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Hospital  

by Robert F. Carr NIKA. for VA Office of Construction & Facilities Management (CFM) Revised by the WBDG Health Care Subcommittee

Within This Page

Building attributes, emerging issues, relevant codes and standards, additional resources.

"A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels." ... Hardy and Lammers

Hospitals are the most complex of building types . Each hospital is comprised of a wide range of services and functional units. These include diagnostic and treatment functions, such as clinical laboratories , imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; and the fundamental inpatient care or bed-related function. This diversity is reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialized knowledge and expertise. No one person can reasonably have complete knowledge, which is why specialized consultants play an important role in hospital planning and design. The functional units within the hospital can have competing needs and priorities. Idealized scenarios and strongly-held individual preferences must be balanced against mandatory requirements, actual functional needs (internal traffic and relationship to other departments), and the financial status of the organization.

Exterior of the VA Medical Center, Bay Pines, FL

VA Medical Center, Bay Pines, Florida

In addition to the wide range of services that must be accommodated, hospitals must serve and support many different users and stakeholders. Ideally, the design process incorporates direct input from the owner and from key hospital staff early on in the process. The designer also has to be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not generally have direct input into the design. Good hospital design integrates functional requirements with the human needs of its varied users.

The basic form of a hospital is, ideally, based on its functions:

  • bed-related inpatient functions
  • outpatient-related functions
  • diagnostic and treatment functions
  • administrative functions
  • service functions (food, supply)
  • research and teaching functions

Physical relationships between these functions determine the configuration of the hospital. Certain relationships between the various functions are required—as in the following flow diagrams.

Flow diagram of major clinical relationships. Reception & registration receive records and post hospital care patients and deal with admittance. Admission receives from reception & registration and services inpatient wards and outpatient wards. Records go to reception & registration, outpatient, diagnostic & treatment, and inpatient wards. Inpatient wards receive from records and admittance and in turn lead to discharge and pharmacy. Inpatient wards' divisions (medical, surgical, and psychiatric) link to diagnostic & treatment's divisions (laboratories, morgue, surgery, x-ray department, P.M.E.R.). Dignostic & treatment receive from records, and its divisions (laboratories, morgue, surgery, x-ray department, P.M.E.R.) link to inpatient wards' divisions (medical, surgical, and psychiatric) and outpatient wards' divisions. Outpatient receives from admittance and records and in turn lead to discharge and pharmacy. Outpatient's divisions (outpatient clinics and emergency) link to diagnostic and treatment's divisions (laboratories, morgue, surgery, x-ray department, P.M.E.R.). Pharmacy receives from outpatient and inpatient wards and gives to discharge from both outpatient and inpatient. Inpatient wards' discharges receive from inpatient wards and pharmacy and gives to post hospital care. Outpatient discharges receive from outpatient and pharmacy. Post hospital care leads back to reception & registration.

These flow diagrams show the movement and communication of people, materials, and waste. Thus the physical configuration of a hospital and its transportation and logistic systems are inextricably intertwined. The transportation systems are influenced by the building configuration, and the configuration is heavily dependent on the transportation systems. The hospital configuration is also influenced by site restraints and opportunities, climate, surrounding facilities, budget, and available technology. New alternatives are generated by new medical needs and new technology.

In a large hospital, the form of the typical nursing unit, since it may be repeated many times, is a principal element of the overall configuration. Nursing units today tend to be more compact shapes than the elongated rectangles of the past. Compact rectangles, modified triangles, or even circles have been used in an attempt to shorten the distance between the nurse station and the patient's bed. The chosen solution is heavily dependent on program issues such as organization of the nursing program, number of beds to a nursing unit, and number of beds to a patient room. (The trend, recently reinforced by HIPAA, is to all private rooms.)

Regardless of their location, size, or budget, all hospitals should have certain common attributes.

Efficiency and Cost-Effectiveness

An efficient hospital layout should:

  • Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces
  • Allow easy visual supervision of patients by limited staff
  • Include all needed spaces, but no redundant ones. This requires careful pre-design programming .
  • Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient handling of food and clean supplies and the removal of waste, recyclables, and soiled material
  • Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces
  • Consolidate outpatient functions for more efficient operation—on first floor, if possible—for direct access by outpatients
  • Group or combine functional areas with similar system requirements
  • Provide optimal functional adjacencies, such as locating the surgical intensive care unit adjacent to the operating suite. These adjacencies should be based on a detailed functional program which describes the hospital's intended operations from the standpoint of patients, staff, and supplies.

Flexibility and Expandability

Since medical needs and modes of treatment will continue to change, hospitals should:

  • Follow modular concepts of space planning and layout
  • Use generic room sizes and plans as much as possible, rather than highly specific ones
  • Be served by modular, easily accessed, and easily modified mechanical and electrical systems
  • Where size and program allow, be designed on a modular system basis, such as the VA Hospital Building System . This system also uses walk-through interstitial space between occupied floors for mechanical, electrical, and plumbing distribution. For large projects, this provides continuing adaptability to changing programs and needs, with no first-cost premium, if properly planned, designed, and bid. The VA Hospital Building System also allows vertical expansion without disruptions to floors below.
  • Be open-ended, with well planned directions for future expansion; for instance positioning "soft spaces" such as administrative departments, adjacent to "hard spaces" such as clinical laboratories.

B/W photo of man workind in an interstitial space

Cross-section showing interstitial space with deck above an occupied floor.

Therapeutic Environment

Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment . A hospital's interior design should be based on a comprehensive understanding of the facility's mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness. (See VA Interior Design Manual .) Some important aspects of creating a therapeutic interior are:

  • Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs
  • Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients.
  • Admitting ample natural light wherever feasible and using color-corrected lighting in interior spaces which closely approximates natural daylight
  • Providing views of the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes are helpful where outdoor views are not available
  • Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage. (As an example, see VA Signage Design Guide. )

For an in-depth view see WBDG Therapeutic Environments .

Cleanliness and Sanitation

Hospitals must be easy to clean and maintain. This is facilitated by:

  • Appropriate, durable finishes for each functional space
  • Careful detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints
  • Adequate and appropriately located housekeeping spaces
  • Special materials, finishes, and details for spaces which are to be kept sterile, such as integral cove base. The new antimicrobial surfaces might be considered for appropriate locations.
  • Incorporating O&M practices that stress indoor environmental quality ( IEQ )

Accessibility

Exterior aerial-style photo of VA Medical Center, Albuquerque, NM

VA Medical Center, Albuquerque, NM

All areas, both inside and out, should:

  • Comply with the minimum requirements of the Americans with Disability Act (ADA) and, if federally funded or owned, the GSA's ABA Accessibility Standards
  • In addition to meeting minimum requirements of ADA and/or GSA's ABA Accessibility Standards, be designed so as to be easy to use by the many patients with temporary or permanent handicaps
  • Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are wide enough for two wheelchairs to pass easily
  • Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious

Controlled Circulation

A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled.

  • Outpatients visiting diagnostic and treatment areas should not travel through inpatient functional areas nor encounter severely ill inpatients
  • Typical outpatient routes should be simple and clearly defined
  • Visitors should have a simple and direct route to each patient nursing unit without penetrating other functional areas
  • Separate patients and visitors from industrial/logistical areas or floors
  • Outflow of trash, recyclables, and soiled materials should be separated from movement of food and clean supplies, and both should be separated from routes of patients and visitors
  • Transfer of cadavers to and from the morgue should be out of the sight of patients and visitors
  • Dedicated service elevators for deliveries, food and building maintenance services

Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include:

  • Increased use of natural light , natural materials, and textures
  • Use of artwork
  • Attention to proportions, color, scale, and detail
  • Bright, open, generously-scaled public spaces
  • Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices
  • Compatibility of exterior design with its physical surroundings

Security and Safety

In addition to the general safety concerns of all buildings, hospitals have several particular security concerns:

  • Protection of hospital property and assets, including drugs
  • Protection of patients, including incapacitated patients, and staff
  • Safe control of violent or unstable patients
  • Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or because they may be highly visible public buildings with an important role in the public health system.

Sustainability

Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design .

Section 1.2 of VA's HVAC Design Manual is a good example of health care facility energy conservation standards that meet Energy Policy Act of 2005 (EPACT) and Executive Order 13693 requirements. The Energy Independence and Security Act of 2007 (EISA) provides additional requirements for energy conservation. Also see USGBC's Leadership in Energy and Environmental Design (LEED) for Healthcare.

Related Issues

The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of "protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy, and may affect location and layout of workstations that handle medical records and other patient information, paper and electronic, as well as patient accommodations."

