healing architecture for hospital

School of ArchitectureDelhi Technical Campus, Greater Noida

Affiliated to – Guru Govind Singh Indraprastha University Delhi

HEALING ARCHITECTURE IN HOSPITAL DESIGN

Submitted by: DIPESH ANAND

Enrollment no. 064181001613

Submitted to: AR.ANKUR TRIPATHI

Submitted in partial fulfillment

of the requirement for the Degree of

Bachelor of Architecture

Batch: 2013

Date: 11/21/2016

HEALING ARCHITECTURE IN HOSPITAL DESIGN 1@2016 , Dipesh anand

ABSTRACTWinston Churchill concisely expressed the effect of architecture and our surroundings with the

comment that: “We shape our buildings and later they shape us.”

The intent of this dissertation is to explore how architecture can inform healing or provide spaces

and events where healing can take place. We as human beings have an inner connection with our

environment by physical, mental, emotional and spiritual means. Healing cannot be understood in

isolation from the factors that operate in the dynamic life of an individual. These include the self,

the family, the community, the environmental context within which life is carried forth, and the

world of spirit or essence.

Furthermore, the arts and art therapy have, over the years, been used to heal different aliments

such as cancer, mental illness, aids, addiction and the elderly have been successful in doing so as

it heals across all ages and race. The question I pose is can architecture do the same? Besides,

can architecture play a superior role in healing? In our built environment we often interact with the

buildings themselves without knowing the fact of relationship between building and surroundings.

Can we create those interactions by evidence based design methods? This dissertation

summarize the principals of life enhancing role of architecture and planning in the healing process.

Through a theoretical approach including the history of healing architecture and the introduction of

architectural and anthropological theories, the project defines four main parameters that should be

included in the design of future spaces for social support: Functions that reflect the everyday life,

materials & textures with a homely atmosphere, importance of daylight in hospitals and details

with interior design in the human scale.

The study also comprises of case studies of two hospital which lies in Delhi NCR, india (1.

Medanta hospital , gurgaon 2. Fortis hospital , gurgaon ). Both the hospitals are multi specialty

in nature. This study includes the innovative solution for healing environment inside and outside

the hospital building through site planning , building planning , interior of the room , views, social

spaces such as waiting areas, atrium , corridors, food court , healing gardens , etc.


ACKNOWLEDGEMENT

The Research Paper presented here would not have been possible but for the guidance &

support of

Ar. Tanya Gupta, HOD, School of Architecture for extending her support & valuable

guidance whenever wherever required.

DIPESH ANAND ,Guide & mentor for her/his relentless pursuit of high academic

standards, the can-do attitude & imbibing professional ethics have helped this project meet

high academic standards & professional working.

My parents who have taught me to strive for perfection in everything I do.

Any other person

And also my friends & colleagues who were always around to help me.

Appreciation & gratitude is owed to them.

DIPESH ANAND

Student

(_2016_)

Batch

Date - 12th december 2016.


HEALING ARCHITECTURE IN HOSPITAL DESIGN

TABLE OF CONTENT PAGE NUMBER

1. Introduction 71.1 Preamble :- ( aim & objective , methodology and scope) 7

1.2 What is healing ? 8 1.3 What is healing architecture? 9

1.4 Historical background 11

1.5 Evidence - based design 12

1.6 Present and future of healing architecture 15

1.7 The future use group 15

2. Space for social support 19 2.1 Introduction 20

2.2 Public space elements (Edward t. hall and Gehl theory) 22

2.3 Homely atmosphere (sense of personalized environment) 22

2.4 Theoretical approach 34

3. Salutogenic design models 50 3.1 Antonovsky’s Theory of Salutogenesis 51

3.2 Alan dilani - psychosocially supportive design 53

3.3 Roger ulrich - theory of supportive design 57

3.4 Jan goelbiewski - neurology of supportive design 59

4. Precedent case studies 60 4.1 Fortis hospital , gurgaon , India 61

4.1.1 introduction 62

4.1.2 reason of this case study 72

4.1.3 Salutogenic design method and evaluation 73

A. Mapping out in relation to Antonovsky's sense 73

of coherence factor

B. Evaluation model in relation guidelines set through 88

study of Edward t. Hall and Gehl theory.


TABLE OF CONTENT PAGE NUMBER

4.2 Medicity , gurgaon , India 92 4.2.1 introduction 93

4.2.2 reason of this case study 94

4.2.3 Salutogenic design method and evaluation 99

A. Mapping out in relation to Antonovsky's sense 99

of coherence factor

4.3 Analysis / interviews 110

4.3.1 interview

4.3.2 analysis

5. Conclusion 114

6. Bibliography

7. glossary



1. INTRODUCTION1.1 Preamble :- ( aim & objective ,

methodology and scope)

1.2 What is healing ?

1.3 What is healing architecture?

1.4 Historical background

1.5 Evidence - based design

1.6 Present and future of healing

architecture

1.7 The future user group

1. INTRODUCTION

The overall aim of this research is to study the life enhancing design in hospital

architecture which increases the healing property of a building through architecture and

planning guidelines. The goal of such healing spaces are they can reduce fear , stress ,

tension and give relief for some time which actually results in healing of the patient. The

study has also been carried out to acknowledge the critical experience of patient , staff

and visitors in hospital buildings.

For detached spectators it seems obvious that, when building and planning hospitals, the

architectural environment surrounding patents, families and sta , should support theff

medical treatment in friendly welcoming and accommodating environments. However, the

majorities of our current hospitals are built on another foundation, and are often

considered the direct cause to stress, anxiety, frustration and generally longer

hospitalization due to the unsuited facilities and environments in today’s health care

system.

This dissertation is done to have a clear and comprehensive information on how to create

a healing environment in light of growing healthcare demand in India. The aim is to have

a humanizing architecture that can positively contribute to the healing process. It should

make the patient enjoy the best of bioclimatic comfort. Healthcare Design must also

satisfy professional requirements.

The physical environment of the healthcare facility should firstly do no harm and secondly

facilitate healing process.

1.1 Preamble :-Objective - The aim of this research paper is to obtain an in-depth understanding of the

physical aspects in hospital design and how these physical aspects play important roles in

creating a healing environment. Other objectives of the present paper are:

• To acknowledge the critical experiences of patients, staff and visitors in hospital

buildings,

•Importance of daylight in hospital architecture,

• To outline the physical aspects in healing environment,

• To investigate the previous and current research available on the subject of health and

environment, design for healing and the effect of day lighting on human beings,

• To examine the elements of physical aspects of existing project brief of public hospitals,

•To study the need for social support during hospitalization,


• To promote social interactions and support ,

• To promote homely atmosphere,

•Study the connection of building and nature.

Methodology - An extraction and assembly of the body of knowledge and on-going

research of healing environment in hospital design is apprehended in this paper. It is

intended to identify potential research areas on the physical aspects of healing

environment in future hospital design . Methodology employed in this research is literature

review, which is followed up by some architectural functional and planning design ideas.

The key findings will focus on the physical and social aspects affecting the hospital

environment which are the most pronounced influential physical factors affecting

bedridden patients.

Scope - The scope and the intention behind the design concept healing architecture is,

as described, not a new way of thinking, but is rather a continuation of earlier assumptions

that the surrounding environment, daylight, nature views and access, etc., had a healing

a ect on patents.ffThis research focus on recovery of the patient which reduces the rehabilitation time which

in turn reduces the stay time in hospitals. The research intends to change the mind of the

designer and improve the designing techniques used by the architect in designing a

hospital.

1.2 what is healing ?Healing is the process of re-establishing harmony within the organism. Illness implies a

loss of this balance and the need for reintegration with the body’s natural ability to heal

and regenerate. Healing cannot be understood in isolation from the factors that operate in

the dynamic life of an individual. These include the self, the family, the community, the

environmental context within which life is carried forth, and the world of spirit or essence.

Healing is dependent on reestablishing successful relationships and developing reciprocity

between these factors. In fact, healing is not a process of curing or fixing, but rather a

return to balance between all of these components1. Health, therefore, is understood as

the presence of this balance; illness is its lack. Far from being inert containers, spaces can


be understood to be fully participant in the healing experience. It is possible to conceive

and create structures that heal. Although materials, structure, and equipment are part of

this Endeavour, equal footing can be granted to the land, the natural world, the

community, our ancestors, and the spirit in all of this.

1.3 what is healing architecture ?

modern hospital + hermitage = future hospital

Hermitage - 1. Homely atmosphere

2. Connection to nature

3. Social structure institution

4.daylight factor

As introduction, the project will describe and define some of those terms used when

considering health care architecture, and according to the planning of future hospitals, the

concept healing architecture is introduced. For detached spectators it seems obvious that,

when building and planning hospitals, the architectural environment surrounding patients,

families and staff, should support the medical treatment in friendly welcoming and

accommodating environments. However, the majorities of our current hospitals are built on


another foundation, and are often considered the direct cause to stress, anxiety, frustration

and generally longer hospitalization due to the unsuited facilities and environments in today’s

health care system. As a response to the current state of modern hospitals and as a weighty

tool in the discussion of our future health care settings, the term healing architecture has gain

ground. It is best described as a design concept, which represents the vision of encouraged

human well-being and healing influenced by well-designed architectural surroundings.

Thus we have explained an equation that says the importance of architecture in hospitalization

which reduces the healing period through its various examples given below:-

1. Homely atmosphere or hermitage -

Authentic healing modalities

Individual process

Spiritual guidance

Hermitage club spa - anti stress

Hermitage workshops

Yoga centre

Meditation centre in nature

Architecture of hermitage should be in relation to natural built environment.

2. Connection to nature -

Nature window views

Garden accessible to patients

Nature art : no abstract at

Daylight factor

Internal courtyard connected to ward , patient room

Quiet in the ccu (coronary care unit)

Music during minor surgery

Air quality

Landscaped courtyard

Floor to ceiling windows

Therapeutic benefits

Landscaped setback

Front porch - (overhang may scale down the size of the building)

Entry garden

Plaza(include trees, shrubs, overall is not of green image , but of a paved urban plaza).

Roof terrace( potentials for expansive views).


Viewing/ walk in garden

Sound of water and attraction of birds to the fountain are particularly appreciated ( roof

garden)

Roof garden for mood change

Wide walkways outside patient rooms provide a buffer from garden activities.

A covered patio style coffee shop provide and shelter for an outdoor eating area within a

garden.

3.social structure -

Green lawn for social improvement in structure.

Imaginative maze for children.

Covered sitting terrace or patio within a nature surrounding.

Single occupancy vs multi occupancy patient room study.

Elements in the social dayroom.

1.4 historical background

In the 17th and 18th centuries, the dual emergence of scientific medicine and Romanti- cism

fortuitously combined to encourage the re-emergence of usable outdoor spaces in hospitals.

The intention behind the concept of healing architecture seems immediately obvious and

straightforward, and it seems rather strange that not all hospitals are based on these concepts

of integrating the architectural environment as support for the medical treatment. However, the

idea of a beneficial effect on patient’s healing process supported by well designed

surroundings is not a new concept. In fact, these ideas may be traced back to thoughts and

ideas evolved in the 18th century. At that time, leading doctors and nurses proposed changes

in the layout and design of hospitals in order to reduce the danger of contamination by

designing smaller wards and increasing ventilation. Later these theories are followed by

Florence Nightingale, who in Notes on Hospital from 1859 published her philosophies and

thoughts of the supporting effect of aesthetic environmental settings for the patient’s physical

and psychological condition. In Denmark, the first public hospital is planned by request of king

Frederik V in 1752. At that time, the medical knowledge was underdeveloped and the

experience of building health care settings were naturally lacking. In the 17th and 18th

centuries, the dual emergence of scientific medicine and Romanticism fortuitously combined to

encourage the re-emergence of usable outdoor spaces in hospitals. The notion that infections

were spread by noxious vapors spawned designs that paid special attention to hygiene, fresh


air, and cross-ventilation. The so-called pavilion hospital became the predominant form

throughout the 19th century. Two- and three-story buildings linked by a continuous colonnade

and ventilated with large windows marked the design of the influential Royal Naval Hospital at

Ply- mouth, England. Recommendations for hospital garden design written by German

horticultural theorist Christian Cay Lorenz Hirschfield at the end of the 18th century uncannily

foreshadow the findings of researchers such as Roger Ulrich at Texas A & M University, who

documented in one study the healing benefits of a view onto vegetation for patients recovering

from surgery (Ulrich, 1984).

