therapeutic environments - devising space designs that provide measurable positive effect on...

Therapeutic Environments

Bharti Sharma M.des, NIFT Mumbai

Mentor : Ms. Sushama Saitwal

Devising space designs that provide measurable

positive effect on patients clinical outcomes

C 2014 Bharti Sharma.All rights reserved

Part 1

Therapeutic environmentsTherapeutic + environments

Supports clinical excellence in the treatment of the physical body

Supports the psycho-social and spiritual needs of the patient, family, and staff

Produces measurable positive effects on patients' clinical outcomes and staff effectiveness

Having a good effect on the body or mind; contributing to a sense of well-being

source:oxford dictionaries The setting or conditions in which a particular activity is carried on }{

Structure

Present scenario

The landscapehealthcare

Health is a state of complete physical, mental and social well-being

and not merely the absence of disease or infirmity.

Human Health

WHO defination

Health industrycare

Comprises of providers of diagnostic, preventive, remedial, and

therapeutic services such as doctors, nurses, hospitals and other

private, public, and voluntary organizations within the economic

system.businessdictionary.com

Health industry: INDIAcarepresent scenario

This industry is currently worth Rs 73,000 crore which is roughly 4% of

the GDP. The industry is expected to grow at the rate of 15 percent

which amounts to an addition of Rs 9,000 crores each year.

2017E $158.2 Bn

2012 $78.6 Bn

2011 $68.4 Bn

2010 $59.5 Bn

2009 $45.0 Bn

2008 $51.7 Bn

expected growth of healthcare sector in India

http://healthcare.financialexpress.com/

Medical Tourism

India has emerged as the fastest growing segment of tourism industry and

seems to be the most promising medical tourism destination in the

world. The report further said that by the end of 2015, its global medical

tourism industry share would be around 3 per cent. UK-based TransWorldNews

The population to bed ratio in India is 1 bed per 1000, in relation to the

WHO norm of 1 bed per 300. In India, there exists space for 75000 to

100000 hospital beds.

Over the last five years, there has been an attitudinal change amongst

section of Indians who are spending more on healthcare.

Rise in retail clinics, single speciality, secondary and tertiary care centres

www.who.int/

Segmentation

3%

Segmentation of the healthcare industry

Medical software and Diagnostics

Segmentation


3% 4%


Health maintenance organizations

(Medical insurance)


Segmentation


3% 4%9%



(Medical insurance)


Health equipments and supplies

Segmentation


3% 4%9%

13%



(Medical insurance)



Pharmaceutical

Segmentation


Hospital management firms

71%

3% 4%9%

13%



(Medical insurance)



Pharmaceutical

Segmentation


3% 4%

A facility with specialised staff and equipment

whose primary function is to provide inpatient

and outpatient services, diagnostic and

therapeutic, for a variety of medical

conditions, both surgical and non surgical.


3% 4%







Objective

Teaching cum- research

General

Speciality

Classi�cation of Hospitals

3% 4%







Objective

OwnershipTeaching cum- research

General

Speciality

Government

Private

Charitable

Corporate








Objective

Ownership

Service


General

Speciality

Government

Private

CharitableGeneral

Specialty

(patients belonging to a particular group,patients suffering from diseases of a particular organ or groups of organs)

(Clinical Services, Surgery, emergency,Outpatient, support service)

Corporate








Objective

Ownership

Service



General

Speciality

Government

Private

CharitableGeneral

Specialty

(patients belonging to a particular group,patients suffering from diseases of a particular organ or groups of organs)

(Clinical Services, Surgery, emergency,Outpatient, support service)

Area of intervention

Corporate

Curing model of Hospitals

Medicine

Medical organization

Infrastructure

DoctorsNurses

management staff

TechnologyServiceCultureEmpathy

based on analysis of secondary data


DoctorsNurses

management staff


Infrastructure

Medicine


Medical Equipments

Environment (space design)

Ancillary and Support Services


DoctorsNurses

management staff


Infrastructure

Medicine


Supports clinical outcomes

Produces measurable positive effects on patients' clinical outcomes and staff effectiveness

Study focuses on these two elements,

And using Architecture in a way that it:

Medical Equipments

Ancillary and Support Services

Environment (space design)

Treatment

The gap so

discovered is

between the

present use of

the hospital space

as a medicinal

infrastructure

element and its

potential use as a

supplementary

treatment for

holistic health.

