Healing Architecture: For a long time, we have supposed that good design will improve patient well-being. Now we have figures to prove it. Bryan Lawson reports on how patient treatment and behaviour improved with new architecture - Theory

Most hospital patients may get the personal attention of a doctor for only a few minutes a day and slightly longer periods of personal care from nurses and therapists. However they often remain in bed, or if they are more fortunate sit, for many hours with little to do. This may well make them even more susceptible to the environment and more sensitive to it. It is reasonable therefore to assume that environment maybe a contribatory factor to their snese of well-being and actual recovery. Over a century ago Florence Nightingale noted the effect of their sort founding on her patients. (1)

Our research set out to test the proposition by measuring effects on patients of hospital architecture. Many in the field poured scorn on our work. Suggesting that patients in hospital have other things on their mmd than the quality of architecture. In fact, we found patients extraordinarily responsive to and articulate about their surroundings. We also found that not only can them time on hospital be substantially improved through good architecture but also that the treatment they receive appears to be enhanced. (1)

One general medical and one mental health hospital were upgrading their accommodation using what is currently considered best practice in hospital design. In each case the hospitals were providing new wards bus using the same patients of patient referral and same treatment regimes in the new buildings as they had in the old ones. In many cases medical and clinical staff were the same. This enabled us, as far as in practically possible, to see clearly any effects resulting from changes to patients environment. (1)

Poole Hospital Trust was returbishing a series of existing 1960s general wards. In the original wards there were six four-bed bays and six one bed bays with lavatories at each end of the ward. In the refurbished unit there are 16 single bedrooms and there four-bed bays. The new bedrooms have a clean simple interior using matural timber and have ensuite bathrooms.

At South Downs Health NHS Trust in Brighten the original accommodation for the mentally ill comprised 15-bed wards in typical Victorian brick institutional buildings with characteristically high ceilings. These were replaced with a new medium secure mental healthcare building designed by Powell and Moya using only single rooms and now known as Mill View Hospital Hove.

Higher satisfaction

In both the newly designed wards, patients showed very significantly higher levels of satisfaction with their surroundings. Ratings given by patients in the newer hospitals were significantly higher for appearance, overall design and spatial organization. Patients in the two new sets of wards were particularly pleased with their own private area, whether it was a room of their own or a bay in a multiple bed ward. (5)

Significantly more of the patients in the newer wards told us that the environment had helped them to feel better. We went on to ask them about the treatment they had received and the staff who bad cared for them. Remarkably, patients in the newly designed environments gave significantly better ratings to their actual treatment. Indeed they also thought more highly of the staff treating them. In most cases these were actually the same people. Some of these differences were not statistically significant but he overall picture is remarkably clear. In the newer environments, patients were more content, though they had received better treatment and their doctors, nurses and therapists were more helpful and attentive.

So far, although this is empirical evidence to support our argument about the effect of architecture on patients, it still remains largely subjective. Two questions remain. First, do the patients actually benefit from this in real health outcomes? Second, what are the major contributory architectural factors responsible?

The two health trusts involved monitored the patients and provided us with a mass of data about their progress while in hospital. Measuring patient progress is not as simple a matter as it might seem since there are many potential indicators with perhaps the most obvious being length of treatment.

In fact many patients in both our physical hospital and mental hospital samples were released significantly more quickly from the new wards than from the old ones. Non-operative acute patients showed a significant reduction of some 21 per cent in treatment times and mental health patients a reduction of 14 per cent.

However, there are interesting indicators that further contribute to the picture. In our physical hospital, analgesic medication is largely taken on demand within prescribed limits. There was a dramatic reduction in the amount of analgesic medication taken by the patients on the new wards. (1) Effectively here we see patients requesting less pain-killing medication in the new hospital ward environments than in the old.

In a mental health hospital it is normal to record many items of patient behaviour including all instances of verbal abuse, physical violence towards others and physical self harm. These records were studied and the results quite remarkable. While the number of incidents of verbal and physical abuse remained largely the same, their severity dropped quite significantly in the new wards. The number of instances of patients injuring themselves was dramatically reduced by two thirds. Patients who become particularly distressed and are considered a danger to themselves are normally put for a period into seclusion in a safe room with intense supervisory care. The amount of time this was necessary was reduced by a remarkable 70 per cent in the new unit with an average reduction of nine days, from 13 to four in a typical stay.