1.5 Evidence - based designwhen architects , interior designer or any other firm wants to design hospitals they consults

politician or decision -makers regarding the new super specialty hospitals , all the issues

related to designing and physical spaces which enhance healing power of the building

through appealing and sensory design solutions, the term often we use " the evidence

based design'. an individual using this method makes his decision based on research

papers and evidence gathered from experienced client operations. an evidence-based

design should results in improvements to productivity , customer satisfaction and economic

estimation.

It was initiated on the basis of evidence-based practice and evidence-based medicine,

evidence-based design is linking the physical environment with better patent outcomes by

using the best current research evidence to guide design decisions, thereby moving towards

a new fundamental design process. (hamilton 2003 and ulrich et al 2004).

The extend of evidence-based design research is increasing. In 2003, more than 600

studies—most in top peer-reviewed journals—that establish how hospital design can impact

clinical outcomes.

The research team found studies that bond the physical environment to patient and staff

outcomes in four areas:

1. Reduce staff stress and fatigue and increase effectiveness in delivering care

2. Improve patient safety

3. Reduce stress and improve outcomes

4. Improve overall healthcare quality

A basic requirement for the architect and the design team is to study or examine perfectly

the research data to have relevant and use of EBD results in a specific building project


followed by a re-contextualization before implemented in a project (Hamilton 2003 and

Hamilton 2004).EBD this way not giving answer related to hospital planning it just

documenting the influential factor of architectural environment ,which have a great influence

on our mind.

Evidence based design in healthcare architecture is not solely capable of ensuring future

well-designed hospitals even architects and planners play a crucial role in evolving the

process. as a requirement in current world and expectation by decision - makers , its an

obvious task for designer to explore more on this field to create future healing environment

for patients , staff and visitors.


1.6 Present and future of healing architecture

The idea behind the concept of healing architecture is not a new concept but is rather a

earlier explanation in more advanced techniques that the surrounding environment, daylight,

nature , views and access,.. etc. had a healing effect on patients. in todays planning of new

modern hospitals has shifted to patient-centered care and the well-being of the patients and

their families, attempting to balance the building codes , functionality and aesthetic

considerations.

Today we are building upon this rational thinking , however with a broadened mind.

evidence and science is no longer limited to medicine , they are also related to interior and

architecture of hospitals. Developed as an extension of evidence-based medicine, research

within the field of architecture and its e ect on patent outcomes is still gaining ground,ff

documenting the benefits of patents hospitalized in well-designed environmental settings

(Ulrich et al 2008 and Hamilton 2003). today most of the hospitals are build on EBD method

for increasing the healing power in our future hospitals.

Through EBD, various proofs has been found, that the sensory perception patents meet

during hospitalization have an impact on their experienced level of stress, and if high, this

will reduce the immune system causing higher level of infection disease and delayed wound

healing. This way, undue noise, interrupted sleep, lack of daylight and generally

dissatisfying environments, will all be factors that a ect the level of stress negatively.ff

(Frandsen et al 2009, Ulrich et al 2008, Francis 2002 and Horsburgh 1995).

1.7 The future user group

1.7.1 PEOPLE AFFECTED BY CANCER

When any patient is diagnosed with cancer, a range of arrangements and precaution are

made, usually the treatment is done immediately after being diagnosed. these treatments

are often performed while at home or hospitalized in the relevant surgical ward. suffering

severe symptoms then it is shifted to oncology ward for treatment.


THE ARCADE AT FOTIS HOSPITAL , GURGAON

The patients in our future hospitals are described as being more sick and weak than today’s

patients - due to enhancement of ambulant treatments and a general more effective

procedure, resulting in faster discharges. (Juhl et al 2008 and Kehlet 2010) According to the

extrapolation of the expert panel, patents in future oncology wards, will this way only be

hospitalized in 2-3 days in average – typical through their most critical period of illness.

(Sundhedsstyrelsen 2010, Juhl et al 2008 and Danske Regioner 2008)

with this elaboration of future patients, and the relative short period of hospitalization , it may

be argued, that the patient experience in hospital is not much of importance as compared to

medicinal approach . As such a logical conclusion that on the other hand would be a direct

continuation of mistaken arrangements of previous hospitals from 1960`s , with layout and

design not according to human scale, finally resulting in long duration of hospitalization and

hospital environment without sensory elements.

I believe that this is the time to stop counting patients as number treat them as humans and

patients, like everyone else , having social attraction and basic need for encouraging social

interaction. otherwise, we will simply build the same hospitals again and again.

The fight against the cancer is not solely doing research in medicinal treatments , but it is

required that what cancer does to a human being , its physical and psychological conditions.

Especially through several course of disease it is essential to have social interaction with

their closeness to feel safe and comfort in hospital environment.

1.7.2 Social relation influence on cancer

Health, and persons in a partnership have this way a generally better health than singles.

This may result from the positive influence by our close relationships, or may in

some cases directly related to the social and emotional support. (Zachariae & Christensen

2004) The human is generally a social creature, and our relationship with other people – our

social relations – is a central aspect of our life. The amount of social support that cancer

patients is experiencing, and especially the possibilities to discuss ones disease and

treatment with other cancer patients, is considered very helping in the stressful periods of

the disease. (Zachariae & Christensen 2004)

The diagnose of cancer generally cause depression , stress , tension , anxiety among the

cancer patient and their families. the risk of developing a profound depression is increased

due to isolated social spaces and lack of control over the situation. the patients are

experiencing upturn process of adaption in order to accept and understand the disease,


changed prospect, various treatment., etc. at that point of time social support is much more

of need to conquer depression and stress.

1.7.3 Patients to patients

Cancer is a very difficult disease to handle and it is very much important to have social

support during these situations for comfort and support. other patient suffering from same

disease regard as a useful support for them, especially for increasing hope and belief. they

may are from different places, but they communicate in same language at that time

( Rasmussen 2003).

The solidarity with other patients may range from intense intense conversation and social

support to inspiration of other patient activities and actions. that's why patient don't feel left

alone with their disease. particularly at time of changed treatments social support from other

patient is proven useful.

1.7.4 Patients and their families

A serious disease cancer not only affect the patients but solely the entire family. Partners,

parents, children, close relatives are also implicated by the disease and long period of

treatment. As it is important that families facing same situation get socially interacted with

each other at equal status. in these forums , families can talk about the problems facing

them without influencing the patients. Families to cancer patents are experiencing a tough

psychical stress, but their well-being is rarely in focus. Depression, confusion, anger,

sadness and other negative feelings and emotions are often unavoidable consequences for

the relatives to a cancer patient, which may be overcome or reduced with increased social

support to the families themselves. (Hansen & Thastum 2005)

1.7.5 Social support in future oncology ward

Though we have stated that social support is very much of importance in treatment of

cancer in order to satisfy their mental condition. the main focus in designing phase there will


be patients themselves and the need of their families will be taken into considerations. there

will be such living areas in single patient room for the social interaction of their families so

that they do not feel that they are totally in medical staff .



A current space for social support in medanta hospital , gurgaon

2.Space for social support 2.1 public space elements

2.2 Homely atmosphere (sense of

personalized environment)

2.3 Theoretical approach

2. SPACE FOR SOCIAL SUPPORT

2.1 INTRODUCTION

In chapter two of this research, hospitalized patient` requirement for social interaction and

social support has been identified. Day by day patient`s general level of stress and fear

increased not only due to changing pattern in disease. Also struggles to perform normal

activities like low level of visits from family and friends may occur a factor of fear. the future

planned single bedroom hospitals is furthermore increasing the rate of fear and stress ,

loneliness and the need of social support in hospitalization is playing a crucial role in future.

spaces for social support interlinked with hospitalized patients is much more important which

will enable knowledge sharing and diverts inspiration among the patients.

Social support in future hospitals is encouraged through social interaction that may vary in

different levels and variation. The social interaction can be done through informal meeting

which we experienced in our daily lives such as, we experienced in trains , mall, parks , gym

, city square, etc. and complete social relationships like we experienced in our homes in

safe and physically well being surroundings. Through these measures social interaction will


2.Space for social support 2.1 public space elements

2.2 Homely atmosphere (sense of

personalized environment)

2.3 Theoretical approach

increase and knowledge sharing and inspiration with patient of equal status are potentially

responsive. The physical surrounding have potential to have ideal settings where common

areas are constructing both initial contact and developed social relationships. In this

contrary the social space may seen as intersection between a public space and a homely environment. Usually our everyday activities are performed with our family and friends,

while in the hospital these simple familiar activities suddenly are occurring with unknown

people in a semi-public space.

If we improved these social spaces then the healing power will also get increased and may

even considered as an influential elements in regard to healing architecture. There are,

however, not found any specific EBD research that define detailed aspects in regards

to design and physical planning of these spaces. (Ulrich et al 2008) Instead, the project is

stating the thesis that by introducing architectural and anthropological theories, a more

thorough understanding of the human perception of space and even specific transferable

architectural aspects There are, however, not found any specific EBD research that define

detailed aspects in regards to design and physical planning of these spaces. (Ulrich et

al 2008) Instead, the project is stating the thesis that by introducing architectural and

anthropological theories, a more thorough understanding of the human perception of space

and even specific transferable architectural aspects may be defined and incorporated when

designing social spaces with inviting, attractive and sensory aspects in future hospitals.


Social support during hospitalization is experienced in various levels of intensity. The need, the promotion and finally the development of social interaction is the main essential steps towards the potential social support.

Lobby of American hospital in Dubai

Social spaces in future hospitals may be seen as an intersection between public spaces and homely environments.


Patent restaurant at Lund University Hospital

THE PUBLIC SPACE ELEMENTS2.2 HOW TO ENHANCE SOCIAL ATTRACTION

2.2.1 PUBLIC SPHERE ENVELOPES THE PERSONAL SPHERE

In this chapter will introduce some of the general theories regarding social interaction and

human behavior in the public space that architects and designers has used until now when

planning and designing urban Scapes.

Giving the possible privacy with some social spaces are necessary and are stated as a

basic qualification of rapid recovery. But constant withdrawal and always keeping oneself to

oneself so as to be spared social contacts and confrontations is often one of the symptoms

of mental illness, and so care is concerned with developing the patient’s social capacity.

The social element also has to be gradually stepped up, but of course depending on

individual situations. The design of the physical environment, accordingly, must support the

individual patient’s gradual expansion of his / her personal sphere. from patient`s own bed to

open door to green or entering to another patient room and sitting down to such social well

being corner to talk. Moving out to the social green area , sit on a bench near green plants ,

having a cup of coffee. Meeting a relative in cafe`. Going on a tour of hospital visit. All these

activities get used to patient daily lives which never make them felt that they are hospitalized

or progressively widening the social context.