Among the many new developments and trends influencing hospital design are:

  • The decreasing numbers of general practitioners along with the increased use of emergency facilities for primary care
  • The increasing introduction of highly sophisticated diagnostic and treatment technology
  • Requirements to remain operational during and after disasters—see, for example, VA's Physical Security Manuals
  • State laws requiring earthquake resistance , both in designing new buildings and retrofitting existing structures
  • Preventative care versus sickness care; designing hospitals as all-inclusive "wellness centers"
  • Use of hand-held computers and portable diagnostic equipment to allow more mobile, decentralized patient care, and a general shift to computerized patient information of all kinds. This might require computer alcoves and data ports in corridors outside patient bedrooms. For more information, see WBDG Integrate Technological Tools
  • Need to balance increasing attention to building security with openness to patients and visitors
  • Emergence of palliative care as a specialty in many major medical centers
  • A growing interest in more holistic, patient-centered treatment and environments such as promoted by Planetree . This might include providing mini-medical libraries and computer terminals so patients can research their conditions and treatments, and locating kitchens and dining areas on inpatient units so family members can prepare food for patients and families to eat together.

Hospitals are among the most regulated of all building types. Like other buildings, they must follow the local and/or state general building codes. However, federal facilities on federal property generally need not comply with state and local codes, but follow federal regulations. To be licensed by the state, design must comply with the individual state licensing regulations. Many states adopt the FGI Guidelines for Design and Construction of Health Care Facilities as a resource, and thus that volume often has regulatory status.

State and local building codes are based on the model ICC IBC International Building Code . Federal agencies are usually in compliance with the IBC except NFPA 101 (Life Safety Code), NFPA 70 (National Electric Code), and Architectural Barriers Act Accessibility Guidelines or GSA's ABA Accessibility Standards takes precedence.

Since hospitals treat patients who are reimbursed under Medicare, they must also meet federal standards, and to be accredited, they must meet standards of The Joint Commission . Generally, the federal government and The Joint Commission refer to the National Fire Protection Association (NFPA) model fire codes, including Standards for Health Care Facilities (NFPA 99) and the Life Safety Code (NFPA 101).

The Americans with Disabilities Act (ADA) applies to all public facilities and greatly affects the building design with its general and specific accessibility requirements. The Architectural Barriers Act Accessibility Guidelines or GSA's ABA Accessibility Standards apply to federal and federally funded facilities. The technical requirements do not differ greatly from the ADA requirements. See WBDG Accessible

Regulations of the Occupational Safety and Health Administration (OSHA) also affect the design of hospitals, particularly in laboratory areas.

Federal agencies that build and operate hospitals have developed detailed standards for the programming, design, and construction of their facilities. Many of these standards are applicable to the design of non-governmental facilities as well. Among them are:

  • Department of Veterans Affairs (VA), Office of Construction & Facilities Management Technical Information Library contains many guides and standards, including Design Guides for planning many different departments and clinics, design manuals of technical requirements, equipment lists, master specifications, room finishes, space planning criteria, and standard details.

Federal Mandates and Criteria

  • Executive Order 13693, "Planning for Federal Sustainability in the Next Decade"
  • UFC 4-510-01 Design: Military Medical Facilities

Publications

  • Design Details for Health: Making the Most of Design's Healing Potential , 2nd Edition by Cynthia A. Leibrock and Debra Harris. New York: John Wiley & Sons, Inc., 2011. — Innovative design solutions in key areas such as lighting, acoustics, color, and finishes
  • Design Guide for Improving Hospital Safety in Earthquakes, Floods, and High Winds: Providing Protection to People and Buildings . FEMA 577, 2007.
  • Development Study—VA Hospital Building System: Application of the Principles of System Integration to the Design of VA Hospital Facilities Research Study Report Project Number 99-R047 by Building Systems Development and Stone, Marraccini & Patterson. Washington, DC: U.S. Government Printing Office, rev. 1977.
  • Emergency Department Design: A Practical Guide to Planning for the Future . American College of Emergency Physicians (ACEP).
  • Healthcare Facility Planning: Thinking Strategically , 2nd Edition by Cynthia Hayward, AIA, FAAHC, ACHA. Health Administration Press and the American College of Healthcare Executives, 2016.
  • Hospitals, The Planning and Design Process , 2nd ed. by Owen B. Hardy and Lawrence P. Lammers. Rockville, Md.: Aspen Publishers, 1996.
  • Hospital Interior Architecture: Creating Healing Environments for Special Patient Populations by Jain Malkin. New York: John Wiley & Sons, Inc., 1992.
  • Healthcare Design — A quarterly magazine with design articles and presentations of recent projects
  • Medical and Dental Space Planning: A Comprehensive Guide to Design, Equipment, and Clinical Procedures , 4th Edition , by Jain Malkin. New York: John Wiley & Sons, Inc., 2014.
  • Sound & Vibration: Design Guidelines for Health Care Facilities by the Acoustics Research Council. 2010.
  • SpaceMed Guide — A Space Planning Guide for Healthcare Facilities — a popular planning tool providing state-of-the-art planning methodologies, industry benchmarks, and planning tips.

WBDG Participating Agencies

presentation of hospital design

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10 forward-thinking design trends in hospitals today

presentation of hospital design

For more than a century, we have seen paradigm shifts and pivots in healthcare and the concept of the hospital as a typology. Going back to the 1800’s, sanitation and hygiene were recognized as being beneficial to overall health. The flu pandemic of 1918 brought recognition of the importance of light and ventilation.  Le Corbusier and the International school drove forward the machine aesthetic in architecture.  In reaction to that, Alvar Aalto’s Paimio Sanitarium for tuberculosis emphasized the role a building can play in the healing process, with the building acting as a ‘medical instrument’. In the 1940’s architect Charles Neergaard rejected the concept of natural ventilation and daylight as representative of health and proposed a hospital with windowless inpatient rooms. Through the 1950’s, we saw a transition towards more enclosed building with integration of HVAC environmental controls, which further removed the humanity from the environment.  In the 1960’s, Le Corbusier proposed the “New Venice Hospital” reintegrating light through venetian square or courtyards and skylights.  In the 1970’s E. Todd Wheeler even imagined a Tropicarium, or tent hospital made of tree-like structures served by drones, as a way to return to nature –which in the current atmosphere of COVID alternate care facilities may not be so unrealistic.  In recent years we have seen a return to biophilia and natural environments.

Now, as we look ahead, here are the key trends in healthcare we expect to see:.

The healthcare industry was one of the first markets to embrace resilience and RELi rating system.  COVID-19 has further reinforced the importance of resilience in hospitals. The Rush University Medical Center Tower , which opened in 2012, is a perfect example. The building, which was designed in the aftermath of 9/11 for bioterrorism events and pandemics, was readily converted to accommodate surge capacity and negative pressure patient treatment areas in the early days of the COVID 19 pandemic.

presentation of hospital design

As data becomes more accessible and institutions continue to weigh the value of design decisions, we expect to see an expansion in the use of evidence-based design (EBD) and data in healthcare. Such research and neuro-architecture principles, along with input from a Patient and Family Advisory committee, were used as guideposts throughout the design and construction of the UC Gardner Neuroscience Institute , ensuring each decision was made to support the unique patient population served in the building.

With the continued globalization of healthcare, we expect to see merging of local culture, conditions, and building methodologies with the advanced care, high safety standard and cutting-edge medical planning across the world. There are lessons to be learned from all countries and cultures. In the era of COVID, Singapore’s open-air inpatient units and outdoor spaces could be a well-tested solution to our ventilation concerns surrounding airborne diseases, where the climate allows it.

presentation of hospital design

Leading up to the pandemic, there was an increased focus on prevention and holistic wellness, with healthcare institutions investing in facilities like the Piedmont Wellness Center in Fayetteville, GA. This state-of-the-art facility offers fitness and sports training, nutritional counseling, and outpatient rehab services all surrounded by hiking trails dotted with art installations.  The COVID pandemic has certainly turned the $4.5 trillion wellness industry on its head, but we expect to see the continued growth of community health and wellness, just in new ways and locations

January 21, 2020 was the first reported case of coronavirus in the US. Just under 11 months later, on December 14, 2020, the first vaccine was administered. Our lesson? The often life and death importance of integrated science and research in medicine. We’re hopeful that COVID will serve as a catalyst for expansion of translational medicine and research.

Even before COVID, we were experiencing worldwide healthcare staffing shortages.  have shown that by 2030, 23 of 50 states will have critical shortages of physicians , with 30 states facing nursing shortages . After a decade’s long focus on patient experience, experiential design can be expected to expand its focus to creating staff spaces that support recruitment and retention.  Robotics and A.I. may be expanded to supplement staff and help to reduce transmission of infection in case of future pandemics.

Technology is advancing at a rapid pace – bionics, robots to clean hospitals and lift patients, and microchip implants, to name a few, are all now a reality.  The impact of more yet-to-be-discovered technologies is a mystery to us all.