Gap identified(Context: India)

Physical Clinical facilities

Experiential attributes of the hospital(eg color, light)

Effect of treatment on mind

Effect of treatment on body

Psychological Hospital

Patient

Psychological Physical

Through Medicine

Treatment

The gap so

discovered is

between the

present use of

the hospital space

as a medicinal

infrastructure

element and its

potential use as a

supplementary

treatment for

holistic health.







Patient


Through Medicine

Through Healing

Treatment

The gap so

discovered is

between the

present use of

the hospital space

as a medicinal

infrastructure

element and its

potential use as a

supplementary

treatment for

holistic health.







Patient







Patient

Psychological Active

Passive

Through Medicine

Through Healing

Treatment

Therapiesused as a medium

Positive effect onmental health (well- being)

Physical

The gap so

discovered is

between the

present use of

the hospital space

as a medicinal

infrastructure

element and its

potential use as a

supplementary

treatment for

holistic health.


Objectives of research

To study the environmental psychology and understand the relationship between behavioural health

and the physical environment.

To identify and analyze the latest developments in the interior design of health care centers and hospitals.

To investigate the various therapies allied to the sphere of space along with other environmental

characteristics and their positive effects on human psyche.

To substantiate the research by the way of design solutions of the interiors of a healthcare center.

Expected result

The research model aims at achieving the following :

Enabling the health care centers to become not merely an ensemble of concrete and contraptions

or a warehouses for sick but a comfortable haven for both the care givers and care receiver .

Incorporating such therapies in space design which have a direct and ongoing effect on

the patient’s psyche as well as measurable positive effects on his/her clinical outcomes .

To evolve space designs that lend the interiors , an environment that enhances staff efficiency,

staff satisfaction and organizational outcomes.

Secondary Research Primary Research Critical Theory Analysis

(Tertiary & Secondary data)Observation

Care Giver Care Reciever Designer

Field Study

Patient And Doctor

Activity Mapping

Interview

Gap Identi�cation

Developmentof Key DesignConsiderations

study analysis identification

Design Development

Hospital feedback

Hospital Design, Interactive spaces, Children Spaces

Behaviourial Health

Therapies and other environmental characteristics found to influence Health outcomes

Environmental Psychology

Child Psychology

Space

Psychology

Design

Medical Science

methodology

Secondary TheorySecondary Visual ResearchSecondary AnalysisTertiary research

Secondary Research

Concepts Theories Present researches

Present researches

Critical review to understand the various theories and concepts related to the field ofenvironment and healthcare.

Critical Theory Analysis

Comprehension and Analysis of present healthcare scenario

Tertiary Data Secondary Data

Phase 1

The liberal use of colors , vivid illustrations and animated characters make the interiors come alive

Use of cool colors and nautical paintings effectively pull off a sereneoceanfront feel , granting the ambiance a sense of calm and peace .

The continuity of the narration is unhindered , maintained by the continuation of illustrations on glass .

Scale and perspective provides quick visual stimulation and acts as a positive distraction.

Secondary Visual Research

Melbourne’s Royal Children’s Hospital Melbourne, Australia

The waiting areas are not conventional sitting arrangements but evolved into activity spaces to engage the child during the waiting hours . Reflecting the sense of warmth and care ,

the soft edges impart tenderness that sharp edging essentially forgoes.

softer and round edges

The illustrations complement the interiors in every respect thus leaving no room for visual tension or distraction.

Randall Children’s Hospital

The corridors make clever use of creative installations , colour blocking and asymmetric designing to not only create a happy sitting space but also break free from the institutional typecast inherent to hospitals .

The children’s rooms are designed to provide a homely environment made complete with warm and comfortable design setting .

