HERD: Health Environments Research & Design Journal

The study investigated the main restorative components of staff break areas in healthcare facilities, by assessing usage patterns, verbal/visual preferences, and perceived restorative qualities of specific design features found in break areas for hospital staff.

Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is a central concern for healthcare administrators. While healthcare leaders are concerned about improving nurses’ satisfaction, performance, and job retention, they may overlook the importance of respite for nurses and underestimate the value of designing staff break areas to maximize their restorative potential.

A multi-method approach combined qualitative explorations (focused interviews and narrative survey questions) with quantitative measurements (discrete survey questions and a visual ranking of break-room spaces), and the results were compared and triangulated.

It was found that staff break areas are more likely to be used if they are in close proximity to nurses’ work areas, if they have complete privacy from patients and families, and if they provide opportunities for individual privacy as well as socialization with coworkers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have significantly greater perceived restorative potential, in comparison with window views, artwork, or indoor plants.

The results of this empirical study support the conclusion that improvements in the restorative quality of break areas may significantly improve nurses’ satisfaction and stress reduction, potentially leading to improved care for the patients they serve.

To examine whether incorporation of simulated nature, in the form of ceiling mounted photographic sky compositions, influences patient outcomes.

Previous studies have shown that most forms of nature exposure have a positive influence on patients. However, earlier studies have mostly focused on wall-hung nature representations. The emergence of simulated nature products has raised the question regarding the effects of the new product on patient outcomes.

A between-subject experimental design was adopted, where outcomes from five inpatient rooms with sky composition ceiling fixture were compared to corresponding outcomes in five identical rooms without the intervention. Data were collected from a total of 181 subjects on 11 outcomes. Independent sample tests were performed to identify differences in mean outcomes.

Significant positive outcomes were observed in environmental satisfaction and diastolic blood pressure (BP). Environmental satisfaction in the experimental group was 12.4% higher than the control group. Direction of association for diastolic BP, nausea/indigestion medication, acute stress, anxiety, pain, and environmental satisfaction were consistent with a priori hypothesis. A post hoc exploratory assessment involving patients who did not self-request additional pain and sleep medication demonstrated confirmatory directions for all outcomes except Systolic BP, and statistically significant outcomes for Acute Stress and Anxiety—Acute Stress and Anxiety levels of the experimental group subjects was 53.4% and 34.79% lower, respectively, than that of the control group subjects.

Salutogenic benefits of photographic sky compositions render them better than traditional ceiling tiles and offer an alternative to other nature interventions.

To explore how hospital real estate can add value to the healthcare organization, which values are prioritized in practice, and why.

Dutch healthcare organizations are self-responsible for the costs and benefits of their accommodation. Meanwhile, a lively debate is going on about possible added values of corporate and public real estate in the fields of corporate real estate management and facility management. This article connects both worlds and compares insights from literature with experiences from practice.

Added values extracted from literature have been discussed with 15 chief executive officers and project leaders of recently newly built hospitals in the Netherlands. Interviewees were asked (1) which values are included in the design and management of their hospital and why, (2) to prioritize most important values from a list of nine predefined values, and (3) to explain how the chosen real estate decisions are supposed to support organizational objectives.

Stimulating innovation, user satisfaction, and improving organizational culture are most highly valued, followed by improving productivity, reducing building costs, and creating building flexibility. Image, risk control, and financing possibilities got lower rankings. The findings have been used to develop a value-impact matrix that connects nine values to various stakeholders and possible interventions.

The findings and the value-impact matrix can make different stakeholders aware of many possible added values of hospital real estate, potential synergy and conflicts between different values, and how to steer on value add in different phases of the life cycle.

Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process. The needs of the various end users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the predesign phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction and then interviewed them about their experience.

An explorative and qualitative design was used to describe participants’ experiences of participating in the group-modeling projects. Participants (N = 20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis.

Two themes were formed, representing the experiences in the group-modeling process: “Participation in the group modeling generated knowledge and was empowering” and “Participation in the group modeling differed from what was expected and required the dedication of time and skills.”

The method can support participants in design teams to focus more on their healthcare organization, their care activities, and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

This post occupancy evaluation (POE) assessed the impact of architectural design on psychosocial well-being among patients and staff in the context of a new complex continuing care and rehabilitation facility.

Departing from typical POEs, the hospital design intentions formed the theoretical basis to assess outcomes. Intentions included creating an environment of wellness; enhancing connection to the community, the city, and nature; enhancing opportunities for social interaction; and inspiring activity.

A pretest–posttest quasi experiment, including quantitative surveys, assessed the impact of the building design on well-being outcomes across three facilities—the new hospital, the former hospital, and a comparison facility with a similar population.

With the exception of connection to neighborhood (for patients) and opportunities to visit with others (for staff) and wayfinding (for patients and staff), impressions of the new hospital mirrored the design intentions relative to the former hospital and the comparison facility among patients and staff. Perceptions of improvement in mental health, self-efficacy in mobility, satisfaction, and interprofessional interactions were enhanced at the new hospital relative to the former hospital, whereas optimism, depressive symptoms, general well-being, burnout, and intention to quit did not vary. Interestingly, patients and staff with favorable impressions of the building design fared better on most well-being-related outcomes relative to those with less favorable impressions.