COVID forced the implementation of telehealth far faster than may have happened otherwise, but we think it is here to stay.

presentation of hospital design

To complement this technology-driven culture, we’re witnessing a resurgence of nature and biophilia in healthcare spaces.  While not quite the open-air natural environment that E. Todd Wheeler dreamed of with his Tropicarium, The Lucile Packard Children’s Hospital Stanford seamlessly links gardens and terraces with clinical spaces – providing a natural, healing environment for patients and staff alike.

According to Scripps Health, adults spend an average of 11 hours a day staring at a screen.  Healthcare is not immune to this reliance on immediate access and the internet of things. We expect to see continued growth of wearable technology, access to providers and medical records, and connectivity between personal health data and healthcare.

presentation of hospital design

While infection control is not a new concept, COVID has made us hyper aware of the materials we select for all spaces, be they healthcare or not. The University of Virginia Health System’s Hospital Expansion Project in Charlottesville, VA, is a perfect example. The lobby, with its light-colored wood ceiling and warm white floors and walls, isn’t just beautiful, it’s also functional as overflow for the ED, and features cleanable, durable materials.

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Presenting a conceptual model for designing hospital architecture with a patient-centered approach based on the patient's lived experience of sense of place in the therapeutic space

Mansour pagiri ghalehnoei.

Department of Architecture, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfshan, Iran

Mohammad Massoud

1 Faculty of Architecture and Urban Planing, Isfahan University of Art, Isfahan, Iran

Mohammad H. Yarmohammadian

2 School of Managment and Medical Information Science, Isfahan University of Medical Sciences, Isfshan, Iran

BACKGROUND:

In recent years, among managers and designers of health-care spaces, there has been a growing tendency to move toward hospital design by combining patient perceptions and expectations of the physical environment of the care area. The main idea of this study was to present a conceptual model of hospital architecture in our country with a patient-centered approach based on some factors that were affecting the sense of place. This model determined the architectural features of treatment spaces from a patient's lived experience that could have a positive mental effect on patients as well. The main question of the research was how to adapt the objective perception to the patient's mental perception to create a sense of place in the hospital space?

MATERIALS AND METHODS:

This research was qualitative with a phenomenological approach, conducted between July and December 2020. Purposeful sampling consisted of 23 patients, 13 males in the male surgery unit and 10 females in the gynecology unit, who were interviewed in-depth. They were hospitalized for at least 3 days in two hospitals (Dr. Pirooz in Lahijan and Ghaem in Rasht). The data were analyzed by the Colaizzi method.

The results consisted of 530 primary codes, 57 subthemes, and 7 main themes. The main themes were hospital location, access to hospital, hospital identity, hospital dependency, hospital attachment, human interactions in the hospital, and hospital evaluation.

CONCLUSION:

The hospital form guided the patient, and the hospital function directed and obviated the patient's needs. The healing environment and human interactions with it caused the patient to be satisfied with the hospital environment.

Introduction

Health is one of the most essential and basic human needs. Hospitals and other medical centers, with doctors and nurses, are the most significant base and supporters of the people in times of illness, dangers, and accidents. Hospitals and medical centers are part of the safety subjects and the context of the treatment process.[ 1 ] One of the recent concerns in the design of hospitals and health-care centers is to be patient centered, which means focusing on improving the patient's experience by providing facilities and attention to their concerns and comfort.[ 2 ] The original mission of hospitals is to provide quality care for patients and meet their needs and expectations.[ 3 ] Since patient satisfaction is a quality indicator in health care,[ 4 ] carrying out this serious mission and patient satisfaction requires quality institutionalization in hospitals. Numerous studies on the quality of hospital services and the rate of patient satisfaction with hospital care indicate many challenges and shortcomings. According to experts, in 90% of public hospitals in our country, patients are not satisfied with the way services are provided.[ 3 ] Patient-centered services are a new approach in the medical systems. In addition, the research shows that this approach increases satisfaction, shortens the duration of treatment, reduces medical costs, reduces medical errors, and overall improves the treatment status.[ 2 ] That is why the features of the system health-care providers are inevitable to change with a patient-centered approach, following that patient-centered care has become one of the main issues in the design and redesign of health-care services.[ 5 ]

Architectural design and quality perception in health-care buildings have changed over time. At first, the architectural quality meant physical structure security and functional efficiency, then esthetic, cultural values, physical needs, and patient psychology added to it. In transforming health-care buildings into patient-centered buildings, the main goal in design is to provide a healing environment for patients.[ 6 ] Most of the time, the hospitals are weak in meeting the patients’ needs and expectations and their emotional needs.[ 7 ] As Berwick (2000) points out, in a modern mindset, the patient is pivotal between the boundaries of two opposing perspectives, such as professionalism and consumerism. For this reason, participation needs to provide a solution. In this sense, the patient experience could consider as the phenomenon key because it covers a wide range of qualities, from performance to more intangible dimensions such as emotional needs, comfort, and satisfaction.[ 8 ]

Understanding the patient experience is sometimes essential in moving toward patient-centered care. Evaluation of the patient's experience by effectiveness and safety of the care, determines the whole picture of the quality of health care. Patient experience and patient satisfaction are not the same. It needs to evaluate the patient's experience by asking the patient if something should have happened at a health-care facility, which is happened or not? In addition, satisfaction is whether the patient's expectations for health-care treatment are met. Two people who receive the exact same care, but who have different expectations for how that care is supposed to be delivered, can give different satisfaction ratings because of their different expectations.[ 9 ]

Weiss and Tyink (2009) discuss the opportunity to provide the ideal patient experience through creating a patient-centric culture. The components of a patientcentric culture encompass competent, high-quality care, personalized care, timely responses, care coordination, and are reliable and responsive. While Frampton (2002) does not provide a clear definition of the patient experience, he implicitly refers to the consistency of the patient's experiences of caring, so he suggests that the experiences focus on two main areas: human interactions and the care environment. He adds that patient-centered care is the living space between what care and treatment provide and how patients and their loved ones experience it.[ 10 ] Among managers and designers of health-care spaces, there is a growing tendency to move toward hospital design by combining patient perceptions and expectations of the physical environment of the care area. Increasing interests and physical environment can help better understanding their role in patient improvement outcomes and user benefit.[ 11 ] From a patient-centered perspective, considering the view of the patients and other users by the hospital designer is significant. Moreover, understanding the quality of the structural environment is also necessary to help understand the relationship between people and the hospital environment.[ 12 ]

Patient-centered care focuses on patients and their companion experience in the hospital, and the design of the health-care environment should support the patient-centered care concept.[ 13 ] The physical environment of health care is an integral part of the patient experience.[ 14 ] The physical environment consists of the building, the organizer of the interior space, the materials, and the exterior space that establishes the spatial connections between buildings.[ 15 ]

Schweiter et al ., 2004, claim that the hospital environment affects the actions, interactions of the patients and their families, and the service providers. Many studies have shown a relation between health-care design and patients’ medical outcomes, for example, the effects of environmental characteristics and interior design on patient recovery and staff performance.[ 16 ] The relationship between the behavior and well-being of healthcare users with their feeling of comfort, relaxed and secured,[ 17 ] and the potential of creation of a healing hospital atmosphere that could reduce negative psychological impact such as stress, depression, and anxiety.[ 7 ] The environment, and a sense of place, play a significant role in improving the quality of treatment and maintaining well-being. For this reason, it is necessary to understand the patient's perspective and perception of the treatment experience and the people involved in the treatment path.[ 18 ]

Harris et al . to identify the environmental sources of satisfaction of that hospital, determined the ratio of the satisfaction with the environment to the overall satisfaction of the patients’ experience of the hospital and examined the differences between the four wards (internal medicine, gynecology, orthopedics, and surgery) in 6 hospitals. The 380 hospitalized patients were interviewed by telephone. The analysis showed that the interior design, architecture, housekeeping, privacy, and ambient environment, identified as sources of satisfaction. Environmental satisfaction was an essential predictor factor of overall satisfaction that in the ranking was below the quality of nursing and clinical care. There was no significant difference between hospitals or wards of levels or sources of environmental satisfaction.[ 19 ] Douglas et al . examined patients’ perceptions and attitudes toward the hospital environment and the factors which helped their experiences. The results showed that patients had a perfect understanding of the range of factors that affected them. They had data, especially given their health status, independent of the specific health conditions that led to their hospitalization. A case study of patients in the four head wards of the hospital showed a wide range of considerations affecting health. The main set of indicators extracted from the internal and external set, each set of indicator factors, had separate elements to evaluate the design. Designing the hospital's interior and exterior, including transitional spaces for patient access, and movement should provide a supportive environment that minimizes anxiety and promotes healing by creating an inviting, calming, and engaging overall effect. The human demand-driven health-care environments have a broader scope than organizational growth and physical development. Patients need environments that support their normal family lifestyle and family functioning. They need a space that protects privacy, dignity, ownership and territory, access needs, and movement through transitional spaces and public spaces.[ 20 ]

Salonen et al . controlled the positive effects of environmental characteristics on health and recovery from health-care facilities to show that a well-designed interior environment supports public health and the sense of well-being. Positive effects of space and the environment on people well known in the era before modern science. In ancient Greece, the temples of the god Asclepius were quite evident, designed to equip patients with nature, music, and art to restore harmony, and developed healing in the absence of other treatment methods. After that, many studies showed that environments with healing properties improve patient safety, reduce patient stress, analgesics, staff tiredness, and stress, and increase overall health and effectiveness. The environmental features that affect the health and recovery outcomes included: environmental safety, indoor air quality (e.g., odor and temperature), sound and noise, building area, and interior design (e.g., building materials, looking at nature and experiencing nature, windows versus no windows, light, colors, furniture layout, and location, room type, ability to control quality elements, complexity environmental and sensory simulations, cleanliness, ergonomics, accessibility, and routing), and art and music.[ 21 ] Indoor environments with healing elements can, for example, reduce anxiety, lower blood pressure, reduce pain, and shorten hospital stays.[ 21 ] The main idea of this study is to present a conceptual model of hospital architecture in our country with a patient-centered approach based on some factors that are affecting the sense of place.