There we should shape the rooms, or shape “rooms within the room”, make small niches or

seating areas of varied character where people can “take a pew”. 14Normally speaking,

mentally ill persons have a larger bubble of personal territory. But the places created must

still make people feel encompassed and secure.

In pune "Mukthangan De-addiction centre" observed that patient rooms are placed near the

amphitheatre space near the natural elements like trees, sunlight and

gentle wind to heal their agitation. The language of making public activity inside the private

spaces are done also in Mukthangan rehabilitation centre with the help of

well lit amphitheatre space in the

centre enclosed by rough wall to give

those agitated people a sense of

protection.

social participation and elective

seclusion

successive expansion of the

personal sphere

parts with different degrees of

seclusion and publicity

secure and intimate seating areas

on the fringes of the public zone

2.2.2 Call for social contact

Now I will discuss writings by architect and professor Jan Gehl and anthropologist Edward

T. Hall, in their theories described in Livet Mellem Husene (Gehl 2003), Byer for Mennesker

(Gehl 2010), and The Hidden Dimension (Hall 1973), respectively.

The call for social contact between individuals is a concept that covers many di erentff

variations, from simple unpretentious contacts to more complex and emotional

conversations and intercourse. (Gehl 2003). Jan Gehl defines in Livet mellem Husene

(2003), the various contacts by their intensity, where close relationships have great intensity,

and the passive and casual meetings have low intensity. From this figure (below), the public

space primarily represents the casual and passive kind of contacts, which compared to the

more intense contacts are considered modest. However, they stll possess great quality and

worthiness, as autonomous contact, or as the basis for more developed kinds of contact.


Mukthangan De-addiction centre, Pune bySirish Beri, Amphitheatre Space

For instance, as maintenance of existing relationships, and especially as inspiration of acts

and activities, that other people are performing. (Gehl2003) If this basic social contact is not

obtainable, the boundaries between isolation and social contact are too pronounced, and

you are either alone or in binding connection with

others. The social contact on the low intensity scale is therefore an evident and important

possibility for persons to interact with others on a casual level, and perform as transition

between various kinds of contact. (Gehl 2003). The establishment of such common

attractive and inviting social spaces are very much required for day meeting to interact

socially patient with equal status for social support which enhances their knowledge about

such situation.

2.2.3 Activities in the public zonesIn regards to activities in the public space, Gehl (2003) defines three types; essential

activities, optional activities and social activities – all with di erent demands to the physicalff

environments. The essential activities which are performed they are regardless of the

physical planning of social environment , they are not in contact to such areas, this may be

the medical treatment.


Social contacts sorted by their intensity.

The optional activities are generally those activities which are done when they are desired

and these activities are only seen if the physical environment are in proper condition. in

respect to this optional activities are common facilities, relaxing walk, informal conversations

,etc. however, if the public or the social space is not in proper condition then only essential

activities will be there.

2.2.4 Sociofugal and sociopetal spaces

The physical environment often performs a very specific character in regards to social

interaction also concerned anthropologist Edward T. Hall (1973). In the writing "The Hidden

Dimension", he refers to a research study performed by doctor Humphry Osmond, who

ascertained that some types of spaces, for instance waiting rooms in train stations had the

ability to keep people apart, while French cafes did the opposite and made people engage

interaction. He defined the arrangements that discouraged social interaction as sociofugal


Activities in the public space is depending on the quality of the physical environment.

spaces and the spaces that encourages and enforces the development of interpersonal

relationships as sociopetal. Meanwhile Osmond had observed in his psychiatric ward

apparently patient wee talking less to each other after such change in arrangement of

furniture in such a sociopetal arrangement, the social interaction increases in that same

ward. When designing future hospitals we should keep in mind the statement of Edward

T.Hall and change can be made through such small arrangements which can change

sociofugal spaces to sociopetal spaces. Layout of furniture plays a very crucial role in

enhancing the social interaction suppose if the chairs are placed back to back then the place

automatically turned into sociofugal spaces. however, if the layout of the chairs are

immediately changed they are face to face then the place changes to sociopetal spaces.

In some occasions the sociofugal setting would be preferable, for instance when studying or

reading, and what is considered sociofugal in one context might even be sociopetal in

another situation depending on the occurring activity and the people involved.

The challenge for the architect is consequently to design spaces with accordance between

the physical space and intended function and to maintain diversity between the

di erent spaces in order to give people the choice for social interaction or privacyff

depending on the circumstances and their own state of mind.

2.2.5 Detail designing

Small detail of furniture arrangement can change the character of the space , if prioritized by

an architect, social spaces of the future hospitals can be improved.

In regards to the human interaction in public spaces, this is best unfolded on the horizontal

level, where it has a rather large area of function. On this level, the social visual field is

capable of intercepting other person’s features and mood in distances up tll 20 meters, and

in shorter distances (1-3 meters), where we normally perform social conversations, our

visual senses are supplemented with other senses in order to form a general impression of

the person we are talking to. (Gehl 2003) Hall (1973) defnes very precise personal

distances, where 0,45 – 1,30 meter describes the close social contact between family

members, for instance around the dining table. Distances between 1,30 – 3,70 meter is

defining the more public social distance between friends, colleagues, etc. and is usually

seen in comfortable seating arrangements. These personal distances influence many details

in the planning of social spaces, and for instance this affects the sizes of tables. If too small,

two patents not knowing each other, would most likely not sit at the same table, as their


intimate distance would be violated. Too large tables however, may make it difficult for

patents to talk together across the table. Studies through the design phase are to consider

these aspects in order to develop social spaces where patents find it natural to meet and

engage contact.

Through other studies of human behavior in public spaces, Gehl (2003) argues, that the

social activities has its own self-prevailing effect, where human actions attract attention and


thereby more people. These studies show an instance , that the use of benches are

depending upon their orientation , where those situated where more human activities are

done neither in quite green environment. (Gehl 2003) As well as the sizes of furniture the

orientation and layout also have significant importance in regards to use and social

interaction.

Finally, the placement of furniture in the room is noticeable, where seating environments

along with the inner facades of common open spaces or in the transition zone between two

areas usually are preferred. In these places ones individual exposure is limited, and it is

easier to create an overview of the surroundings and to feel comfort in these situations.

(Gehl 2003)

.Piamo Sanatorium, Alvar Aalto, View of Lounge room with special furniture


Shri. Siddhivinayak Ganapati Cancer Hospital

Location: Miraj, Maharashtra, India

Project Work Status: Completed Projects

Project Completed: 1997

The main idea behind the project was to create an environment that does not convey the

conventional, dull, dark, smelly and confined ambiance of a typical hospital. Good light,

ventilation and a lively open interaction with nature became the paramount criteria. The

hospital building is well illuminated and ventilated, incorporating plants and landscaping to

bring about colorful, bright, soothing and reposeful mood. The landscaping and building

have thus somewhat therapeutic value.


2.3 THE HOMELY ATMOSPHERE (SENSE OF PERSONALIZED

ENVIRONMENT)

HOW TO DEVELOP SOCIAL INTERACTION

As concluded, my research is that spaces for social support in future hospital environments

is defined as an intersection between the public space and physical environments with a

comfortable, homely atmosphere - a social place, where patients engage meetings and

social interaction, thus enabling social support.

The first step towards social support is consequently for the patients to meet each other,

which may include the theories of Gehl (2003 and 2010) and Hall (1973), described in the

previous chapter ‘The public space - how to promote social interaction’. The next step is to

develop this initial social interaction to intense level, and this process is believed to require

specific demands of the physical environment. In our daily life these levels of superficial

conversations are usually performed with our families or close relatives in safe and familiar

surroundings. (Rasmussen 2003) When hospitalized, the family contact may be reduced

(Ulrich et al 2008) and the environment today is often characterized by institutional settings

– far from familiar and well-known. Hence, the two aspects that form the basis of this social

interaction and support in our everyday life are apparently not present today.

From architectural point of view it is very difficult to raise the visits in patients room. instead,

other patient and staff can act as a family member at that point of time may be even for

better social support in some health related issues.

In hospitals patient are confined to such environment where the general freedom of choice,

is strictly limited. However, the things concerning the social interaction and the allocated

social spaces do not necessarily have to be so di erent from the spaces we recognize from ffour daily life and our own homes. By changing the design of hospital dayroom of patient to

an inviting , familiar and homely environment recognizable for the patients leads to better

social support.

The question remaining is how this home feeling and homely environment is defined outside home?


2.3.2 Feeling at home

Home is by the anthropologist Mark Vacher (2006) defined as a connection between a

human being and a physical object. This object is usually a building, although more

primitive units also perform as homes with the same psychological characteristics.

A home is personal and intimate, and not something you can buy. When we talk about

houses we are capable of describing them without mentioning the people living there but

when we describe a home it always belong to someone. (Vacher 2006) Houses are not

only frames for people, people are framed by houses and the things they harbor, at the

same time as people project their own emotions, dreams and hopes onto the things and

the spaces that constitute the house.

That our homes are personal is exemplified by Sjørslev (2007), who define a building as

a house as soon as someone moves in, although this house is not a home until it is

personalized and the resident have supplied his individual touch. Our home is therefore

filled with personal objects, memories, heirlooms, etc., and even though our daily use of

these objects may be of functional or aesthetic character, the sentimental value often

exceeds the functional value by far. (Sjørslev 2007)

kitchen and dining area in typical room


Finally, the details and arrangement of furniture should reflect a homely environment.

The size of the room, furniture orientation and the room accessories like artwork,

greenery, light fittings, etc. are important aspects that should be incorporated and

considered along with the design of the space, in order to design a holistic social space

facilitating social interaction and support.

2.3.3 Home outside HomeFuture social spaces with a familiar and homely atmosphere by implementing some

fundamental characteristics derived from our homes and everyday life. One of these

characteristics is the activities and potential functions of the room. Today many of the

daily activities and routines in the hospital are performed without involving the patent,

where for instance meals are planned in advance, cooked in large industrial kitchens and

served at certain times. Another essential characteristic related to the homely

atmosphere is believed to be the materials and textures of

the dayrooms. Today these rooms are often marked as institutional and are often

decorated and furnished as the bedrooms, hence the distinction between the dayroom

and the rest of the hospital are often immaterial. The materials used in today’s hospitals

(wood, fabrics, textiles, colors, etc.) May be the same as we use in our own home but the

way they are used have very different conceptions. Textiles are for instance a material

that is used rather carelessly, and does not

derive the potential as we experience in our

domestic environment. At homes the textiles are

applied for curtains, cushions, blanket,.etc all

adding a tactile perception to the material, which

imply comfort and coziness to the space and

experience. Today this critique may be noticed in

many hospitals, as the high restriction in regards

to hygienic and durability demands have

excluded nearly all tactile materials, including

textiles, from many applications. However, recent

research and development in smart textiles is

improving the potential use of textiles in new

recognizable ways in future hospital

environments, where the use of tactile and


A private space in the sun at Maggies London

sensory materials, like textiles, would be possible to implement with great beneficial

value. Finally, the details and arrangement of furniture should reflect a homely

environment. The size of the room, furniture orientation and the room accessories like

artwork, greenery, light fittings, etc. are important aspects that should be incorporated

and considered along with the design of the space, in order to design a holistic social

space facilitating social interaction and support.

Summary

The homely atmosphere in future hospitals may be difficult to define, as our home is

usually very personal and individual and therefore impossible to transfer directly to

a health care environment. However, it is the research of this project, that by

implementing three fundamental characteristics of our home and everyday life, including

functions; materials and textures and details, it is possible to create a more homely

atmosphere in the social spaces, than we experience today. This atmosphere is

considered beneficial for the more developed levels of social interaction and social

support, as the conversations in safe, comfortable and homely environments are

believed to be more outspoken and emotional than the acquaintances in the regular,

standardized and clinical dayrooms we experience today.