The small lounging spaces at regular intervals provide personal space to patients and their accompanists

Texas Children's Hospital Page Southerland Page,Houston, Texas

The bright and contrasting combination of yellow and violet add a dash of playfulness to the interiors making them appear less institutional.

interactive spaces

Ceiling designs and sky installations generate awe and interest among young and old alike .

Sky installations add more interest

Randall Children’s Hospital

Ingenious and Interactive learning areas in corridors seek toengage the attention of the onlookers

The traditional black and white signage is given a new life through interesting , colourful icons that speak for themselves .

The accessories of the rooms play upon nature therapy through prints in refreshing greens . To ease the tension of patients the

ECG room is given a serene dreamlike background almost meditative in nature .

Designing for Healthcareanalysis of various models suggested by medical researches and centers to create and healthcare envirnoment

Disease

Physical Environment

Medicine

Technology

(Disease centric) Cure


Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality

Care (patient centric)


Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality


Hope

Music etc

engagement of senses

architecture

Empathy

ArtNature

Aroma

Entertainment

Interaction

communication

comfortway finding

lighting

color

communication

equipments

medical facilities


Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality


Hope

Music etc


architecture

Empathy

ArtNature

Aroma

Entertainment

Interaction

communication

comfortway finding

lighting

color

communication

equipments

medical facilities

Environmental psychology

Parallels between Behaviourial health and Physical Environmental

Psychoneuroimmunology

Designing for Healthcare

Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality


Hope

Music etc


architecture

Empathy

ArtNature

Aroma

Entertainment

Interaction

communication

comfortway finding

lighting

color

communication

equipments

medical facilities

Disease Patient(Disease centric) Cure Care (patient centric)


Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality


Hope

Music etc


architecture

Empathy

ArtNature

Aroma

Entertainment

Interaction

communication

comfortway finding

lighting

color

communication

equipments

medical facilities

Disease Patient

Balance

(Disease centric) Cure Care (patient centric)


Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality


Hope

Music etc


architecture

Empathy

ArtNature

Aroma

Entertainment

Interaction

communication

comfortway finding

lighting

color

communication

equipments

medical facilities

Disease Patient

Balance

Patient experience Effectiveness of treatment

Florence Nightingale

Body-and-mind connection.

Consumer- and user-focused culture are growing, patients will

be making demands on the quality, context and accessibility

both of services and of the environmental components that

encourage good health.

(Disease centric) Cure Care (patient centric)


Disease


Medicine

Technology


Patient

Social Environment

Therapy

Spirituality


Hope

Music etc


architecture

Empathy

ArtNature

Aroma

Entertainment

Interaction

communication

comfortway finding

lighting

color

communication

equipments

medical facilities

Patient experience Effectiveness of treatment

Social Environment

Art

Effectiveness of treatmentPatient experience

Reduce pain, fear, anxiety & other psychological conditions,

need for sedative drugs, length of stay

Improve physical functioning, mental /psychological

functioning, patient / care giver communication,

care giver empathy

Increase adherence to medical regiments,

satisfaction with overall quality of careArtEnvironment some factors from each category

physical

psychological

Social Environment

Art


NatureArt

A study at the University of British Columbia demonstrated that using wood, in the design of a room lowered sympathetic nervous system activation and patient stress.

Provides a sense of fascination, Acts as a positive distraction,Reduces negative emotions and blocks stressful thoughts

Researches have also found that nursing homes with physical or visual access have greater caloric intake and exercise than those without.

A revolutionary study by Ulrich (1984) found that postsurgical patients recovered more quickly when exposed to a window view .

Environment some factors from each category

physical

psychological

Social EnvironmentEffectiveness of treatmentPatient experience

Nature

Color & Light

Art

In Indian culture, each color is assigned to various energy centers of the body. Color has electromagnetic energy that can influence healing in similar ways to sunlight.

Egyptians used colour for cures and ailments. Built temples for healing and used gems (crystals) through which the sunlight shone.