Theoretical framework of research

Phenomenology is the study of lived experience or lifeworld, and the human lived experience of space focuses on understanding the sense of place.[ 22 ] Sense of place means people's mental perception of the environment and their more or less conscious feelings about it. In the interaction between humans and place, three types of relationships are formed. The first one is the cognitive relation that is general perception to understanding the geometry of space and its orientation. The second is the behavioral relationship that is the perception of space capabilities to meet the needs. Third, an emotional connection means the perception of satisfaction and depending on the place. The sense of place is cyclically interconnected and is formed in three stages: 1 – place identity, 2 – place attachment, and 3 – place dependence. In other words, identity, dependence, and attachment to place consider as cognitive, behavioral, and emotional variables, respectively. The constituent elements of these concepts are placed together in different degrees of physical elements, personal, immaterial, and mental elements. The main question of this study was how to adopt the objective perception to the patient's mental perception in creating a sense of place in the hospital space in The Patient,s Lived Experience.

Research method

This research is a qualitative study with a descriptive phenomenological approach. Phenomenology as a method means to study and accurate identification of lived experiences of people in different situations. Living space or place is also the situation where lived experience is formed.[ 23 ] Descriptive phenomenological research aims to be aware of the researcher biases and assumptions to put them in parentheses or put them aside to have a preconceived notion of what they achieved? in the research. This awareness prevents the researcher from assuming the influence of presuppositions or biases on the study[ 24 ] since the main idea of a phenomenological research method is to create a comprehensive description of the experienced phenomenon to understand its intrinsic structure.[ 25 ]

In this study, patients’ lived experience of factors affecting the sense of place in the hospital spaces, applied to create a comprehensive description of the experienced phenomenon. Purposeful sampling consisted of 23 patients. Patients included 13 males in the male surgery unit and 10 females in the gynecology unit with a maximum of 48 h of discharging from the hospitals.

The participants were hospitalized for at least 3 days in two hospitals and interviewed in-depth. An orderly pattern was used from repetitive data collection and analysis at the same time to data saturation, and the data were analyzed by the Colaizzi method. Colaizzi speaks of the final validity that is done by referring to each informant. Therefore, he considers the validation of comprehensive descriptions of the studied phenomenon by the participants as the most significant criterion for evaluating the findings of phenomenological research.[ 26 ]

Accordingly, the researcher provided the participants with the text of the interviews and asked them to study the findings and control their consistency with their experiences. Furthermore, the ability to generalize the results of qualitative research is not as discussed in quantitative research. In qualitative research, more than paying attention to the fact that the samples represent the whole society, it pays attention to the fact that the obtained information shows the available data.[ 27 ]

The place of research

A 225-bed public hospital with a gorgeous landscape opened in March 2017. This hospital was a general hospital with 225 active beds and more than 700 personnel, considered as the medical center of the west of the province. The hospital built according to the latest standards and regulations of the Ministry of Health, Treatment, and Medical Education and was put into operation in March 2016. The design of this hospital was a process of analysis and composition that included a list of required functions for the plan and a list of design standards to combine them and making A form that follows the performance of the hospital. This hospital, mainly designed to maximize performance and workflow, included four wards: internal medicine, general surgery, obstetrics, and pediatrics, as well as laboratory, radiology, pharmacy, emergency, and nutrition wards.

A 200-bed private hospital opened in 2013. This hospital, located on a highway in one of the most beautiful areas with a beautiful and natural landscape having 200 active beds and more than 700 staff with providing different physical spaces, using advanced equipment, specialized and subspecialized physicians along with Special facilities is One of the first choices for area patients.

The statistical population

The statistical population consisted of 23 patients, including 13 men and 10 women, whose selected from the gynecology and male surgery wards of the two hospitals (to obtain more rich and unique narratives about their lived experience). The average day of hospitalization in public hospitals was 3–5 days (at least 3 days). The selected patients were hospitalized in one, two, or four-bedroom treated, discharged and, interviewed (at a maximum time of 48 h after discharge). Whereas, the quality of the care, the type of surgery, and the financial subjects could affect the levels of patient satisfaction such as disturbing variables, so preferably patients selected who mostly performed light operations such as the appendix, hernia, and benefited from the same nursing services. They were workforces, and all of them were employed and covered by insurance.

Ethical considerations

Prior to the interview, participants were informed About the goals and importance of research. And Their participation in this study was with their consent. and to They were assured of conversation and information Used only for academic research and interview details Remain confidential during and after this investigation. Let us record Interview and its use in the study.

Demographic description of participants

The participants in the study were a total of 23 people, including 10 women and 13 men. The average age of the participants was 41.8 years, who are neither old nor young but middle aged. Middle age is the peak of the ability and efficiency of a person in society, has gained in youth, and has not lost its strength and power due to not reaching old age and old age. Perhaps consequently, it is said that middle-aged people gain the highest quality of life in their social relationships. One of the most famous researches on the age of youth and old age, related to the detailed study that Domenic Abram (2010) conducted in Europe and tried to show with a high statistical sample (40 thousand people) people of different countries of age and what is their perception of the year. The result demonstrated that people in average age consider the end of youth to be around 30 years old, and the beginning of aging is about 60 years old.[ 28 ] Alistair et al ., 2016, pointed out: the effect on satisfaction, divided into two categories: factors that determine satisfaction and its components. As a determining factor, older patients are generally more satisfied than young people. Other determinants of satisfaction investigated show a possible relationship to education level, where less educated patients are more satisfied. Studies have shown that gender and race, however, are not influencing factors or determinants of satisfaction[ 29 ] To reduce the effects of the disturbing variables not selected in the study of elderly and very young or illiterate people. There was no significant difference between men and women in terms of gender.

Research finding

This study used semi-structured in-depth interviews and in-depth talks with patients in the male and female surgery wards. The sequence of questions was not the same for all participants and depended on the interview process and the patient's answers.

However, the interview guide assured the researcher that they would collect a similar type of data from all informants.[ 30 ] The focus of the interview was generally on the patient's experiences in the hospital environment. To this end, the researcher tried to create a safer space for the participants to express their experiences without asking detailed questions. The researcher with a general question (What happened when you came to the hospital) Began to ask questions and left the next step of the interview to the participants. The seven-step Colaizzi method was applied to analyze the data. First, the whole provided descriptions with participants recorded to convert into a text commonly called a protocol, revised many times to get a feeling and get used to them. Second, referred to each of the protocols and extracted sentences and phrases related directly to the phenomenon of the sense of place (this step is known as extraction of the essential sentences). Third, a trial to understand the meaning of each sentence. This stage is known as formulating meanings. In the fourth stage, the concepts, formulated and related to each other and placed in clusters of themes (main themes).

The theme or theme expresses the requisite information about the data and research questions and partly shows the meaning and concept of the pattern in the data set. It is a pattern found in the data and describes and organizes observations at the least and interprets aspects of the phenomenon utmost. In general, it is a repetitive and distinctive feature in the text that reflects the specific understanding and experiences of the research questions.[ 31 ] The result of the effort included 530 codes, the 7 main themes, and 57 subthemes, summarized in Table 1 .

Results of information analysis of steps 1-4 of Colaizzi method

STEP 5: Factors affecting the sense of place from the patient's lived experiences in the therapeutic space included 530 codes, 7 main themes, and 57 subthemes, summarized in Table 2 .