Textile use in a lliving area of single patient room, fortis hospital, gurgaon

2.4 THE THEORETICAL APPROACHHOW TO ACHIEVE SOCIAL INTERACTION AND SUPPORT

Appealing and attractive spaces for social interaction and support in future

hospitals are depended on the surrounding architecture and the detail of the

physical design, seems easily accepted through evidence-based decision maker, urban planners and anthropologists if the environment is not providing possibilities

for social activities, there will not be any interaction between patients-hence no social

support. The architectural e ects described in the previous chapters, will in this chapter beff

compiled in three guiding subjects, including functions (1); materials and textures (2) and details (3), and through a translating description, their aspects are defined in

regards to the context of hospitals. This theoretical approach will define the main visionary

guidelines for the design phase of this project as well as form the basis of the evaluation

model used in the later following case studies.

The theory described by Gehl(2003) and T.Hall (1973) states that people attracts people, if the social area remains unattracted then physical environment remain empty all the time. When patents or their families have engaged social interaction,

maybe through the attractive functions, they should develop these contacts, which call for

spaces recognizable from their own home, partly achieved through a mix of functions –

reflecting the everyday life. Following the ideas and theories of the described

anthropologists, the materials and textures should overall assist in creating a familiar,

sensory and homely atmosphere. The final aspect considered as one of the main

guidelines for future social spaces are the details and interior planning in human scale,

concerning scale, personal distances and sociopetal spaces. Often small details change

the way

we experience a room, and some of the main physical elements in today’s hospitals, like

acoustic ceiling sheets, integrated artificial lightning, vinyl flooring, etc. are only

supported by the details of for instance co ee serving, greenery, arts and furniture, allff

together defining the social space as institutional, inhuman and basically unfit for social

interaction.


2.4.1 FUNCTIONSREFLECTING THE EVERYDAY LIFE

We often see uninspiring and unattractive spaces in hospital which is not used by

the patient. Above all , patient should have choice between social and private

space, ideally a gradual transition between them. Private spaces may appear in

single room but a new concept is needed to get complete framework of common

spaces and dayrooms in the future should appear social. This social aspect may derive

from inviting, attractive and socially obvious functions performed by patents and their

families in the common areas of the patent ward.

Accordingly, the specific programming of the common spaces in future hospitals is

essentially important to design very deliberate. Firstly, the patients should engage

acquaintances, through a process that may be compared to the human interaction in

public spaces or the small talks with our neighbor in the front yard. In a future patent ward

these informal meetings may occur in the common dayroom or even in natural flow

intersections and recesses along the hallway. Secondly, the patents should develop these

initial relationships, through deeper conversations and social interaction, which may cause

for more recognizable and familiar settings, reflected in the patents’ everyday life. When

considering functions in the common spaces, these might actually be quite parallel to the

activities performed in our daily life and the planning of a patient ward may

even be compared to a regular single-family house having rooms for: conversations and

drinking coffee in the living room, relaxing in the lounge area; dining around the kitchen

table; simple cooking in the

kitchen; entertaining around

the television, etc. By

introducing these social

activities in new-designed

patent wards, and by making

them optional and inviting for

both patients and their

families, spaces for social

interaction and support are

believed to have improved

conditions in future hospitals.


2.4.2 MATERIALS & TEXTURESFAMILIAR AND HOMELY ATMOSPHEREBesides reflecting the everyday life through planned activities and programming of the

social spaces, materials and textures also have significant influence on the way we feel,

act and interpret the room, and should reflect the familiar and homely environments we

are accustomed to from our own house.

A deliberate choice of materials for any room, i.e. the visual surface and the tactile

perception, are often under prioritized in many projects, and in health care architecture,

the high demands for hygiene, cleaning and durability are usually decisive factors when

considering materials in both bed rooms and common areas. Consequently, the

spaces often appear clinical and institutional, with standard equipment and furniture,

acoustic ceilings, white plaster walls, etc. As regards to social interaction, these spaces

are predicted to limit the potential, as the patients will adapt their behavior to the

institutional surroundings with no conclusive benefit for engaging social interaction and

social support. Today human qualities are competing against hygienic standards and

general call for durability, and the predominant challenge for the health care architect is

therefore to balance between the homely expression and the rational clinical demands,

keeping in mind that the close compromise may determine the success or failure of the

spaces for social interaction.


2.4.3 DETAILSINTERIOR PLANNING IN HUMAN SCALE "In context of EDWARDT.HALL(1973)and GEHL(2003)"Small details may change our use and perception of any space rapidly, and if only

prioritized by the architect, spaces for social support may be improved significantly in

future hospitals. First of all, the overall scale of the room should be familiar in size and

easy to overview if more personal conversations should take place, and even in regards

to dimension of the furniture, Hall’s (1973) theories regarding social distances may be

implicated. Smaller tables will for instance force patents to sit within their intimate

distances (0,45 – 1,30 meter), which may be advantageous for deeper conversations and

social support. However, if the patients do not know each other yet, the small table and

intimate distance may be an unconscious limitation for patients to join an occupied table,

and the patients will then never engage important initial contact. The design of details and

furniture should therefore contemplate the intended social concept in the common areas.

In this regard, Gehl (2003) is furthermore describing how the placement and orientation of

furniture in public places influence the specific use. Seating environments along the

perimeter of the room is usually preferred, where the individual exposure is limited, and it

is possible to create a comfortable overview of the surroundings. Details in the orientation

of the furniture may even define the social status of the room, where a face-to-face layout

facilitates a sociopetal behavior and the back-to-back arrangement is creating a

sociofugal, private space. Ideally the patent ward should provide both private spaces

(sociofugal), passive observational spaces and social spaces (sociopetal) - although not

necessarily in the same room. (Hall

1973). Today, details like light

fittings, acoustic regulators, blankets,

cushions and other equipment are all

details. However, by bringing focus

to these significant details as well,

the future design for social spaces

may become a holistic design

solution creating a homely and

inspiring atmosphere promoting

social interaction and support.


2.4.4 THE LITERATURE STUDIES (secondary study)In order to visualize the substance of the parameters (functions, materials and textures,

and details), defend in the previous chapter, three various case studies will in the following

chapter be described and evaluated based on the analysis form stated below. The overall

thesis of this project defining the future spaces for social support as an intersection

between the public space and the homely atmosphere is the overall basis for

choosing three individual cases for analysis and comparison. Secondly, the cases are

selected depending on the patent’s/person’s motivation for attendance, which follow the

three guiding needs defined in Maslow’s hierarchy pyramid (Poston 2009). The basic needs

as exemplified in a hospital (case 1), the psychological needs is exemplified in a cancer

caring centre (case 2), and finally the self-fulfillment needs which is exemplified in a high-

end gourmet restaurant (case 3). To summarize the chapter of the wide-ranging case

studies, a concluding compilation will define the common relevant guidelines for the design

phase.


CASE 1 - LUND UNIVERSITY HOSPITAL


CASE 1 - LUND UNIVERSITY HOSPITAL

CASE 2- HEJMDAL

CASE 3 - RESTAURANT GERANIUM

2.4.4.1 CASE 1: LUND UNIVERSITY HOSPITALKAVA - SURGICAL EMERGENCY DEPARTMENTLund University Hospital is placed in Skåne, Sweden as one of the larger regional hospital

with 980 beds. The basis for this case study is the surgical emergency department

(KAVA) with 24 beds and 4-500 patients per year hospitalized for 48 hours in average.

Patents in this ward may be compared to oncology patients in regards to medical/surgical

treatment and their general physical condition and mobilization. The ward consists primarily

of multi bedrooms, where the beds are separated with curtains. When this specific ward is

chosen as hospital case, it is due to the recent modernization and remodeling performed a

few years ago in connection with transferring the ward. Here one of the focal points, among

others, was new arrangements of social spaces. The recent buildings are constructed in

1968 and is today causing problems with the physical surroundings in regards to patient

treatment and human healing condition. When the ward was chosen to move to another

floor, sta was given the possibility to rethink the interior layout and organization of theff

ward without changing the main construction. Nurses and other members of sta initiated aff

process, where future requirements, visions and ideas were discussed and planned for the

new settings. The intention of improving the social spaces was strong, and the fact that it

was even a focal point in the nurse’s vision for a future ward shows appreciated awareness

of its importance. The base in the new dayroom is the staff operated ward kitchen, where

the meals to the entre ward are finalized (after being brought to the ward precooked from a

central). Staff is consequently always present in the room performing a homely activity (in

regards to cooking and not the method), and brings life and atmosphere to the space.

Concurrently, the

kitchen offers snacks

and drinks directly

from the kitchen

counter, and

mobilized patients

can always get

something to drink

and eat directly from

the kitchen – like in

their own home.


Dayroom in the KAVA ward (Surgical emergency department). The social space is placed at the end of the blind corridor leading to the patent bedrooms.

The general use of materials and textures indicates a clinical environment with institutional

furniture, vinyl flooring and acoustic ceilings. Complimentary, there are single specific

elements like a fruit basket, freshly brewed coffee, biscuits served in glass jar and blankets

in the lounge area that attempt to drag the room towards a more homely

atmosphere. Along with the kitchen function these small details actually do support the

domestic feeling of the dayroom with added features that may revive memories from

the patients’ everyday life. However, the first impression and the overall experience of the

dayroom as clinical and institutional is still predominantly. The intention of making the social

space homely is noticeable although it lacks in completion of the commenced ideas, and a

deliberate holistic approach towards creating social spaces in future health care

environments are still needed for perfection.

FUNCTIONSWhat are the options for residence?The dayroom is considered the primary place

for residence outside the bedroom, although

there are some smaller furniture

arrangements in the hallway itself. These are

not used during the observation, and they

seem to be placed randomly in the busiest

place of the hallway next to the elevator and

with no seclusion from the semi-public

corridor space.

What are the optional functions?Besides reading and watching television as

entertainment, the primary activity is

relaxation in the lounge area and dining at

the tables. Secondly, the ward kitchen is an

integrated part of the dayroom, and it offers

self-provide able snacks at the ward buffet

and the kitchen counter - patents have no

access to the kitchen itself.


Does the functions in the social space invite to participation?At the time of observation

(between breakfast and lunch),

there were only a few people in

the room, however occupied for

longer periods. There was

consequently only little social

interaction – maybe because of

different activities (snacking at

the dining table and TV

entertainment in the lounge

area). As the functions are

considerably simply there seems to be moderate possibilities to join in occurring activities,

although it may not be inviting as such.

MATERIALS AND TEXTURESList and short description of used materials, textures, furniture?Walls are standard white walls, floors

are grayish vinyl and

the ceiling of white acoustic panels

with integrated lightning – the same

as the rest of the ward (although

change of color in floor vinyl); The

kitchen is closed off for patients

due to hygienic demands and

consists of steel and white laminated

surfaces; Furniture in the dining area

are wooden dining tables and chairs

with steel frame and wooden seating; Furniture in lounge area of wooden tables and

armchair and a couch with wooden frame and textile covered cushions.


How is the room characterized by materials and textures?In regards to materials and

textures, the room is considered

quite institutional, as the vinyl

floor and acoustic ceiling are

predominant. The furniture in the

lounge area have textile covered

cushions although the dominant

wooden frames and general

design of these are institutional

recognizable.

Are the use of materials and textures consistent and deliberate?The furniture in the lounge area, kitchen area and dining

area is varied, although it does

not accentuate any stories

or define a consistent use. The

materials in the dayroom

are not distinguished from the

other areas of the hospital, and it

may be di erent to tell theff

di erence between variousff

rooms. In general the materials

and textures seem chosen and

applied haphazardly, and there is

a overall lack of homogeneity

and deliberateness in the

hospital in this regard.

