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Figure 1: Waiting area of inpatient tower at Promedica, Toledo – allowing daylight, access to nature and social connectivity
By Dr. Upali Nanda, Director of Research, HKS Architects
The environments we live in impact our health. This is not an over-statement. This is a fact that has been proven, again and again, via scientific evidence. Yet, we don’t think of the design of the built environment as fundamental to the care of the patient, similar to the care regiment or a clinical protocol. What if we thought about our health facilities, as a key component of the patient’s treatment plan — not just providing the stage on which health delivery happens, but as an active component of the healing process as well. In this article we will explore how the built environment, via health facilities, can be a health facilitator.
Daylight: To Improve Sleep, Stress, Mood and Burnout
Daylight is an area with compelling evidence around it. Studies link daylight to reducing depression, improving mood, reducing opioid usage, reducing ICU delirium (by supporting circadian rhythms) and reducing LOS (Length of Stay). Orientation matters when it comes to daylight — research shows that in brighter orientations, such as SE, the average LOS was shorter than patients in rooms with No Window (NW). In healthcare environments daylight is now mandated in all patient rooms in the U.S. But daylight can have profound impact on caregivers and family as well. For example, exposure to daylight for at least three hours a day was found to cause less stress and higher satisfaction at work. Using daylight as a key component of not just design, but the health plan in itself, is a great opportunity. What if doctors prescribe daylight as part of the discharge plan for patients? Or as part of a healthcare stay?
Figure 2: Texas Health Frisco, Breezeway Connector to activate biophilic public space – ©HKS Architects
Access to Nature to Reduce Pain Medication, Stress and Anxiety, Improve Social Connection and Memory, and Encourage Mobility
Nature can be considered another powerful non-pharmacological intervention. A compelling body of evidence links exposure to nature to reduced LOS, reduced medication, and reduced stress. Exposure to nature can also improve memory, which is key for an increasingly aging population. Research also shows that exposure to nature can be beneficial in both real, and simulated settings (through visual art, VR, multi-media etc.).
Additionally, having nature as a destination within a health facility can also become a mobility incentive that can enable early mobility, and thereby discharge, for patients. Gaining health habits while in health facilities could be a powerful goal.
Figure 3: Strategies for promoting healthy movement and healthy food choices ©CADRE 2017
Point of Decision Design Strategies to Nudge Healthy Choices
In all health settings, but especially primary care settings, the built environment can also be used to encourage patients (and staff) to make better decisions around food and movement. Recent research argues that the most effective way of promoting better health decisions is to focus on designing for points of decision. For example — to think about where someone decides about eating junk food or healthy food, and make the healthy food option more available, accessible, affordable, and appealing. Similarly, to think about where someone plans about movement — walking/ biking/ public transport or car and make healthy mobility choices easier and more attractive. Figure 3 shows some of the strategies that can be used to promote healthy diet and movement in health facilities. If health facilities can serve as catalysts for healthy habits, then they can actively influence the continuum of health.
Figure 4: Proposed Master Plan for Children’s Hospital Campus (c) HKS Architects
Public and Fluid Spaces to Promote Social Connectivity and Patient Engagement
Public spaces can also be used to facilitate social connectivity. The ability to leverage waiting areas for education, empowerment and engagement, as well as build communities (especially for specialty clinics) could be significant. Research also suggests that social integration is a strong predictor of well-being and longevity and the characteristics of outdoor common spaces can play a role in maintaining social ties. All too often the health facility is constrained to the walls of the building. Tremendous potential of making health facilities, health facilitators, lies in the master planning. This way the entire design can have a connective tissue of whole health.
In summary, we do our field a disservice if we limit ourselves to purely clinical objectives. Clinical excellence is key and should be a given. However, it is creating a healing fabric, where facilities can actively promote, rather than passively support health, that can make our facilities, health facilitators, and an active contributor to better health for our people and communities.
References available on request.