Combining the results in the form of a comprehensive description of the research topic

The sense of place in the hospital space refers to the patient's specific experience in a hospital environment. It is a general feeling that the patient feels about the hospital. To create a sense of place, the hospital environment must have a particular structure and features that increase the sense of place and strengthen it. Then, the product will be a positive evaluation of patients from the hospital environment. Factors obtained in evaluation of patients from the hospital in the patient's lived experiences of the hospital space include the location of the hospital (e.g., hospital location in the city, adjacent, parking, and passage width), access to the hospital (e.g., proximity, communication network, and public transport), hospital identity (e.g., visibility attributes, form attributes, use and significance attributes, being different from specific places, being similar to other places, and knowledge of being located in hospital), hospital dependence (e.g., way, wayfinding, space, space performance, space relationship, space location, space access, space dimensions, overall hospital atmosphere, full hospital, individual location past, and successful treatment), attachment to the hospital (e.g., light, noise, odor, color, lighting, thermal comfort, safety, cleanliness, fresh air, view out, viewing nature, positive distraction, number of beds, single room, good sleep, privacy, personal space, facilities, family facilities, artwork, texture like flooring materials, inside and outside, local information, and waiting time), human interactions between hospital users (including doctor, nurse, office personnel, service staff, treatment staff, and family), and the hospital evaluation (general evaluation).

Factors affecting the sense of place from the patient's lived experience in the therapeutic space included 530 codes, 7 main themes, and 57 subthemes, summarized in Table 2 .

STEP 6: Comprehensive description of the factors affecting the sense of place in the lived experience of the hospital space

(Step 6 of the Colaizzi method: Comprehensive description of the factors affecting the sense of place in the lived experience, of the hospital space as a clear statement of the basic structure of sense of place in therapeutic dwelling presented, under the title (intrinsic structure of the phenomenon).

Architecture plays a central role in human life. It provides the most dominant kind of human-made places and well-designed buildings by supporting and enhancing the unique worlds. For example, schools sustain a world of teaching and learning; dwellings, a world offering privacy; and at-homeness, familial intimacy, and hospitals, a world facilitating health and healing.[ 32 ] On the other hand, architecture is the art of creating space,[ 33 ] and when the relationship between man and space, based on experiences for man, space becomes place.[ 34 ] A place or living space is a situation where our lived experiences take shape,[ 35 ] and lived experience is an experience that is achieved without voluntary thinking and without resorting to classification or conceptualization.[ 36 ]

Man's lived experience of space focuses on a sense of place,[ 22 ] and a sense of place is a sensory relationship with a place perceived through concepts and signs. Human attention to that place leads to forming a rich image of it.[ 34 ]

Sense of place refers to a person's experiences in a particular environment. It is a general feeling that a person feels about places.[ 37 ] To create a sense of place the environment, must have a particular character and structure that gives a sense of place, increases, and strengthens it. The product is the positive evaluation of residents of that environment.[ 38 ]

STEP 7: Final validation.

Colaizzi speaks of the final validity that is done by referring to each informant. Therefore, he considers the validation of comprehensive descriptions of the studied phenomenon by the participants as the most significant criterion for evaluating the findings of phenomenological research.[ 26 ]

Accordingly, the researcher provided the participants with the text of the interviews and asked them to study the findings and control their consistency with their experiences.

Limitation and recommendation

In this study, the sense of place subject, considered only from the patient view. Since patient-centered care design focused on improving the patient and family experience to achieve a more inclusive result and model, subjects also could assess from the companion perspective.

In this study, factors presented in the patients’ lived experience of the hospital environment in the overall evaluation of the hospitals included hospital location, hospital access, hospital identity, hospital dependency, hospital attachment, and human interactions within the hospital. The mentioned factors indicated that the evaluation of the hospital environment was the result of a conscious effort to assess the actual quality of the hospital environment rather than familiarity through the extended stay in it and expressed as a general evaluation that represented the patient's feelings toward the hospital. The study also showed that providing a successful and perfect treatment with human interactions between patients and users and companions in an ideal hospital creates a general sense of place toward the hospital. A complete hospital has an efficient space through fixed features of the environment and a healing environment with the help of variable elements of the environment and hospitalization in one position. Appropriate position in the city, accessibility, and easy identification could create a general sense of place in the patients.

The proposed conceptual model of the hospital, based on the factors affecting the sense of place in the patient's lived experience of the hospital space, shows a picture [ Figure 1 ] of the simultaneous presence of the features of the hospital space architecture based on the factors affecting the sense of place and how a sense of place forms. According to this model, the hospital architecture creates by influencing the creation of space and experiencing it by the patient and turning that space into a place and understanding the components of the place, namely a place, site, users, form, function, and concept of the healing environment.

An external file that holds a picture, illustration, etc.
Object name is JEHP-11-188-g001.jpg

Conceptual model of hospital-based factors which affect the sense of place of the patient's lived experience in the therapeutic space

The location of the hospital and how to access it are the factors of its choice. The hospital form guides the patient, and the hospital function directs and meets the patient's needs. The healing environment and human interactions with it cause the patient to be satisfied with the hospital environment.

Acknowledgment

  • Dr. Pirooz hospital staff in Lahijan, Ghaem hospital staff in Rasht, and the patients participating in this study
  • Dr. Paridokht Karimian
  • Zahra Pagiri Ghalehnoei.

Approval ID: IR.IAU.KHUISF.REC.1400.107.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Designing smart hospitals of the future: What to know

presentation of hospital design

When the Hospital of the University of Pennsylvania  opened its 17-story, $1.6 billion Pavilion building last October , it marked the culmination of a several-year plan to create a patient-centered building built for the future of medicine. Looking at the facility design can provide journalists with a sense of where new hospital construction is headed and provide plenty of ideas for feature stories.

In the largest capital project in Philadelphia hospital’s history, designers called on features used by Disney to hide from public view core services like linen and trash chutes, and reserve the outside of the building and views of downtown for patients and families, said John Donohue, Penn Medicine’s vice president of entity services, during a March presentation at  HIMSS22 , the Health Information and Management Systems Society’s annual meeting. 

They also included a new main telecommunications equipment center, 31,000 network ports, and almost 900 Wi-Fi access points, including some just outside the building where staff congregates during breaks in nice weather. 

Each of the 504 patient rooms has a 75” monitor that integrates functions like television viewing and weather with information about the patient’s care plan and names and photos of care team members. Through an integrated pillow speaker, patients can use voice commands to call for a nurse; control the room’s lighting, window shades and temperature; turn on or off privacy glass on side of the room facing the hallway, and work the television or play music. Care providers wear badges that wirelessly transmit their photos and positions to the patient’s digital board. Rooms can be converted to serve as either intensive care unit beds or regular patient rooms as needs change. During the next phase of design, building engineers will incorporate clinical imaging so doctors can pull up patient scans on the monitors in patient rooms when discussing their care. 

Following similar footsteps, Houston Methodist also broke ground on a 400-bed hospital in Cypress, Texas, designed to be a smart hospital of the future. Scheduled to open in the first quarter of 2025, the building will incorporate elements to transform safety and quality through digital innovation, said Debra Sukin, M.H.A., Ph.D., regional senior vice president for Houston Methodist, in an interview with AHCJ.

Patients want to be known when they come into the hospital, Sukin said. They don’t want to have to stop and spend 20-30 minutes filling out forms. They also want predictability, such as being able to know their co-payments. New digital applications will allow patients to schedule appointments, fill out forms and check billing status without having to spend as much time on the phone, Sukin said. Practitioners will also have the ability to easily schedule operating room or clinic time.

Not every element in health care can be made 100% virtual or digital, Sukin cautioned. Therefore, designers are focused on building out the so-called “phygital” (physical and digital) environment. Smart patient rooms will be wired for cameras and voice-controlled functions. They’ll have tablets or other functions capable of video visits, entertainment and access to the hospital’s spiritual care library. Artificial intelligence-powered tools will help with documentation or analyzing data. Robots will play a role in the operating rooms and food prep areas and possibly extend to the labs or other locations. Cafeteria services will be extended into the night shift by having grab-and-go stations for prepared food with barcode technology through which employees can check out using Apple Pay or swipe their badge for a deduction on their paycheck. 

In other changes, hospital locations for treatment and monitoring also have been expanding. The Mayo Clinic in Florida began its Care Hotel model in July 2020 to offer patients an environment outside of the hospital where they can receive both in-person and virtual care following a low-risk surgery or procedure. The hotel is staffed by a registered nurse from 7:00 a.m. to 7:00 p.m. for vital sign assessment and dressing changes. Patients are monitored remotely during the remaining hours. In a survey of 102 patients who tried the hotel between July 2020 and June 2021, 87% reported having a positive experience and 94% said they were likely to recommend the program to others. These results were  published in the Annals of Medicine and Surgery . 