DETAILS


Scale and partition of the room?The main dayroom is large in

scale although with specifically

defined partitions, and the room

is consequently experienced

domestic in scale. The kitchen

area is by a counter closed off

towards the patent zone and is

physically separating the room

in two. The patient area are sub

organized in a lounge area and

a dining area of two tables.

Furniture and distances?The lounge area is furnished

with a 3-person couch and

two armchairs surrounding an

oblong co ee table. In scaleffit is recognizable from private

homes and the multiple

seating options provide

alternatively choice regarding

social distances; The dining

area consist of two tables with

4 and 6 chairs respectively.

The 6 person table is placed

in the perimeter of the room in

front of the window. The table

for 4 persons is placed in the

middle of the room and is not

used during observation.

Other details?Specific details are worth mentioning as room accessories


including a fruit basket and containers with biscuits in the

kitchen area, as well as the blankets in the lounge. The intention of making a homely

environment is remarkable,

although not quite succeeded. The overall impression of

the room is due to the general use of materials still significantly institutional and it takes

more than just small details to define attractive and welcoming social spaces.

CONCLUSIVE REMARKSLund University Hospital is a case illustrating the good intention of improving the social

spaces in the existing hospital wards. It is a significant progress just to call attention to the

problem of unfulfilled common areas, and with the enhanced focus from the staff, some

hospitals are taking the lead – and in Lund with various success. The fact that a fair amount

of square meters are dedicated to the dayroom is positive, and the room even has some

small elements, where the intersection between the homely atmosphere and the public

space is combined - although not convincingly enough. The room is still experienced quite

institutional, especially expressed by the overall materials like vinyl flooring and acoustic

ceiling sheets, and the lack of tactile and sensory elements. The idea of letting the kitchen

be a central part of the room is in general good and even recognizable from our own home,

but the fact that it is closed off from the patients may instead work as an amplified reminder

of hospitalization? The kitchen table towards the patent area, is however a self-service are,

which share familiar elements, although the freshly brewed coffee, which is chosen for

its homely character, instantly turn institutional when being served in 3 liter coffee pot with

stacked industry cups. The small details could easily have been better thought through, and

why should the patients not have access to a smaller part of the real kitchen themselves?

In general the dayroom in Lund meets many of these adversative examples, where the

intention lacks completion due to small details that easily could have been improved

if they were only in focus. The room is therefore experienced as institutional even though

some positive elements do exist, and the future design of these spaces needs a

more holistic approach towards material use and the general perception of space.

Compared to the other dayrooms experienced in Lund University Hospital, the KAVA ward

is indeed a consolation. On the floor below the dayroom is a 15 m2 room in the middle of

the building envelope with no windows and natural lightning, and consequently it seems to


be empty most of the day. The spaces for social support in future hospitals should, in

regards to design and planning, be more holistic and well considered, than it is experienced

in Lund.

HEALING ARCHITECTURE IN HOSPITAL DESIGN 49@2016 , Dipesh anand 3. SALUTOGENIC DESIGN MODELS

3.1 ANTONOVSKY’S THEORY OF SALUTOGENESIS In contrast to the traditional study of the sources of disease, known as pathogenesis,Salutogenesis is an approach to medical treatment and healthcare that focuses on the origins of health. It was developed in the late 1970s by Aaron Antonovsky, a professor, researcher and medical sociologist who was interested in answering the question of how most people manage to live relatively healthy lives despite being faced with disease, emotional and physical stress, social struggles and other challenges: “Given the ubiquity of pathogens—microbiological, chemical, physical, psychosocial, social and cultural—it seems to me self-evident that everyone should succumb to this bombardment and constantly be dying” (Health Stress and Coping ). He wrote: “the question then becomes not how some concentration camp survivors or poor people manage to stay healthy, but how any of us manage to stay healthy—the question of Salutogenesis” . By shifting his focus from disease to health, Antonovsky began to develop a systematic research methodology with a focus on what promotes health, as opposed to what causes disease. Finally, Antonovsky was concerned that the pathogenic approach implies a dichotomous relationship between health and disease; that is, a patient is healthy in the absence of disease. This idea precludes the possibility of disease and health being interrelated, simultaneous and multi-dimensional conditions. In the 1990s, architect Alan Dilani suggested that Antonovsky Salutogenic approach be applied not only to medical treatment and research, but also, to the physical design of healthcare facilities as a means to promote health. He suggested the use of Antonovsky theory to create Psychosocially Supportive Design, a theory and framework that promote health through the design of the physical environment. In order to understand how Salutogenesis can be applied to design, it is necessary to identify some key concepts of Salutogenesis, the most notable being the dis-ease/ease spectrum, the relationship between stress and tension, the role of personal and social resources that one has available—or as Antonovsky calls these, Generalized Resistance Resources—and sense of coherence. Antonovsky placed health and disease, or ease and dis-ease, together on each end of a continuum.

He defined the health ease/dis-ease continuum as a: “multi-faceted state or condition of the human organism” . He emphasizes that Salutogenesis is not about making a sick person well, rather it is about identifying their location on the continuum, and mitigating the stress that may move them towards the dis-ease side . One of the key defining characteristics of the Salutogenic model is what Antonovsky refers to as a sense of coherence. He defined sense of coherence as: “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that

(1) the stimuli derived from one’s internal and external environments in the course of living

are structured, predictable and explicable;

(2) the resources are available to meet the demands posed by the stimuli; and

(3) these demands are challenges, worthy of investment and engagement”


3. SALUTOGENIC DESIGN MODELS

According to Antonovsky the strength of one’s sense of coherence is determined by three key factors: comprehensibility, manageability and meaningfulness (Table 1)


3.2 ALAN DILANI - PSYCHOSOCIALLY SUPPORTIVE DESIGN

In the 1990s, architect Alan Dilani, proposed that Antonovsky’s principles be applied to the built environment, specifically to the design of healthcare facilities. Since then, Dilani and many other architects, designers and theorists have begun to further explore Antonovsky’s theory and to approach architecture, interior and urban design through a Salutogenic lens,.Alan Dilani conceived this idea to promote health “The Psychosocially Supportive Designapproach is offered as a useful theory and framework to guide healthcare designers and planners who consider how the physical environment impacts wellness factors in order to promote health”. According to him Salutogenic design not only identifies the cause of stress it can also introduce the wellness factor that can strengthens health. “The theory suggests that we not only design for stress reduction, but focus on salutary rather than risk factors”.Based on his vast research he created a list of design qualities that he argues strengthen an individual`s sense of coherence.

(Table 2) lists these attributes and categorizes them based on Antonovsky’s sense of coherence factors.

This includes the designers and developers, as well as the doctors, staff and possibly the patients and their families. If the entire team understands the impact that design has on a sense of coherence and in turn on the success of a project, they may be more likely to support the design process and to encourage the upkeep of the facilities. “The organization should measure the sense of coherence; the staff should comprehend it and act on it”

3.2.1 Psychosocially supportive designThe quality and character of the designed environment should be considered to be a powerful instrument capable of improving and strengthening health processes. The question how health care environments could promote the patient’s health should be a major issue for designers and planners. Since the new care philosophies (Salutogenic based perspective) involve both the human body and its psychosocial context the interaction between the nursing staff and the patients will become increasingly important in the future.


One of the conditions for health promotion in hospitals is to create an organization that provides the major parts of care services as close to the patient as possible, within the patient’s familiar environment. An emphasis on patient-focused care presupposes a different building structure, as it requires a decentralization organization. Instead of the traditional grouping structure the new model for RIT 2000 (University Hospital in Trondheim), in Norway, has been organized around the patient and his/her disease. The planning for RIT 2000 has broken important new ground by integrating and extending concepts such as a patient-centered care philosophy and environmental design, and multi disciplinary care teams.

Traditional wards where the staff is based somewhere in a room far away from patient rooms will disappear. In modern wards, there will no longer be a nurse station but a centrally placed workstation, which is easy to reach, and where the staff is always available. From there, the staff should be able to survey and watch a group of patients within a very short walking distance. This arrangement is called a “cluster”. A ward can consist of two or three clusters which can easily be coordinated and flexibly used depending on the patients’ demand for care. Communication and contact between staff and patients is made easier in this way, creating a feeling of security for both staff and patients.Research has shown that access to nature, daylight and other wellness factors like art and music can result in the patient using fewer drugs and spending less time in the hospital. Nature can affect our emotions positively. It can easily catch a person’s attention or interest and in turn can stop or reduce anxiety while bringing about desirable psychological changes. It can reduce blood pressure, ease pain and stimulate our senses positively.An increase in the consideration of wellness factors within design could have beneficial effects on well being and health processes and thereby creates environments that are not only functionally efficient but also highly psychosocially supportive.


3.3 ROGER ULRICH - THEORY OF SUPPORTIVE DESIGN

Although Roger Ulrich’s Theory of Supportive Design does not specifically follow

Antonovsky’s Salutogenic approach, it does support the physical characteristics of Salutogenic

design. The Theory of Supportive Design is a stress-based model that is a marriage of semi

scientific and scientific research. It looks at how design affects healthcare outcomes in a

traditional design setting, using stress as a starting-point. According to Ulrich, manifestations of

stress can be psychological, physiological and behavioral. Ulrich states that instead of working

to mitigate these negative manifestations, the design of traditional healthcare facilities actually

worsens them. Noise, lack of privacy, and visually un-stimulating design elements can

undermine a patient’s sense of personal control or autonomy, whereas, supportive design can

aid in coping with stress and foster improved medical conditions.

Ulrich focuses on three supportive design guidelines :-

1. Design that fosters a sense of control with respect to physical surroundings; 2. Design that facilitates access to social support; 3. Design that provides access to positive distractions

Some of the scientific research done by Ulrich on the :-A. influence of gardens and plants in hospital and in other healthcare settings.B. view through the window may influence recovery from the surgery.C. new spaces where patents through social interaction and support may reduce their experience of loneliness and fear in the hospital environment.

He identifies general guidelines intended to help inform the designer’s creativity and point the

designer in a direction that will lead to stress-reducing design and that can be tailored to meet

specific needs and goals. Although Ulrich’s model may have helped inform Salutogenic design

and provides some key design characteristics that will alleviate stress, it lacks the integrative

and holistic approach that is key to Salutogenesis. Ulrich’s model is much more specific than

Salutogenesis and does not look at the bigger picture of health promotion through design and

how designers can achieve this goal, from conception to completion. It is still, however,

valuable to recognize Ulrich’s theory, as it is a significant contributor to current Salutogenic

design models.


CURRENT EXAMPLE:-The Khoo Teck Puat Hospital (KTPH) in the city / state of Singapore is setting new standards

for incorporating nature into the design and layout of the health facility. Tim Beatley in UVA

Design describes it as “arguably the greenest, most biophiliac hospital in the world”.

Using the principles of biophilic design, and incorporating nature’s influence into the

design of healthcare facilities has numerous positive benefits. With this in mind,

Interface’s Essence range has been designed using natural patterns and hues to create

spaces that echo nature; helping hospitals become places of rejuvenation and healing rather than decline and sickness.


3.4 JAN GOELBIEWSKI - NEUROLOGY OF SUPPORTIVE DESIGN

Jan Golembiewski, a leading researcher of the relationship between the built environment

and mental wellbeing, states that: “Salutogenic theory is a particularly useful tool as it is

specific and easily applied to an architectural application” Similarly to Dilani, he maintains

that comprehensibility, manageability and meaningfulness— which support a strong

sense of coherence and foster a natural healing process—have clear architectural

ramifications.

