of positive distraction in neonatal intensive care unit settings. Journal of Perinatology, 26, S34–S37.

40.

Shepley

M. M.

Gerbi

R. P.

Watson

A. E.

Imgrund

Sagha-Zadeh

(2012). The impact of daylight and views on ICU patients and staff. Health Environments Research & Design Journal, 5(2), 46–60.

41.

Standley

J. M.

(1986). Music research in medical/dental treatment: Meta-analysis and clinical applications. Journal of Music Therapy, 23, 56–122.

42.

Stern

A. L.

MacRae

Gerteis

Harrison

Fowler

Edgman-Levitan

… Ruga

(2003). Understanding the consumer perspective to improve design quality. Journal of Architectural and Planning Research, 20, 16–28.

43.

Stichler

J. F.

(2012). Patient-centered care: A healthcare reform imperative and a hospital design opportunity. Health Environments Research & Design Journal, 5(2), 24–28.

44.

Terry

P. C.

Lane

A. M.

Lane

H. J.

Keohane

(1999). Development and validation of a mood measure for adolescents. Journal of Sports Sciences, 17, 861–872.

45.

Thompson

D. A.

Yarnold

P. R.

Williams

D. R.

Adams

S. L.

(1996). Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Annals of Emergency Medicine, 28, 657–665.

46.

Ulrich

R. S.

(1981). Natural versus urban scenes: Some psycho-physiological effects. Environment and Behavior, 13, 523–556.

47.

Ulrich

R. S.

(1984). View through a window may influence recovery. Science, 224, 224–225.

48.

Ulrich

R. S.

(1991). Effects of interior design on wellness: Theory and recent scientific research. Journal of Health Care Interior Design, 3, 97–109.

49.

Ulrich

R. S.

Zimring

Zhu

DuBose

Seo

H. B.

Choi

Y. S.

… Joseph

(2008). A review of the research literature on evidence-based healthcare design. Health Environments Research & Design Journal, 1(3), 61–125.

50.

University of Colorado Denver. (2016, 6). Factor analysis in SPSS. Retrieved from http://www.ucdenver.edu/academics/colleges/nursing/Documents/PDF/FactorAnalysisHowTo.pdf

51.

Van den Berg

A. E.

Koole

S. L.

van der Wulp

N. Y.

(2003). Environmental preference and restoration: (How) are they related? Journal of Environmental Psychology, 23, 135–146.

52.

Verderber

(1986). Dimensions of person–window transactions in the hospital environment. Environment and Behavior, 18, 450–466.

53.

Verderber

(2010). Innovations in hospital architecture. London, England: Routledge.

54.

Vincent

(2009). Therapeutic benefits of nature images on health. Doctoral Dissertation. Available from All Dissertations. (Paper 432)

55.

Wilson

L. M.

(1972). Intensive care delirium: The effect of outside deprivation in a windowless unit. Archives of Internal Medicine, 130, 225–226.