The model is part of a multi-pronged hospital-at-home effort by Mayo, according to  an article in Healthcare IT Today . Additional services to be provided in patient homes in partnership with a tech vendor include infusions, skilled nursing, medications, labs and imaging, behavioral health and rehabilitation. The effort is part of a larger initiative called Mayo Clinic Platform, which seeks ways to leverage technologies such as artificial intelligence, connected health and natural language processing, the article noted.  

Some hospitals have taken hospitality a step further, adding patient lounges to nearby airports. Knowing that between 50-60 patient families fly in to the Memphis International Airport for treatment at St. Jude Children’s Research Hospital each week, the local airport authority gifted a private lounge for St. Jude patients and families in the airport’s new concourse,  according to a recent news release . Staffed by employees, the lounge, which opened on March 24, features seating areas with charging stations, board games and books; a kitchenette with coffee, tea and snacks; and a monitor that provides up-to-date flight status information. Free transportation to gates is available.

The Cleveland Clinic is looking to follow suit, opening a lounge for patients at Cleveland Hopkins International Airport. Clinic staff proposed a plan to renovate a 480-square-foot space inside the airport to offer concierge and hospitality services for patients and help make travel arrangements,  Cleveland.com reported . About 3,000 patients fly to the airport for treatment at the clinic each year, the article noted. If approved, the clinic would lease the space for at least three years. The Mayo Clinic in Minnesota has a similar space at Rochester International Airport where patients can visit a help desk providing appointment and transportation information.

Resources for reporters

  • Hospital of the University of Pennsylvania – Pavilion
  • The Hospital of the Future  – an article from Health Tech Digital 
  • The Hospital of the Future virtual briefing  – a free webinar from Modern Healthcare, held February 10, 2022
  • Plans Approved for Houston Methodist ‘Smart Hospital of the Future’ in Cypress  – an article from Medical Construction & Design

presentation of hospital design

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2024 SHERF fellows

Karen Blum is AHCJ’s health beat leader for health IT. She’s a health and science journalist based in the Baltimore area and has written health IT stories for numerous trade publications.

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Sara Harrison

How Do You Design a Better Hospital? Start With the Light

The Centro Hospitalario Serena del Mar in Cartagena Columbia and a helicopter pad.

Just as medical care has evolved from bloodletting to germ theory, the medical spaces patients inhabit have transformed too. Today, architects and designers are trying to find ways to make hospitals more comfortable, in the hopes that relaxing spaces will lead to better recovery. But building for healing involves just as much empathy as it does synthesizing cold, hard data.

“Part of the best care might be keeping people calm, giving them space to be alone—things that might seem frivolous but are really important,” says Annmarie Adams, a professor at McGill University who studies the history of hospital architecture.

In the 19th century, famed nurse Florence Nightingale popularized the pavilion plan, which featured wards: big rooms with long rows of beds, large windows, lots of natural light, and plenty of cross-ventilation. These designs were informed by the theory that dank indoor spaces spread disease. But wards offered almost no privacy for patients and required plenty of space, something that became difficult to find in increasingly dense cities. They also meant a lot of walking for nurses, who had to trudge up and down the aisles.

Over the next century, that focus on natural light faded in favor of prioritizing sterile spaces that would limit the spread of germs and accommodate a growing raft of medical equipment. After World War I, the new norm was to cluster patients’ rooms around a nurses’ station. These designs were easier on nurses, who no longer had to trek long corridors, and they were cheaper to heat and build. But they retained some of the trappings of older-style residential treatment facilities, like sanatoria where patients would convalesce for long periods of time; both mimicked fancy hotels with ornate lobbies and fine food, measures intended to convince middle-class people that “they were better off in hospitals than at home when seriously ill,” Adams wrote in a 2016 article on hospital architecture for the Canadian Medical Association Journal. This design, she argued, was meant to give people faith in the institution: “a tool of persuasion, rather than healing.”

In the late 1940s and 1950s, hospitals transformed again, this time becoming office-like buildings without frills or many features meant to improve the experience of being there. “It was really designed to be operational and efficient,” says Jessie Reich, director of patient experience and magnet programs for the Hospital of the University of Pennsylvania. Many of these rooms had no windows at all, she points out.

By the middle of the 20th century, the hospital had become sort of the opposite of what Florence Nightingale had envisioned, and many of those buildings, or ones modeled after them, are still in use today. “The typical hospital is designed as a machine for delivering care, but not as a place for healing,” says Sean Scensor, a principal at Safdie Architects, a firm that recently designed a hospital in Cartagena, Colombia. “I think what’s missing is the empathy for people as human beings.”

Although Nightingale had been operating largely on anecdotal evidence that light and ventilation were important, she had been right—but it took over a century for scientists to gather the quantitative data to back her up. For example, a pivotal 1984 study published in Science followed patients after gallbladder surgery. The 25 patients whose rooms had views of greenery had shorter hospital stays and took fewer painkillers than the 23 patients whose windows faced a brick wall.

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outside of hospital. covered with greenery

An exterior view of the Centro Hospitalario Serena del Mar in Cartagena, Columbia.

Numerous recent studies show that exposure to nature and natural light can reduce pain , and that even a brief contact with the outdoors reduces stress. One 2019 study published in Frontiers in Psychology followed a group of 36 city dwellers for eight weeks and tested their saliva for biomarkers, including the stress hormone cortisol. The researchers found that spending just 20 minutes outside reduced people’s cortisol levels by over 20 percent. Another 2019 study found that taking regular breaks in outdoor gardens eased stress for ICU patients and their families. 

Foyer of hospital

A foyer at the Centro Hospitalario Serena del Mar.

“The ambient environment influences our senses,” says Rana Zadeh, co-director and co-founder of the Health Design Innovations Lab at Cornell University. “The spatial environment influences how we can move and circulate. These are important in healthcare settings.”

The same is true for psychiatric facilities, where design can help lower stress by reducing crowding and noise and increasing exposure to gardens and natural light. In one 2018 study published in the Journal of Environmental Psychology, researchers concluded that a Swedish hospital that used those design-based interventions lowered patient aggression so much that the staff decreased the use of physical restraints by 50 percent.

Starting in the 1980s, Adams says, hospital designers began to shift away from favoring efficiency and office-like buildings and back towards light, open space, and positive patient experiences. Today, many buildings have large, central atria, similar to those at a mall or airport. Because that architecture is so familiar, Adams says, it makes the hospital less frightening and makes medical care feel more normal. “The hospital has come to look like a shopping mall or a spa,” she says. “It makes you feel like, ‘Oh, I’m just at the mall. I’m not really here for my cancer treatment.’”

Pavillion

An atrium at the Penn Pavilion, showing Decoding the Tree of Life, a sculpture by Maya Lin.

The Hospital of the University of Pennsylvania is one of the most recent examples of this trend in patient-centered design; in October, they opened a new pavilion to house the emergency department and in-patient care for the cardiology, neurology, neurosurgery, oncology, and transplant departments. “One of the things we know is that sleep is really, really critical to healing,” says Reich, who was one of many hospital employees who worked with the architects to finalize the design. So the new more-than-500-room building uses an “onstage/offstage” design to minimize noise and disruption. Private patient rooms are “onstage,” lining the outside of the building. Supply and medication rooms and staff break rooms are “offstage,” clustered in the core. Separating the two reduces noise and gives staff more private space, too. Each nursing specialty is now housed on the same floor, making it easier for nurses to coordinate care instead of having to travel between floors to consult about a patient.

Patient Room

Penn Pavilion patient room

Every room also has a large window, which Reich says helps promote patients’ circadian rhythms , or sleep-wake patterns , “because it allows them to understand when it's day.” It’s also meant to prevent common hospital complications like delirium by giving patients a connection to the outside world that can help orient them in time and space.

But not all design ideas end up being good solutions. When designing the new Centro Hospitalario Serena del Mar in Cartagena, the architects thought it would be great if patients were able to open their windows to get a breath of fresh air. “But there were practical issues,” says Scensor, whose firm designed the new building. Dust could get in and cause infections. Or the tropical humidity could wreak havoc on the hospital’s carefully-controlled environment.

Instead, the firm chose windows that were giant, but sealed, prioritized greenery, and made the space easier to navigate. Scensor points out that when people enter hospitals, they’re often anxious and confused. But thoughtful design can help. Color coding or using different building materials to differentiate departments can make it easier for patients to find their way. Safdie Architects also designed an interior garden to help orient people in the building and provide a sense of calm, and reduced glare by using indirect lights that would be less harsh than overhead fluorescents. “It’s not about luxury or extravagance,” Scensor says. “It’s a basic thoughtfulness about people feeling cared for and respected.”