He studies the architecture and design of psychiatric healthcare facilities through the lens of

comprehensibility, manageability and meaningfulness.

1.Comprehensibility- he says, is making sure that perceptual cues are present to assist

perceptual processes. These include attention to texture and materiality, controlling the size

of spaces and the numbers of patients and normalizing environmental features.

2.Manageability- making provisions for patients to exercise control of their environment.

Features such as operable windows or access to sporting facilities can make a significant

difference in the level of manageability a patient may feel. Meaningfulness refers to a

personal or cultural connection and can be enhanced by aesthetics or by consideration of

spatial organization, such as providing spaces for visitors or for special personal

belongings. it is the most special ingredient of sense of coherence.

Golembiewski states that: “Under normal circumstances people have a great deal of ability

to adapt to new surroundings—even in stressful situations… However, when environmental

factors start to erode a general sense of coherence—when meaning, control and

comprehensibility are lost—resistance to disease weakens and perceptual difficulties are

exacerbated, often creating a vicious circle of increased vulnerability and anxiety”.

In his research he found that manageability, comprehension and meaning have significant

architectural ramifications and they are central to Salutogenic design. As well, his studies

that show how environmental factors may erode a sense of coherence and, in turn, will

weaken resistance to disease and perpetuate anxiety



4. Precedent case studies5 4.1 Fortis hospital , gurgaon , India

4.2 Medicity , gurgaon , India

4.3 Analysis / interviews

5.1 FORTIS HOSPITAL, GURGAON , INDIA 5.1.1 INTRODUCTION

5.1.2 REASON OF THIS CASE STUDY

5.1.3 SALUTOGENIC DESIGN METHOD AND EVALUATION

A. Mapping out in relation to Antonovsky`s sense of coherence factor

B. Evaluation model in relation guidelines set through study of Edward T. hall

and Gehl theory.

5.1.4 CONCLUSION


4.1.1 INTRODUCTIONLocation : sector 44, Gurgaon

Site area : 43,303 sq. m.

Built – up area : 65,961 sq.m.

FAR : 1.52Principal Architect : Ar. Rajinder kumar,

Rajinder Kumar Associates, New Delhi

Fortis Memorial Research Institute, Gurgaon (FMRI ) is a flagship hospital of the Fortis

Healthcare Limited.

FMRI is a multi super-speciality, hospital.

FMRI is a set on an 11 –acre campus.

It has 430 functional beds, with a further planned increase in beds to 1000.

FMRI is accessible easily by road, It can also be reached using Delhi Metro, as the hospital

is located opposite to the HUDA city metro station

DEPARTMENTS - Minimal Access, Bariatric & GI Surgery

Plastic Surgery

Ophthalmology

Pulmonology

Plastic Surgery

Dental Sciences

Internal Medicine

Cosmetic & Plastic Surgery

Invasive Cardiology

Paediatrics

Minimal Assess Surgery (Gynae)

C-DOC

Neonatology

Liver Transplant, GI & Hepato Pancreato Biliary Surgery

Mental Health & Behavioural Science

Radiation Oncology

Radiology

Rheumatology

ENT


Gastroenterology & Hepatobiliary Sciences

LOCATION :-


NIEGHBORHOOD CONTEXT :-


4.1.2 REASON OF THIS STUDY

There are tremendous reason for choosing this hospital , main aim to create

an environment which should not give a sense of boring hospital. The design

philosophy behind this hospital to provide the health and well being of the

people they serve through integrated, innovative, and compassionate care,

also creates spaces that allow for privacy, rejuvenation, choice, humanistic

scale, feel and experience, communication, and collaboration. The Hospital

should incorporate new trends like wellness, technology and creates a Gen

Next Medical Center which sets new standards for healthcare focusing on

healing & nurturing robust health. At the south corner is a quiet & sun-filled

healing garden for patient, recuperation & areas of respite for staff and

families. All major areas in the hospital will have natural light for healthy and

sustainable environment.

The architecture of this hospital considered the healing source, although

factors like daylight, room atmosphere, sound, music, art and optional privacy,

altogether are believed to assist in creating carefully designed environments

that affects and supports the psychological and physical healing of the

patients.

With acceptance of the architectural influence on human healing aspects, it is

even more obvious that healing architecture should be incorporated in the

planning of future hospitals.




Based on research done by Alan Dilani on theory of Salutogenic by Antonovsky , he

created a list of design qualities which enhance the sense of coherence . In case of Fortis

Hospital there are some design qualities which enhances coherence factor of the building.

Although , in hospital some patients are in stress , anxiety , fear , loneliness , insecurity ,

frustration and generally longer hospitalization due to the unsuited facilities but in case of

Fortis Hospital there are no such situation which demoralize the patient. The design of this

hospital suggest that we not only design for stress reduction , but focus on salutary rather

than risk factors. There are several design features which shift the pathogenic approach to

Salutogenic approach manifests in the built environment. According to Antonovsky the

strength of one’s sense of coherence is determined by three key factors:

comprehensibility, manageability and meaningfulness.

A.1 COMPREHENSIBILITY - It means when faced with stressful situation or

challenge , a person will have the ability to seek meaning in it, and will do his or her best to

overcome it. There are some design characteristics which help in enhancing the sense of

coherence among the patient , staff and visitors , discussed below;-

1. WAY FINDING Modular planning of clinical floors to optimizes flexibility and improves way finding.

Clear organization and simple circulation system within medical areas eases patient

and staff use.

Flexible floor plates provide shared practice space, systems, and amenities for

various clinical modules and sub-specialties.

Ward layouts in older hospitals generally provide long corridors organized around a central

nursing station, where medication and charts are located. Research has shown that nurses

spend much of their time walking up and down halls increasing fatigue and stress and

sharply cutting the time available for observing patients and delivering direct care.

Common console for cathlabs , MRI, X-RAY , AND ICT decreases the circulation pattern

proves efficient for patient and staff.



SIMPLE CIRCULATION SYSTEM

DIRECTION SIGAGE BOARDS EASE PATIENT USE.


ESCELATORS FOR EASE AND FAST MOVEMENT FOR BOTH VISITORS

PLAN OF THE NIGHTINGALE WARD

VIEW OF THE NIGHTINGALE WARD. ( LESS CORRIDOR SPACE USED IN

PLANNING OF WARD MAKE IT EFFICIENT FOR STAFF AND PATIENCE).

2. PERCEPTIONThe experience already starts when guest or patient enters the lobby area , where an

welcoming fountain sculpture and reception welcomes the visitor with a holistic experience.

In a beautiful designed combination between the functional space and interior decoration ,

the holistic experience make you feel forget where you really are. When focusing on the

lowest levels of Maslow’s pyramid of needs, the physical and psychological, respectively,

the high-end hospital like Fortis is primarily addressing the self-fulfillment needs of

the visitors, and Fortis is accordingly providing a holistic experience, where design and

atmosphere is united in a multiple sensory expression.


3. LANDMARKWhile entering the central courtyard we see a white sculpture titled Loveable Curious Child

– a baby with a stethoscope plugged into the ground, creates a landmark of the hospital

building. Around this sculpture many people take selfie and sit together, seems to be an

vital part of the hospital social space.


REFRESHING & CONGENIAL ENVIRONMENT FOR PATIENTS BY CREATING A MODERN, UP MARKET & PLUSH INTERIORS.

VIEW OF A CENTRAL COURTYARD

4. PLEASURE It also accommodate a small cinema name as " FORTIPLEX", for visitors it is a recreational

hall where visitors can watch a cinema for several time, so that they will get some

relaxation and stress free time


A.2

MANAGEABILITY- A person can sense of the situation , problems or challenges that

they face. it also mean making provision for the patients to exercise control over their

environment. Features such as operable windows or access to sporting facilities can make

a significant difference in the level of manageability a patient may feel. “The feeling that a

person is in control of his or her environment and life circumstances is very fortifying… the

feeling that you are totally out of control is absolutely disempowering”

1. AESTHETIC ELEMENTS

2. NATURAL LIGTH

Perception of sunshine contributionstudy done for the fortis hospital ( included both patient and staff interviews)

Survey question Patient Staff

Considered sunlight to be a nuisance 2% 55%

Considered sunlight to be pleasurable 91% 33%


Considered sunlight to be calming 95% 37%

Considered sunlight to be unfavorable 1% 18%

The study found that these patients subsequently required less narcotic pain medication,

experienced a shorter hospital stay, and had fewer negative evaluative comments in

nurses’ notes.

SECTION SHOWING NATURAL LIGTH PENETRATION IN THE ATRIUM


All major areas in the hospital will have natural light for healthy and sustainable

environment. Skylight at the roof transmitting natural light into the most common &

waiting areas.

DOUBLE OCCUPANCY ROOM SINGLE OCCUPANCY ROOM

The integration of natural physical environments into treatment for human sufferers has

always proven to be an effective course of action. Elements in nature emulate qualities of


calmness and serenity that are necessary for a healing environment. There are two

benefits of windows: one is daylight and the other is view.

3. GREEN ENVIRONMENT

VIEW OF THE EXTERIOR LANDSCAPING AT THE ENTRANCE PORCH

Landscaping in order at the entrance give visitor and patient a sense of order , decreases

the stress and anxiety among the patient , ultimately arouses a level of coherence factor

among themselves. it also provide a sense of supportive design for patient as plants

represents life , growth and hope. they can provide interest and diversion.

A.3 MEANINGFULNESS- In the face of a challenge or stressful situation, a person has

adequate their disposal and that they trust , which can help them cope.

1. SOCIAL SUPPORT

ARRANGEMENT OF FURNITURE IN MAIN ATRIUM SPACE increases the social support

among the visitors as they talk to each other about the disease or experience without

knowing the patient, these kind of seating arrangement make these spaces as sociopetal.


The fact that it is only space adds a social unifying value, even though it is still possible for

di erent groups to sit ff privately at the same sofa at one time. The ground floor is the center

for social interaction, where people arrange meetings or just engage on informal basis.

2. MUSIC AND ARTStudies have shown across a variety of

patient groups that pleasant music,

especially when controllable, often can

reduce anxiety or stress and helps some

patients cope with pain.


ARRANGEMENT OF FURNITURE IN MATERNITY WAITING AREA FOR MOTHER is designed in such a homely

attmosphere which reduces stress level

among the patient. The detail with the false

cieling and sofa shows the intention making

the waitinf area comfortable , homely space

but the specific choice of curtain make it

seem clinical in some respect.

Wallpaper at pediatric centre Wallpaper at oncology department

Patient Based Art Programs include artwork that is selected based on the unique needs of

each patient groups (such as Cancer, Pediatric, Geriatric, Women, Heart, ICU, Rehab and

Psychiatric). Patient Based Art helps to deinstitutionalize the clinical setting while illustrating

a sensitivity to location and patient demographics. Patient based artwork can also aid in way

finding by helping to visually identify areas.

A successful healthcare art program consists of a coordinated series of visual elements

placed in public and private spaces throughout the facility. The selection of these elements,

as well as their size and placement, is crucial to the success of the program.

If photographs and slides of nature are viewed positively and reduce stress, it is probable

that artwork that replicates nature would also have this effect. Research on adult patients

suggests that by infusing art into the healthcare setting, patient-focused design may foster

improved moods or reduce stress that would impact the negative thoughts that could impede

the healing process.


ALL PHOTOGRAPHS ARE CLICKED BY DIFFERENT DOCTORS ACCORDING TO THIER EXPERIENCE AND ALIGNED IN THE HOSPITAL CORRDIOR.