Beyond the value of assessing the impact of the design intentions on outcomes, the approach used in this study would benefit evaluation strategies across a diversity of health and other public and large-scale buildings.

The aim of this study is to investigate the best placement of windows in short-term rehabilitation facilities in terms of daylighting and outdoor views by exploring the impact of windows on resident perception of stress, mood, activities, and satisfaction.

The physiological and psychological benefits of daylighting have made it an increasingly important topic in multidisciplinary research. Although multiple studies have been written about the impact of daylight on physiological responses, few investigations have been made into the nonvisual effects related to resident mood, satisfaction, and stress level. In addition, researchers typically propose recommendations for quantitative aspects of illuminance, rather than addressing the behavioural outcomes.

A combination of qualitative and quantitative methodologies were used to address the research questions. Thirty-four participants, who were living temporarily in the inpatient rehabilitation units of two skilled nursing facilities, were subjects in semistructured interviews and a 7-question 5-scale survey. While residents expressed the need to have direct visual access to the outdoors, they indicated that daylight was of even higher benefit. Additionally, they noted that size and location of windows impacted their stress levels, moods, and activities. More than half of the facility residents reported changing their postures for either better outdoor views or less light disturbance while sleeping.

The results of this study emphasize the importance of daylighting for residents in rehabilitation units. Architects should acknowledge the role of daylighting and window views in the design of rehabilitation facilities.

Conducting high-quality design research in a mental health setting presents significant challenges, limiting the availability of high-quality evidence to support design decisions for built environments. Here, we outline key approaches to overcoming these challenges.

In conducting a rigorous post-occupancy evaluation of a newly built mental health and addictions facility, St. Joseph’s Healthcare, Hamilton, we identified a number of systematic barriers associated with conducting design research in mental health settings.

Our approach to overcoming these barriers relied heavily upon (i) selecting established measures and methods with demonstrated efficacy in a mental health context, (ii) navigating institutional protocols designed to protect vulnerable members of this population, and (iii) designing innovative data collection strategies to increase participation in research by individuals with mental illness. Each of these approaches drew heavily on the expert knowledge of mental health settings and the experiences with mental health, facilities management, and research of a research team that was well integrated within the parent institution.

Engaging multiple stakeholders (e.g., care providers, patients, ethics board, and hospital administrators) contributed their trust and support of the research. Traditionally, post-occupancy evaluation researchers are independent of the facilities they research, yet this is not an effective approach in mental health settings. We found that, in working toward solutions to the three obstacles we described, having team members who were well “networked” within the parent institution was necessary. This approach can turn “gatekeepers” into champions for patients’ engagement in the research, which is essential in generating high-quality evidence.

Designers can and should play a critical role in shaping a holistic healthcare experience by creating empathetic design solutions that foster a culture of care for patients, families, and staff. Using narrative inquiry as a design tool, this case study shares strategies for promoting empathy.

Designing for patient-centered care infuses empathy into the creative process. Narrative inquiry offers a methodology to think about and create empathetic design that enhances awareness, responsiveness, and accountability.

This article shares discoveries from a studio on empathetic design within an outpatient cancer care center. The studio engaged students in narrative techniques throughout the design process by incorporating aural, visual, and written storytelling. Benchmarking, observations, and interviews were merged with data drawn from scholarly evidence-based design literature reviews.

Using an empathy-focused design process not only motivated students to be more engaged in the project but facilitated the generation of fresh and original ideas. Design solutions were innovative and impactful in supporting the whole person. Similarities as well as differences defined empathetic cancer care across projects and embodied concepts of design empowerment, design for the whole person, and design for healing.

By becoming more conscious of empathy, those who create healthcare environments can better connect holistically to the user to take an experiential approach to design. Explicitly developing a mind-set that raises empathy to the forefront of the design process offers a breakthrough in design thinking that bridges the gap between what might be defined as “good design” and patient-centered care.

The environment is inextricably related to mental health. Recent research replicates findings of a significant, linear correlation between a childhood exposure to the urban environment and psychosis. Related studies also correlate the urban environment and aberrant brain morphologies. These findings challenge common beliefs that the mind and brain remain neutral in the face of worldly experience.

There is a signature within these neurological findings that suggests that specific features of design cause and trigger mental illness. The objective in this article is to work backward from the molecular dynamics to identify features of the designed environment that may either trigger mental illness or protect against it.

This review analyzes the discrete functions putatively assigned to the affected brain areas and a neurotransmitter called dopamine, which is the primary target of most antipsychotic medications. The intention is to establish what the correlations mean in functional terms, and more specifically, how this relates to the phenomenology of urban experience. In doing so, environmental mental illness risk factors are identified.

Having established these relationships, the review makes practical recommendations for those in public health who wish to use the environment itself as a tool to improve the mental health of a community through design.