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Healing Spaces - The Importance of Architecture in Healthcare

by Dr David Peters(more info)

listed in environmental, originally published in issue 143 - January 2008

If we are ill, we know intuitively that a building can affect how we feel – and how well the practitioners around us do their work. It follows then that the built healthcare environment could influence medical outcomes as well as the quality and costs of services. But how might the built environment boost or undermine healing process? Ulrich’s famous study of the 1970s found that after gall bladder operations, patients with a view of the hospital grounds needed less pain relief, complained less, had lower blood pressure, a smoother recovery, and went home earlier than patients whose window looked out on a brick wall. A measurable outcome! And we know that light affects hormones, brain activity and the way people behave; which may explain why too much light and noise in neonatal intensive care units disrupts babies’ REM sleep enough to delay their physiological development.

St Mary’s Hospital Isle of Wight  © Heather Coulson – www.heathercoulson.com
St Mary’s Hospital Isle of Wight  © Heather Coulson – www.heathercoulson.com

No doubt, such stresses impact directly on medical outcomes in ways that can be measured, but the cause of the effect isn’t always obvious. Angela Clow’s small study of people visiting an art gallery over lunch time showed a significant drop in levels of stress hormones;[1] was this due to the art, the lunch, the silence? These are complex questions, but where stress is involved, the built environment can either make it worse or be part of the solution. Ulrich, in the light of the hospital window studies, suggested that healthcare environments are less stressful when they give people a greater sense of being in control of their physical surroundings, encourage access to social support and provide what he called
positive distractions. For example, people can be given control of lighting and music; and decent corridors with good signs will reduce their feeling of being lost in a faceless labyrinth. Kitchens for visitors, meeting areas and sleepover facilities for carers all increase that crucial sense of social support. Distractions might take the form of art, garden zones, windows with views, and healthcare spaces that are attractive.

All these aspects of the built environment where healthcare happens also impact on clinical staff; they too need a sense of control, social support and have positive distractions. Here we must also consider boundaries and power: how much access does the healthcare space let others have; how does the space support privacy and dignity – especially during the illness journey when contact with clinicians sometimes involves invasive procedures? Do certain kinds of space encourage an industrial, impersonal and alienated attitude towards oneself and others, support clinicians’ perception of themselves and their patients as sensitive individuals, inspire better communication and decision-making, or support collaboration and empowerment? Experience certainly suggests that the built environment has a bearing on all this.

We considered the easy research questions first: how a window affects outcomes; how a room affects socialization. Yet how much more complex is the overall effect of a whole building! We would have to take into consideration all those aspects we have considered so far, plus the need for sheer functionality (cleanliness, sustainability, physical access etc) on the one hand, and on the other, the need for a structure to be potentially something expressive or symbolic; emblematic of public ideals, vision, shared beliefs. As a counterpoint, healthcare spaces are more than ever expected to be patient-centred. Peter Scher stressed way back in 1994 that users have to be involved from the design stage on, and that positive, patient-centred spaces could promote healing processes, enhance staff performance, and support the way carers work. By including art, proper light and space – especially in areas with high stress levels – ‘good design can help to achieve contentment and satisfaction, rather than irritation and discomfort.[2] And in addition, built space can be inherently calming, inspiring, depressing or horrifying. If such effects are aesthetic then what does the term mean? It’s something we feel in our heart and in our bones, but how should we comprehend, explore and tap this potential to make spaces that heal?

High tech and rocketing costs will continue to transform hospital work, and future advances will place ever new demands on healthcare environments. Yet there is something timeless and deeper, archetypal even, from which healing springs, and which healing spaces may sustain. In his book Places of the Soul[3] Christopher Day tells us that:

“To be healing, a place must be harmonious, bringing change as an organic development so that new buildings seem not to be imposed aliens but inevitably belong where they are. They must respond to the surroundings and be responsible, seeking to minimize pollution caused by their materials. But places – and buildings – must be more than that; they must be nourishing to the human being.”

“Nourishing to the human being”. We can unpack this vitally important phrase at the physiological level, or use psychological methods, or rely on designers’ more intuitive approaches. Like everything truly worth knowing about humankind, healing space can only be understood from multiple perspectives. I believe it will require trans-disciplinary research to disclose why buildings can support or erode our capacity for being whole people, and for delivering whole person healthcare.

References

1.    Clow A and Fredhoi C. Normalisation of salivary cortisol levels and self-report stress by a brief lunchtime visit to an art gallery by London City workers. Journal of Holistic Healthcare. 3: 29-32. 2006.
2.    Scher P. Environments for Quality Care. Manchester: Arts for Health. 1994.
3.    Day Christopher. Places of the Soul – Architecture and Environmental Design as a Healing Art. UK. The Aquarian Press. 1990. Architectural Press. 2003.

Further Information

The British Holistic Medical Association in partnership with Nutri Centre have created the Healing Spaces Awards 2008, which recognize the importance of the built environment in which healthcare happens. The Awards Panel are seeking examples of surroundings that enable holistic healthcare to support personal or communal healing and wellbeing – whether a meditation space, group-work rooms, a community garden, an art room, exercise areas, a health library, even an entire multidisciplinary health centre. There is a £2000 prize for large scale projects, such as a practice centre, and a £500 prize for small scale projects, such as a treatment room. Entry forms can be downloaded from www.bhma.org

Image Acknowledgement

Courtesy of Heather Coulson ABIPP ARPS; Tel: 01730-825228; Fax: 01730-825993; heather@elsted.demon.co.uk; www.heathercoulson.com

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About Dr David Peters

Prof David Peters is Chair of the British Holistic Medical Association (BHMA.org), an open association for everyone concerned to develop medicine as if people matter. David is the Clinical Director and Professor of Integrated Healthcare at the University of Westminster (U of W), is on the Board of Directors of the U of W Institute of Health and Wellbeing, a transdisciplinary research and training group exploring biopsychosocial approaches to health creation and treatment. He may be contacted via petersd@westminster.ac.uk

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