3. VIEWS

VIEW OF THE GREEN AREA FROM DOUBLE OCCUPANCY ROOM IN SOUTH - EASTDIRECTION.


VIEW OF THE GARDEN AND THE CITY FROM SINGLE OCCUPANCY SUITE ROOM IN NORTH DIRECTION.

Views of vegetation, and especially water,

appear to sustain interest and attention more

effectively than urban views of equivalent

information rate . Because most natural

views apparently elicit positive feelings,

reduce fear in stressed subjects, hold

interest, and may block or reduce stressful

thoughts, they might also foster restoration

from anxiety or stress. in comparison with

the wall-view group, the patients with the

tree view had shorter postoperative hospital

stays, had fewer negative evaluative

comments from nurses, took fewer moderate

and strong analgesic doses, and had slightly

lower scores for minor postsurgical

complications . natural scene had

comparatively therapeutic influences, it

should be recognized that the "built’ view in

this study was a comparatively monotonous

one, a largely featureless brick wall.

B. EVALUATION MODEL IN RELATION GUIDELINES SET THROUGH STUDY OF EDWARD T. HALL AND GEHL THEORY.

B.1 FUNCTIONS What are the options of residence ?


The living area in suit room considered as primary place for visitors , where visitors always

remain close to the patient. Although looking at the furniture arrangements in the living

room looks almost like you are in such a homely atmosphere, which ultimately increases

the sense of coherence among the patient. The lighting in the room sets a relax mood of

patient and visitors both , which changes the pathogenic place to Salutogenic place.

What are the optional functions ?You can watch television as

entertainment , the primary activity is

relaxation on the lounge. Other than

this there are no such optional

activities like kitchen counter for self-

provide able snacks in the room.

Does the function in the space inthe social space invite theparticipation?When you arrive in the center staff

is welcoming the guest

accommodatingly and friendly

describing the various possibility in

house. This behavior enhances the

homely atmosphere , arouses a

sense of coherence among the staff

and visitors. The arrangement of

furniture also allows different visitors

to sit together and talk to each

other.


seating arrangements in the suite room for visitors.

seating arrangements in the cafe area for visitors.

B.2 MATERIAL AND TEXTURE

List and short description of used material,textures, furniture? The red color broad strip dominating the central

courtyard is a sound absorbing material which

reduces the bad noise , enhances the healing

power of hospital. Furniture are consists of

couches and armchairs in white upholstery with

colorful accessory cushions and small wooden

tables aside.

How is the room characterized by materials and texture?In regards to material and textures , the space is

not seems to be very attractive and luxury, as the

travertine stone flooring and designed false

ceiling generally predominant.

The furniture used in lounge area have

leather covered cushions ,recliners and

general design of these are luxury.

Are the use of materials and textures consistent and deliberate?


seating arrangements in the central courtyard area for visitors.

The red color strip dominating interior of atrium

Recliners in NICU waiting areas

The furniture in the ward area seem to be institutional , although it does not define a consistent

design as compared to single occupancy room . The material in the ward are distinguished

from the other areas of the hospital. There is some lack of luxury in these common ward as

compared to other areas.

B.3 DETAILS Scale and partition of the room ?The main suit room is large in scale

through with specially defined partition

with door accessibility and the room is

experienced personalized in scale.

The living area in this category divide

the room into two. The patient area is

kept quiet institutional and a living area

is non institutional.

Furniture and distances ?The living area is luxury designed with

a 6 - person dining table and one

armchair with a coffee table. In scale

it is recognizable from private homes

and the multiple seating options

provide alternative choice . The l-

shape sofa is placed along the

perimeter of the room and is not used

during observation.

Other details ? Specific details such as flower pot

at the window bay as well as lamp in

the living area arouses a feeling that

a patient is in his/her home. t is done

to define attractive and welcoming

social space.


Not that much luxury in common ward areas

The room is divided in patient and visitors use in presidential suite.

There is one dining table and couch for seating.

4.2 MEDANTA HOSPITAL, GURGAON , INDIA 5.2.1 INTRODUCTION

5.2.2 REASON OF THIS CASE STUDY




Small details gives a feeling of home.

4.2.1 INTRODUCTION Medicity will be a world class 1,200 bed hospital with 10 super specialties, 40

high-tech, air-conditioned surgical amphitheatres equipped to perform robotic

surgery, and much more. On its campus, there will be a medical college and a

paramedical college, as well as a diagnostics and research and development

facility.

Area: 43 Acres

Built Up Area: 15, 00,000sq ft

Client: Global Health Pvt. Ltd. (The Institute of Integrated Medical Sciences & Holistic

Therapies)

Architect: cardinal hardy architects / jodoin lamarre pratte architects / group arcop

Cost: 900 Crores Rs. (Approx)

Status: Design Development

Departments : Division of Endocrinology and Diabetes

Division of Endocrinology and Diabetes

Division of ENT & Head Neck Surgery

Department of Internal Medicine

Department of Ophthalmology

Division of Plastic, Aesthetic & Reconstructive Surgery

Department of Pathology & Laboratory Medicine

Department of Physiotherapy & Rehabilitation

Division of Radiology & Nuclear Medicine


http://www.medanta.org/department_radiology_medicine.aspx

http://www.medanta.org/department_physio_rehabilitation.aspx

http://www.medanta.org/department_pathology_laboratory.aspx

http://www.medanta.org/department_surgery.aspx

http://www.medanta.org/department_opthalmology.aspx

http://www.medanta.org/department_internal_medicine.aspx

http://www.medanta.org/department_ent_headneck.aspx

http://www.medanta.org/department_endocrinology.aspx

http://www.medanta.org/department_endocrinology.aspx

Department of Transfusion Medicine (Blood Bank)

Emergency & Trauma Care

Pharmacy

4.2.2 REASON OF THIS STUDY

There are enormous reason for choosing this hospital , The prestigious

Medicity project, a state-of-the-art institute of integrated medical sciences and

holistic therapy, will, for the first time in the history of medicine, combine

different streams of medical science such as allopathy, Ayurveda,

homeopathy, naturopathy and unani, to find a holistic treatment for modern

ailments and diseases.

The design philosophy behind this hospital to provide the health and well

being of the people they serve through integrated, innovative, and

compassionate care, also creates spaces that allow for privacy, rejuvenation,

choice, humanistic scale, feel and experience, communication, and

collaboration.

The architecture of this hospital considered the healing source, although

factors like daylight, room atmosphere, sound, music, art and optional privacy,

altogether are believed to assist in creating carefully designed environments

that affects and supports the psychological and physical healing of the

patients. This is a project that is very close to our heart. The Trehan family,

who formulated the vision and encouraged a detail-oriented execution of the

project, were wonderful people to work with. We wanted to create an uplifting

and happy space far removed from how we generally see hospitals. It was a

tremendous opportunity to create a difference, especially amongst people who

were unwell and recuperating.


http://www.medanta.org/department_pharmecy.aspx

http://www.medanta.org/department_Emergency_Trauma.aspx

http://www.medanta.org/department_bloodbank.aspx

NIEGHBORHOOD CONTEXT:-


MEDANTA HOSPITAL

SITE PLAN :-


5th floor level plan :- Green color represent healing garden , as it is enclosed

between the buildings, which acts as a central green court or we can say a healing

garden for the patient to increase common activity aoruses the sense of coherence

among the patientand the staff.

N


10th floor level plan :-

N


4.2.3 SALUTOGENIC DESIGN METHOD AND EVALUATIONA. Mapping out in relation to Antonovsky's sense of coherence factor

A.1 COMPREHENSIBILITY1. Way findingClear organization and simple circulation system within medical areas eases patient and

staff use. In case of medanta there is no such common ward arrangements which arouses

a problem related circulation of staff and visitors. Ample amount of daylight is penetrating in

the corridor areas so that there will no dark spots in the corridor, proper signage boards

and welcoming staff helps visitors in way finding to their destination.


Daylight in corridor ,but does,nt have soft edges lift lobby showing rectangular dead end

The language of forms in architecture also has a correlation to the feeling one

obtains from the space. For example the natural environment has soft edges, but no

right angles (Red stone). However, the right angles in our everyday life are endless

in the built environment. The architecture of a healing environment can take on the

qualities of natural conditions through imitation in form. While one might feel

constrained and boxed in rectilinear spaces, the fluidity of an organic space creates

no such feeling. Without right angles, the spaces become seemingly less harmful

and comforting to the human eye. "It is not the rectangle which is the problem, but its


life-sapping characteristics. Where materials, textures, colors, light, living line and

human activity can reinvest such forms and spaces with life, the ly None the less, in

general, one feels on much safer ground with non-rectangular, or shape-moderated

spaces.”-RogerUlrich

2. Colors As the color of the ceiling and walls are mainly white , slightly change in bedrooms but

although it is kept as institutional look. The ceiling is cement plastered incorporating

various HVAC or piping with adequate cove lighting.

View showing the texture and colors of waiting areas and private rooms


3. NatureMedanta come up with the design solution to give natural views to visitors waiting area and

lounge area through floor to ceiling windows. It is evidence that visitors having a view of nature

remain calm and peace. Outside the building there is also an assembly area for the visitors

where visitors walk and talk with each other, in term increase the social support among them.

Stepped terrace landscaping in front of window. visitors having view of terrace landscaping through window.

Green lawn in front of the hospital entrance for social gatheringGreen entrance and landscaping in a systematic pattern arouses a sense of control among the patient and

visitors, which realizes the patient a sense of security ultimately increases the coherence factor among the staff

and patient.


4. PleasureThere is a provision of lounge area for visitors with a capacity of 20 recliners and 15 sofa set

with center table, so that visitors find relax when they are tired or in stress. They can also

watch television and read magazine, it is 24 hrs open for the visitors.

The furniture used in lounge area have leather covered cushions ,recliners and general design

of these are luxury.

View of the lounge area for the visitors for night stay.

A.2 MANAGEABILITY1.Natural light

Perception of sunshine contributionstudy done for the medanta hospital ( included both patient and staff interviews)

Survey question Patient Staff

Considered sunlight to be a nuisance 2% 45%

Considered sunlight to be pleasurable 89% 35%

Considered sunlight to be calming 91% 32%

Considered sunlight to be unfavorable 1% 12%


Systematic arrangement of shrubs and trees

As the orientation of the building is north -south oriented, building has two big bed tower

which is interconnected with one central arm. The two bed tower enclosed an green area in

between which is having shaded area due to south-east block. While talking about the

interior space of bedroom , The bedroom on outer side of south-east block get ample

amount of daylight while the inner face is in shaded region , on the other side north-west

block getting the west sun in the inner side while the outer side is in shaded region. Other

areas like food court and waiting lounges are getting ample amount of daylight. Some

areas like waiting areas in OPD section on above floors are not getting daylight , seems to

pathogenic in that case , which increases the stress level among the patient and visitors.

Day light penetrating in the food court through double Waiting areas at each floor situated at perimeter of

height glazing , refreshes the mood of visitors. building connected through window.

Healing garden enclosed between the building block not Some waiting areas are not getting ample

getting direct sunlight from east direction. amount of daylight makes them boring .


Bedroom facing south-east direction , ample amount

Bedroom facing north-west direction, deficient of

of daylight through window.

daylight.

2. Green environmentHealing landscapes have long been an important

aspect of human life. When people first began erecting dwellings, healing places could be

found within nature through sacred groves, special rocks and caves . With same approach

of Roger ulrich , medanta also accommodates a healing garden or we can say a therapeutic

garden on the fifth floor level for the patient use only.