But the trouble, says Adams, is that just providing open or green space isn’t a cure-all. People respond to spaces in different ways. In one 2010 study published in Social Science and Medicine , she examined how children and parents reacted to the atrium at the Hospital for Sick Kids in Toronto, Canada. Some families loved the space; it felt like an escape from the clinic. But other children were terrified. When they were in it, they saw other sick kids, some of whom looked scary because of burns, surgical scars, or the effects of chemotherapy. “What it tells you is that everybody sees these spaces in different ways, and a problem with the postwar hospital was that it assumed a kind of middle class, suburban perception of everything,” she says. “We’re trying to get away from that now and have a more multicultural perspective of space.”

The best solution, she thinks, is variety. Even if airy spaces help many patients, hospitals should provide options: spaces where kids can run and make noise, ones where families can gather, and ones where people can find quiet and privacy. “There are many, many needs, and the needs are always changing,” says Adams. Medical technology, social expectations, and what happens in a hospital are all constantly evolving. The best buildings might just be the ones that can keep up.

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Evaluation of a joint workshop on study design for hospital and community pharmacists: a retrospective cross-sectional survey

  • Yuki Asai   ORCID: orcid.org/0000-0002-1933-8592 1 ,
  • Yasushi Takai 2 ,
  • Toshiki Murasaka 3 ,
  • Tomohiro Miyake 4 ,
  • Tomohisa Nakamura 5 ,
  • Yoshihiko Morikawa 1 ,
  • Yuji Nakagawa 6 ,
  • Tatsuya Kanayama 7 ,
  • Yasuharu Abe 8 ,
  • Naoki Masuda 8 ,
  • Yasushi Takamura 8 ,
  • Yoshihiro Miki 8 &
  • Takuya Iwamoto 1  

Journal of Pharmaceutical Health Care and Sciences volume  10 , Article number:  14 ( 2024 ) Cite this article

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Although pharmacists often identify numerous clinical questions, they face several barriers, including the lack of mentors for research activities in clinical settings. Therefore, a workshop for the appropriate selection of a study design, which is a fundamental first step, may be necessary. The purpose of this study was to evaluate the effectiveness of a workshop on study design for hospital and community pharmacists. Moreover, the characteristics of pharmacists with little involvement in research activities were extracted using decision-tree analysis to guide the design of future workshops.

A workshop was conducted on October 1, 2023. It comprised three parts: lectures, group work, and presentations. Questionnaire-based surveys were conducted with workshop participants regarding their basic information, their background that influenced research activities, their satisfaction, and their knowledge/awareness. For the questions on knowledge/awareness, the same responses were requested before and after the workshop using a five-scale scoring system. Multivariate logistic regression analysis was conducted to identify independent factors influencing research activities. Decision tree analysis was performed to extract low-effort characteristics of the research activities.

Of the 40 workshop attendees, the overall satisfaction score for the workshop was 4.38 of 5, and the score for each question was 4 or higher. Significant increases were observed in the scores of knowledge/awareness after the workshop. Moreover, 95% of the pharmacists answered that it would be highly useful to conduct a joint workshop between hospitals and community pharmacists. Although independent influencing factors were not detected in the multivariate logistic regression analysis, the decision tree analysis revealed that pharmacists who were no member of an academic society (85%, 11/13) or members without any certifications or accreditations related to pharmacy practice (80%, 4/5) were the least active in clinical research. In contrast, those belonging to academic societies and holding certifications or accreditations related to pharmacy practice frequently conducted clinical research.

The present study revealed that a joint workshop on study design may have the potential to change pharmacists’ knowledge and awareness of research activities. Moreover, future workshops should be conducted with pharmacists who do not belong to academic societies.

Pharmacists often identify numerous clinical questions, and skills are required to conduct their own clinical research [ 1 ]. A recent survey at several Japanese national universities revealed that the number of papers increased from 2.87 per faculty member/year in the period from 1979 to 1980 to 10.77 per faculty member/year in the period from 2019 to 2020 at pharmaceutical and medical faculties [ 2 ]. This may reflect the increased research activity in the medical area at this educational institution. While research activities have been thriving in universities in which mentors are located, there may be barriers to research activities, such as the lack of mentors for clinical research in community pharmacies [ 3 ]. Therefore, it was considered necessary to establish a guidance system for research activities in clinical settings. Considering the current situation, the Mie Pharmaceutical Association established “The Research Activity Promotion Team” in February 2022 to promote clinical research activities by hospitals and community pharmacists.

The researchers selected a study design suitable for specific clinical questions, which is a fundamental first step [ 4 ]. In clinical research, it is necessary to understand the biases of each study’s design in terms of the subjects under investigation, such as related to the credibility of data, and to eliminate biases as much as possible to be able to appropriately interpret the results. The selection of an inappropriate design may potentially undermine the validity of clinical research [ 5 ], and it is thus important to conduct a workshop on how to select a correct research design. We held the first workshop on research design on October 2, 2022, for hospital and community pharmacists. One year after the first workshop, a second workshop was held and its effectiveness was evaluated. Furthermore, as research activities in the Mie Prefecture need to be stimulated, it is important to create an incentive for pharmacists to engage in clinical research, as they are commonly not involved in such research. It is thus necessary to elucidate the characteristics of pharmacists who are hardly involved in research activities to plan future workshops.

The purpose of the present study was to evaluate the effectiveness of the workshop based on changes in the participants’ knowledge and awareness of research activities. Moreover, the characteristics of pharmacists with little involvement in research activities were extracted using decision tree (DT) analysis to deduce the appropriate design of subsequent workshops.

  • Study design

We conducted a retrospective cross-sectional survey of 40 pharmacists, including hospital and community pharmacists, who attended the workshop. All participants were members of the Mie Pharmaceutical Association.

The workshop information was distributed via e-email to all pharmacies and hospitals belonging to the Mie Pharmaceutical Association in the period from August 21, 2023 to September 18, 2023. The workshop was held on October 1, 2023. The timetable is presented in Supplementary Table  1 . First, the lectures focused on selecting an appropriate study design. Second, the research topics were assigned to two groups of five to six members each to construct the study project with the assigned responsible mentor. Finally, a presentation session was conducted to discuss the project.

Questionnaire

Questionnaires were collected using Google Forms (Google, Mountain View, CA, USA). The questionnaire consisted of basic information, influencing backgrounds on research activities, satisfaction, and knowledge/awareness. Details of the questions are provided in Supplementary Table  2 . For questions on knowledge/awareness, the same responses were obtained before and after the workshop. While questionnaires before the workshop were collected at the time of registration, a second questionnaire survey was performed immediately after the workshop.

The effectiveness of the present workshop was evaluated based on an increase in the participants’ knowledge and awareness of research activities via the questionnaires.

Statistical analysis

While the Wilcoxon signed-rank test was used to examine the differences in continuous variables before and after the workshop, categorical factors were analyzed using McNemar’s test. Categorical variables were compared using the chi-square test or Fisher’s exact test.

For the question “Have you ever reported results of your research activities (conference presentations and/or research papers) since you started working? (Supplementary Table  2 ), “Only once or not at all” responses were defined as low involvement in research activities. For multivariate logistic regression analysis, low involvement was used as the objective variable and factors that exhibited p  < 0.05 in the univariate analysis. DT analysis was performed according to our previous study [ 6 ], based on the chi-squared automatic interaction detection algorithm. All statistical analyses were performed using SPSS Statistics version 27 (IBM Japan, Tokyo, Japan), and the significance level was set at p  < 0.05.

The questionnaire response rate was 100% (40/40 participants). The participating pharmacists had a wide range of experience, with more community than hospital pharmacists (Table  1 ).

The overall satisfaction score for the workshop was 4.38, with all questions scoring 4 or higher (Table  2 ). While 75% of the respondents reported that time allotment was adequate, 20% desired more time for group work.

As shown in Fig. 1 A to C, significant increases in the respective scores were observed after the workshop. Although no statistically significant differences were observed, 95% of pharmacists answered that it would be highly useful to conduct another joint workshop (Fig.  1 D). Moreover, respondents who answered “Yes” were most likely to comment “I would receive different opinions from different workplace distributions” (Supplementary Table  3 ).

figure 1

Workshop questionnaire on knowledge and awareness for research activities. A If you have a clinical question, do you want to work on it? B Can you develop your own research project? C Do you think a research mindset is necessary in your daily work? D Do you think that a joint workshop between hospitals and community pharmacists is useful?

Univariate analysis revealed that being a member of an academic society ( p  = 0.001, 95% confidence interval: 0.014‒0.427) and participating in the first study design workshop ( p  = 0.003, 95% confidence interval: 0.025‒0.525) were associated with clinical research efforts (Table  3 ). However, independent influencing factors for clinical research efforts were not detected in multivariate logistic regression analysis.