Affects mood and perception

Improves sleep, adjustment to night-shift work among staff


physical

psychological

Art

Social Environment

Art


Social Envirnoment

Comfort

Communication

Care giver

Interaction

promotes confidentiality and privacy

hygiene personal attention

with staff

with treatment (sense of control, information etc)

with environment

empathy

Way finding , zoning & Signage

other hospital communication

Staff effectiveness, teamwork, Qualification

physical

psychological Nature

Comfort

Color & Light

CommunicationCare giverInteraction

Art

Social Envirnoment


Social Environment

Art


Medicine

Social Envirnoment

Environment Nature

Comfort

Color & Light

CommunicationCare giverInteraction

Medical environment

Medical environment

Medical Staff

Medical Staff

Artsome factors from each category

Art

Medicine

both stimulate a patient’s trust over the medication given

physical

psychological

Primary ResearchObservation Interview Activity mapping

Observation

Three Hospitals-2 private & 1government

Patient and Staff (Doctor, nurses etc)

Activity Mapping

Interview

Care Giver Care Reciever Designer

Doctor Therapist Nurse (2 out patient & 1 admitted) (1 architect & 2 interior designer)(1 each)

Phase 2

areas identi�ed

Expert Views

Userexperience

Examinationroom, wards

Rooms (Children

& Maternity)

Administrativedepartments

Reception

Waiting lounge

ICU, OT Gardenspaces

interviews

& analysis Secondary Data

interviews,

observation & activity mapping

feel numb, afraid, having no control

Hope

Mental well-being(staff)

Unoccupied time (feels longer than occupied time)

Uncertain waits

Feel Anxiety

Clean & hygienic.

feelshomesick

Areas ofhealing

Aesthetic appeal

Positivedistraction

Anxiety (makes waits seem longer)

Expect information, assurance, support, and comfort

Feel their injury is more urgent than others. (leads to distrust )

Should relax and get a sense of control.

Distraction

Managenurse walking time& exhaustion(negative effect on productivity.)Should have

positive energy

Need empathyrather sympathy

Sense of control

Feel extreme anxiety

Fearful &worrying experience

Clinical Facilities

Medicallycontrolled

Patient Sleep& restoration

Trust dependson the staff

Feel homesick.

Socially disconnected

Alone and depressed

Unoccupiedtime

Risk of injury frommedical equipment

no user -interaction

Synopsis Interview

& observation

areas identi�ed

Design Solutions


Rooms (Children

& Maternity)


Reception

Waiting lounge

More therapeutic

Design not barrier in medical treatment

Healthy Work environment

Reduce exhaustionand Walking time.

Home awayfrom home


based on interviews,

Secondary analysis & Secondary

Visual Analysis

Creating an interaction map (patient, other patient, staff)eg making them busy with loads of paperwork

Inviting & calming

Feel a sense of control

limit noise & stress

Programs forstaff well-being.

Connects patient’s experience and treatment plan

control over light, temperature

Ceiling Design

Liberalized visiting policy

Integratescomplementary

therapy

Healing Garden

BothPhysical & VisualInteraction

More Interactive

Medicativein nature

Dieses centricdesign

Care

Cure

Experience

areas identi�ed


Rooms (Children

& Maternity)


Reception

Waiting lounge


InteractionSocialSpacial

Elimination of Psychological

stressors

Spirituality

Therapies

Aroma Therapy

Art

Applicationof designelements

areas identi�ed


Rooms (Children

& Maternity)


Reception

Waiting lounge


PositiveDistractions

Access to Nature

Elimination of Environment

stressors

Entertainment

Stimulation &engagement of

�ve senses

areas identi�ed

Reception

Waiting lounge (examination ward & ICU, OT)

VisualResearch

No interaction with artworks

No two way interaction

Seating arrangement highlights the waiting time (unoccupied time)

No spaces for kids interaction

no positive distraction

Poor communication design,way finding

areas identi�ed Patient rooms

VisualResearch

The Ceiling design lacks innovation and shows no experimentation of space .

The upholstery design does little to lift the mood .

The ambiance design is simplistic and bland reinforcing the institutional feel in the environment .

areas identi�ed Miscellaneous

VisualResearch

Outdoor space unutilized

Lack of designing elements in corridors,staircase, walls and glasses.

No positive distractions in these areas.

No usage of areas for complimentaryactivites.

No usage of therapeutic elements insuch spaces.