Healing gardens foster`s the following elements:a. Sense of controlPatients/residents must know a garden exists, be able to find it easily and be able to access

and use the space in an active or passive way. It should also have areas for privacy that are

shielded from window views. A variety of types of spaces can aid in allowing users to make

choices. Feelings of control can also be enhanced by involving users in the design of the

garden.


HEALING GARDEN

b. Social supportSpatially enclosed settings that allow for socializing are often preferred by users. Designing

for small as well as the occasional large group (associated with hospital initiated programs

and large extended family visits) is important. However, all considerations for social support

should not deny access to privacy (which undermines patient control)

c. Physical movement and exerciseMild exercise can be encouraged by designs that allow for patient accessibility and

independence and provide features such as walking loops.

d. Access to nature and other positive distractionsMedicinal and edible plant species and those that engage all of the senses are often a

good choice for the design’s plant palette, as are plants that encourage wildlife.

e. Sense of personalized environment

Schematic diagram showing the interaction of bedrooms and healing garden adjacent to each other on 5th floor

Above figure shows the spatial assessment of Medicity based on the green approach, shows

the arrangement of bedrooms along the healing garden which increases the physical

interaction between the nature and patient helps in reducing the stress level among the

patient , ultimately enhances the coherence factor, makes Medicity as a Salutogenic model.

There has been provide such access control for the visitors , only patient are allowed in

healing garden with nurse in daytime. There is a department name as "PANCHKARMA" based on Indian therapeutic surgeries, utilizes

healing garden for the rehabilitation or healing

of patient in some case.

A.3 MEANINGFULNESS1. ArtWhen I was in hospital, the photographs on

the corridor walls kept my mind off

thermometers and at Gurgaon’s multi-

specialty hospital Medanta, the sculpture at

the entrance is very soothing to relatives of

patients. Titled the Trees of Life or the

Mannat (wish fulfilling) Trees and made by

Rajasthani artist Ruchur Tiwari, the sandstone structures are 21 feet each in height and

stand tall, inviting visitors across religions. On the base of the tree is a beautiful cluster


of mauli, the sacred red thread that relatives tie while praying for recovery of their loved

ones. Not only is the artwork helpful for the patients but it also touches on the work life

of doctors and technicians who work in the stressful environment. “If I go to a room with

a painting, I do look at it and appreciate it. It’s not only aesthetic but also has an impact

on your behavior and provides an environment that is not sterile in terms of thought,”

says Dr Randhir Sud, chairman of the Medanta Institute of Digestive and Hepatobiliary

Sciences. Anything that helps any patient remove emphasis from her or his illness is a

huge help.

2. ViewsWhile visiting the inner wing of bedroom tower , view from the transparent glass window

seems to be pleasant and green. For persons experiencing anxiety or stress, studies

indicate that certain types of nature scenes rather quickly foster more positive feelings,

and promote beneficial changes in physiological systems – for instance, lower blood

pressure. Those patients assigned a landscape with trees and water experienced less

anxiety, and required fewer strong pain doses, than control groups assigned no pictures.


The Trees of Life installation at the Medanta hospital, Gurgaon, created by Rajasthani artist Ruchit Tiwari.

Positive distractions are a small subset of environmental-social phenomena that are

distinguished by their capacity to quickly and effectively promote restoration from stress

(Ulrich, 1999).

View of the nature through different room increases the

coherence factor among the patient.

3. Positive distractionThere are lots of positive attraction in the hospital which make it look like a non

institutional place such as food court , healing garden , luxury lounge area , small

cafeteria , green lawn at the entrance of hospital, etc. Such positive attraction distract

the mind of patient and visitors to a relax mode , thus reduce stress n anxiety among

them. The great majority of patients prefer representational art depicting serene,

spatially open natural environments having scattered trees and/or no turbulent water

features--but consistently dislike abstract art. Although designers, artists, and some

healthcare staff react positively to abstract images, or to art having a sense of

"challenge" or ambiguity, there is evidence that such properties in pictures can

negatively affect patient stress and worsen other outcomes.


Art work in bedroom distract patient mind. Temple and green areas outside the building.

Lavish food court give variety to visitors. Television in patient bedroom distract patient mind.

4. Patient experience


5.3 ANALYSIS / INTERVIEWS


4.3.1 interviews ( Therapist interview)


4.3.1.2 Psychologist interview


4.3.1.3 Consoler interview


4.3.2 Analysis


5. CONCLUSIONThe ability of architecture to heal the mental and physical illness with the different planning

parameters and the elements that can enhance healing has been explored. Without

compromising on the need, the ability of all patients to be outdoors in a good environment is, in

my view, the absolutely greatest strength in the design of this caring environment. The

spontaneous process of making architecture, it’s almost as if we formulate our own “abstract”

ideas of what we envisage a space to be, through special images from memory we assemble

architecture to be a part of the real world. It not only seems that art is inherent in all of us, it is

also possible that architecture is inherent in all of us. As an act of healing it is symbolic of our

perseverance as a species to live a fulfilled existence. In exploring art as healing, architecture as

an art and lastly, architecture as a healing space, I can deduce that the common bond between

them is that art does have healing qualities and it can be said that such healing qualities provide

therapeutic harmony in all of us. I believe its effects may be limitless in measuring the benefits to

the Self. The journey of healing through art seems to be a process of retrospection, Self growth

and Self discovery. This investigation has brought about key design objectives that may be

crucial in space making concepts for my healing architecture in healthcare design.

The purpose of creating a green oasis which patients can retreat to unescorted by staff, in my

opinion, has to be achieved. Even in a number of problems where the outdoor environments are

concerned, everyone agrees that the existence of the gardens and light courts is something

absolutely positive and something that is very good for the patients. It is also clear that being

allowed out in the gardens is perceived as conferring an opportunity of greater sovereignty. In

this way I think the aim of increasing normalcy has been achieved.

Patients often experience different needs from time to time, and so the architect should

consciously design the place or the environment so as to facilitate the process which recovery.

In the design process, the architects should consciously reduce the institutional ambience and

create such Salutogenic design which will shift the pathogenic approach . As I see it, there is

scope for the patients to use different parts of the environment, both indoors and outdoors

depending on the stage of the recovery process they have come to. Outdoor spaces are always

with lusting green and the sound of water to heal their agitation. Indoor is more towards the

sunlight that enhance the healing and the ventilation to give the patient high level of

conformability.


With the aid of my detail study and the precedents I have concluded four connections that has

to be consciously addressed while designing.

1. The connection with the personalized environment - Healing begins when one is in a

space of Homely atmosphere. The physical space however is one that must be comfortable and

a reflection of oneself. The physical environments have great influence on our social behavior

and the possibilities for patents to engage social activities promoting social support. The

common spaces should provide more than just the possibility for patents to form this basic

contact.

2. The connection to sensory experience : The integration of all the senses helps complete

the highest potential of an environment to allow for healing to emerge. As, Human beings cannot

live without natural surroundings. The symbiotic relationship that exists between the two is one

that has to be nurtured. A physical and visual link with nature has positive beneficial qualities

that help in healing and health in general.

3. The connection with Light: Natural sunlight kills harmful bacteria and cleans air. Apart from

these obvious natural benefits of sunlight, natural light - when controlled - gives a space

character that is sensual so giving a space an emotive quality which can be felt by the end-user.

Light is also a symbol of growth and life as it benefits the natural world in that way.

4. The connection with the City: The city environment is harsh and busy and tends not to offer

many places or spaces of retrospection and contemplation. The site should be a part of the city

but detached from the fast pace. The end user should be able to arrive conveniently with public

transport to the site to allow a large catchment of people seeking a place for healing. The site

should also be in a place that is not difficult to navigate and find.


8. BIBLIOGRAPHY -www.hindustantimes.com/brunch/art-is-finding-an-unusual-home-in-indian-hospitals/story-

yk6GAHLQvEFfJYd46rWCVN.html

timesofindia.indiatimes.com/life-style/health-fitness/de-stress/music-therapy-to-heal-cancer-

patients/articleshow/51921616.cms?from=mdr

kgd-architecture.com/portfolio_page/fortis-hospital-gurgaon-i-healthcare-4/

soundofarchitecture.com/blog/architectural-healing-how-the-built-form-changes-lives

archinect.com/firms/project/14168405/medicity-medanta/60103380

Salutogenic Places: Designed to Thrive. Farrow Partnership Architects. YouTube

Golembiewski, Jan A. "Start Making Sense Applying a Salutogenic Model to Architectural

Design for Psychiatric Care." Facilities

Golembiewski, Jan A. "Salutogenic Design: The Neurological Basis for Healthcare

Design" World Health Design Journal.

Dilani, Alan. "Psychosocially Supportive Design." World Health Design Journal

Dilani, Alan. “A new paradigm of design and health in hospital planning. World Hospitals and

Health Services, 41.4

“About Maggie’s.” Maggie’s Centres. The Maggie Keswick Jencks Cancer Caring Centres

Ulrich, R. S. (2000). Environmental research and critical care. In D. K. Hamilton (Ed.), ICU 2010:

Design

for the Future. Houston: Center for Innovation in Health Facilities, 195-207.

Ulrich R S (2004) The role of the physical environment in the hospital of the 21st century: a

once-in-a lifetime opportunity. New York: Robert Wood Johnson Foundation.

Ulrich, R. S., LundÈn, O., and J. L. Eltinge (1993). Effects of exposure to nature and abstract

pictureson patients recovering from heart surgery. Paper presented at the Thirty-Third Meetings

of the

Society for Psychophysiological Research, Rottach-Egern, Germany. Abstract published in

Psychophysiology, 30 (Supplement 1, 1993): 7.

Ulrich, R. S., Simons, R. F., Losito, B. D., Fiorito, E., Miles, M. A. and M. Zelson (1991). Stress

recovery during exposure to natural and urban environments. Journal of Environmental

Psychology 11:

201-230.

Ulrich R, Zimring C, Quan X et al (2006) The environment’s impact on stress. In S Marberry

(Ed.), Improving healthcare with better building design. Chicago: Health Administration Press,

37-61.


GLOSSARY -

Environment: that which environs or surrounds; surrounding conditions, influence, or forces, by

which living forms are influence and modified in their growth and development.

Heal: to restore or be restored to health

Health: the general condition of the body or mind with reference to soundness and vigor

Well-being: a good or satisfactory condition of exis tence; a state characterized by health,

happiness, and prosperity

Psychology: the scientific study of the human mind and its functions, esp. those affecting

behavior in a given context.

Flexibility: responsive to change; adaptable

Meditation: a stylized mental technique... repetitively practiced for the purpose of attaining a

subjective experience that is frequently described as very restful, silent, and of heightened

alertness, often characterized as blissful

Urban: Characteristic of the city or city life.

Evidence-based: entails making decisions about how to promote health or provide care by

integrating the best available evidence.

Therapeutic: having or exhibiting healing powers.

Spirit: the principle of conscious life; the vital principle in humans, animating the body or

mediating between body and soul.

Body: the physical part of a person

Mind: the element of a person that enables them to be aware of the world and their experiences,

to think, and to feel; the faculty of consciousness and thought.

Habitat: the natural home or environment of an ani mal, plant, or other organism.

Sequence: a set of related events, movements, or things that follow each other in a particular

order.

Sequence: a set of related events, movements, or things that follow each other in a particular

order.

salutogenis -Salutogenesis is a term coined by Aaron Antonovsky, a professor of medical

sociology. The term describes an approach focusing on factors that support human health and

well-being, rather than on factors that cause disease (pathogenesis).

pathogenesis -The pathogenesis of a disease is the biological mechanism (or mechanisms)

that leads to the diseased state. The term can also describe the origin and development of the

disease, and whether it is acute, chronic, or recurrent.