In the DT analysis, pharmacists who did not belong to academic societies (85%, 11/13) or members who did not have any certifications or accreditations related to pharmacy practice (80%, 4/5) were hardly involved in clinical research, whereas those who were affiliated with academic societies and held certifications or accreditations were highly involved in clinical research (Fig.  2 ).

figure 2

Decision tree model for predicting backgrounds of pharmacists with low involvement on research activities

The questionnaire showed that the level of satisfaction was very high, and the content fit the needs of the participants. Moreover, an increase in knowledge and awareness of research activities was observed (Fig.  1 ), suggesting that the workshop was meaningful for pharmacists who want to start clinical research. E-learning and lectures have been reported as the most desired forms of learning in clinical research for community pharmacists [ 7 ]. Although the usefulness of face-to-face active workshops has been reported in clinical research learning methods [ 8 ], a concern was that more time for group work would result in fewer participants. However, no participants in this workshop desired a decrease in group work time; rather, some participants requested an increase (Table  2 ), indicating the need for group work and more opportunities for participants to discuss topics in depth in future workshops. The usefulness of this joint workshop was linked to a better understanding of the current situation regarding the different business categories and research activities of pharmacists in different professional fields (Supplementary Table  3 ).

Although the multivariate logistic regression analysis did not identify any independent factors associated with low involvement in research activities (Table  3 ), the DT analysis revealed that pharmacists who were not members of an academic society or members without any practical awareness may be associated with low involvement (Fig.  2 ). As membership is regularly required in academic societies, the results of the DT analysis may be as expected. Organizing workshops on more basic topics, such as the importance of research for pharmacists and how to identify clinical questions, may be of interest. Regular research conferences have been reported as a critical factor in research activities by resident physicians [ 9 ]. Moreover, as several reports have shown the usefulness of web-based educational programs received by community and hospital pharmacists [ 10 , 11 ], web-based workshops may be useful depending on the level of achievement.

The present study has several limitations. First, as pharmacists who attended this workshop might have had a high awareness of research activities, the usefulness of this workshop might have been overestimated. Second, because the second questionnaire was performed immediately after the workshop, the results of this questionnaire might have yielded high ratings. Third, the factors influencing the low involvement in research activities may differ by population. Forth, the degree of the increase in the number of conference presentations and papers submitted by participants remains unknown.

Conclusions

The present study revealed that a workshop on study design may have the potential to change pharmacists’ knowledge and awareness of research activities. Future workshops should target pharmacists who are not members of academic societies. Therefore, the Research Activity Promotion Team should continue to hold workshops and support research activities for the members of the Mie Pharmaceutical Association.

Availability of data and materials

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

Decision tree

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Acknowledgements

We thank the participants of the workshop on study design who cooperated in the surveys for this study. This study was supported by Mie Pharmaceutical Association.

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Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

Yuki Asai, Yoshihiko Morikawa & Takuya Iwamoto

Department of Pharmacy, Mie Heart Center Hospital, 2227-1 Ooyodo, Meiwa, Taki, Mie, 515-0302, Japan

Yasushi Takai

Konan Pharmacy, 1874-4 Karasu, Tsu, Mie, 514-0315, Japan

Toshiki Murasaka

Department of Pharmacy, Ise Red Cross Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan

Tomohiro Miyake

Pharmacy, Mie Prefectural Mental Medical Center, 1-12-1, Shiroyama, Tsu, Mie, 514-0818, Japan

Tomohisa Nakamura

Ichishi Dispensing Pharmacy Takano Store, 226-7, Takano, Ichishi, Tsu, Mie, 515-2504, Japan

Yuji Nakagawa

Sanai Pharmacy Ikuwa Store, 826-1, Daimon, Ikuwa, Yokkaichi, Mie, 512-0911, Japan

Tatsuya Kanayama

Mie Pharmaceutical Association, 311 Shimazaki, Tsu, Mie, 514-0002, Japan

Yasuharu Abe, Naoki Masuda, Yasushi Takamura & Yoshihiro Miki

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Contributions

Conceived or designed the study: YA, TM, YT, and TI. Performed research: YA, YT, TM, TM, TN, YM, YN, TK, YA, NM, YT, YM, TI. Analyzed data: YA. Wrote paper: YA. All authors read and approved the final manuscript.

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Correspondence to Yuki Asai .

Ethics declarations

Ethics approval and consent to participate.

Participants’ completion and return of the questionnaire implied a consent to participate in this research. The analysis was conducted respecting the anonymization of responses. The ethical review committee of the Mie Pharmaceutical Association estimated that an ethical review was not required based on the Ethical Guidelines for Medical and Health Research Involving Human Subjects.

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Supplementary Information

Additional file 1: supplementary table 1..

Contents of the workshop on study design. Supplementary Table 2. Questionnaire for the workshop. Supplementary Table 3. Reasons for the usefulness of joint workshops between hospitals and community pharmacists.

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Asai, Y., Takai, Y., Murasaka, T. et al. Evaluation of a joint workshop on study design for hospital and community pharmacists: a retrospective cross-sectional survey. J Pharm Health Care Sci 10 , 14 (2024). https://doi.org/10.1186/s40780-024-00337-x

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Published : 04 March 2024

DOI : https://doi.org/10.1186/s40780-024-00337-x

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    U.S. Public Health Service (USPHS): • 100 bed hospital area = 260 m2 • 200 bed hospital area = 520 m2 Generally the area of the storages is 2-2.6m2 /bed. 59. Mortuary division: Location: • In the ground floor or basement floor. • Exit from emergency entrance or service entrance. Area of the department: 1.

  14. Hospital Powerpoint Templates and Google Slides Themes

    These hospital-themed PowerPoint templates can enhance your presentations by providing a professional and visually appealing design that aligns with the healthcare industry. With their clean layouts and medical-related graphics, they can help you effectively communicate information and engage your audience.

  15. Free Medical & Healthcare PowerPoint Presentation Templates

    The Claricine medical PowerPoint template features a fresh and clean design. It includes 65 unique slides and was designed in 16:9 format. You'll also find editable shapes, infographic elements, charts, maps, and fully animated slides. This healthcare PPT template also includes 11 premade color schemes. Advertisement.

  16. 6 Easy Steps to Create an Effective and Engaging Medical Presentation

    In short: getting the presentation design right is just as important as delivering it well. Here's how to create an effective and engaging medical presentation — without wasting hours on PowerPoint! ... In fact, blue is the single most common logo color among the leading healthcare organizations in the USA and around the world! And ...

  17. Hospital PowerPoint Templates

    The Hospital templates present medical and healthcare slides to be used in relevant presentation areas. These templates are helpful in demonstrating hospital and emergency care topics. The hospital PowerPoint templates include introduction slide decks with a collection of visually appealing graphics. Further templates contain flat vector shapes and infographics that are helpful in ...

  18. Public Hospital Google Slides theme and PowerPoint template

    Free Google Slides theme and PowerPoint template. Public health service hospitals have a paramount importance for the general public, as they provide a quality service. You, as a health professional, may want to present your data, graphs and other pieces of information about any medical center. Use this great template and gain support!

  19. Free Medical Center Google Slides and PowerPoint templates

    Hospitals, private clinics, specific wards, you know where to go when in need of medical attention. ... Slidesgo AI Presentation Maker puts the power of design and creativity in your hands, so you can effortlessly craft stunning slideshows in minutes. Try AI Presentation Maker. 5 years of great presentations, faster. ...

  20. Free Medical Google Slides themes and PowerPoint templates

    Download the Pharmacology - Doctor of Medicine (M.D.) presentation for PowerPoint or Google Slides. As university curricula increasingly incorporate digital tools and platforms, this template has been designed to integrate with presentation software, online learning management systems, or referencing software, enhancing the overall efficiency ...

  21. 15+ Hospital PowerPoint Template PPT FREE Download

    Medical and Hospital PowerPoint Template. If you are looking to design a minimal and modern style look for your PowerPoint presentations then these slides are perfect for you. In this pack, you get a total of 70 different creative slides for designing professional projects for your clients. You get these templates with retina and full HD format ...

  22. 12+ Free Healthcare PowerPoint Templates

    Medical PowerPoint Template. This beautifully designed free healthcare PowerPoint template has all the tools you might need for a medical presentation. It has slides you can use to showcase different procedure options or different service tiers. It has several text slides so you can easily add any messages you find convenient.

  23. 8 Custom Hospital PowerPoint Designs

    10. Clinical PowerPoint Presentations. 8. Medicine PowerPoint Presentations. 7. Vet PowerPoint Presentations. 5. Custom hospital PowerPoint Presentations. Be inspired by these 8 hospital PowerPoint Presentations - Get your own perfect hospital PowerPoint design at DesignCrowd!

  24. Evaluation of a joint workshop on study design for hospital and

    Although pharmacists often identify numerous clinical questions, they face several barriers, including the lack of mentors for research activities in clinical settings. Therefore, a workshop for the appropriate selection of a study design, which is a fundamental first step, may be necessary. The purpose of this study was to evaluate the effectiveness of a workshop on study design for hospital ...