Background: Health care settings are generally regarded as stress inducing environments. Stress can alter the immune response, impair wound healing and create a greater risk for asthma, diabetes, gastrointestinal disorder and myocardial infarction. Beginning in the 1980s and 1990s, there has been increasing interest in healing environments and evidence-based design concepts. Yet, there has been little progress developing healing environments and using evidence-based design for psychiatric inpatient units, a uniquely stressful environment. Psychiatric units today continue to use designs such as caged in outdoor patio areas that resemble facilities that incarcerate rather than facilities which reduce stress and facilitate healing. The purpose of this systematic literature review was to identify design features that are evidence-based which can be used to create an optimal inpatient psychiatric patient room by: (1) analyzing the research literature for evidence of architectural and design elements that could be used in the inpatient psychiatric care setting to reduce stress and improve the well-being; (2) identifying design elements that are consistent with accreditation and licensing standards for inpatient psychiatric units; and (3) designing a psychiatric inpatient room that has evidence-based elements to reduce stress and improve well-being. Methods: A systematic literature review was conducted to identify factors in the inpatient healthcare environment that support an optimal healing environment. The PICO question for this review was what design factors in the inpatient healthcare environment support an optimal healing environment? A search of five databases and a hand search of reference lists were conducted. The search included studies from 1980 to the present, original research conducted on inpatient units with adult patients that investigated an intervention with an outcome that promotes a healing environment. Experimental, quasi-experimental, non-experimental, systematic literature reviews and expert opinions were sought and evaluated using a scale to analyze scientific rigor and research quality. Results: A total of 6,874 articles were identified in the search. Seventy-six articles were eligible for full text screening. After review of the full text, 38 articles were determined to be eligible for evidence analysis. After removing 11 inadmissible articles due to poor quality, 27 articles were included in the final synthesis. The search found research on eight hospital design features which may support optimal healing environments: artwork (n = 7), building configuration (n = 2), finish materials (n = 7), interior details (n = 6), lighting (n = 11), nature and view (n = 8), noise (n = 10), room configuration (n = 6). More than 50% of the research on optimal healing environments used quasi-experimental and non-experimental designs with rare use of experimental research designs. Overall, the quality of the research on optimal healing environments is not high, but results were reasonably consistent across studies. Conclusions: Evidence suggests seven design features for healing inpatient psychiatric environments, including: (a) single rooms, (b) calm, naturalistic and domestic artwork or photographs, (c) east facing windows, (d) plants, (e) acoustic ceiling tiles, (f) patient rooms removed from noise producing unit areas and (g) a window view of nature. These seven recommendations were examined for consistency with existing Arizona statutes and industry standards for behavioral health care environments. Recommendations found to be inconsistent with these statutes and standards were modified to reach congruency with the statutes and guidelines, and then an evidence-based design of a psychiatric inpatient room design was formulated and is illustrated. Future research on interventions to create healing environments at the greatest scientific rigor is needed along with measurement techniques to quantify stress responses to the environment.

The U.S. Army Medical Department (AMEDD) has used the interstitial building system (IBS) as a design component for some of the hospitals in its healthcare infrastructure portfolio. Department of Defense (DoD) leadership is aware of increases in healthcare costs and understands the importance of safely reducing costs, which may be possible through design initiatives. An analysis was performed on facility maintenance metrics for ten different U.S. Army hospitals, including IBS design and conventional / non-interstitial building system (NIBS) design. Statistical analysis indicated a significant difference in cost and time data between IBS and NIBS for most of the building systems considered (HVAC, electrical, plumbing, and interior). Scheduled maintenance for the plumbing building system was not found to have a significant difference in costs; scheduled maintenance for the HVAC and plumbing building system was not found to have a significant difference in time expended. The data in this study showed that facility maintenance cost and time were generally lower for IBS than NIBS. Time spent (and associated cost) for scheduled maintenance of the electrical and plumbing building systems were slightly higher in IBS, though not significantly higher for plumbing. It may be easier to reach the plumbing and electrical building systems due to the greater accessibility afforded by IBS design. While a cost premium is estimated for integrating IBS design, the savings provided by life cycle facility maintenance is estimated to be up to three and a half times the initial cost premium.

Since the 1960s, researchers have been exploring how the design of the built environment impacts the health and well-being of occupants and users. By the 1980s, further research began to focus on healthcare facilities in particular and how design could influence patient healing and medical staff performance (Alfonsi, 2014). Evidence-Based Design (EBD) is "the process of basing decisions about the built environment on credible research to achieve the best possible outcomes" (CHD, 2016). The desired outcomes of Evidence-Based Design recommendations include improvements in the following: patient healing, patient experience and comfort, medical staff performance, and medical staff job satisfaction (CHD, 2017). Extensive research has been done on the subject of EBD; however, the question remains whether or not the latest research findings are being utilized by the design and construction industries in practice. The purpose of this research is to determine whether or not the latest scientific knowledge and research findings are being implemented into hospital renovation projects by the healthcare design and construction industries. A list of recommendations from existing EBD literature was compiled. Construction documents from 30 recent healthcare facility renovation projects across the United States were then obtained and analyzed. The findings indicate that EBD recommendations are being adopted in practice at consistently high levels. These findings also reveal that there are still areas of potential improvement which could inform those who influence or determine building and design codes, standards, and guidelines. The results are instructive to owners, designers, and contractors by providing a glimpse into how well the industry is recognizing and implementing known best practices. The findings likewise open up new opportunities for further research which could lead to additional improvement in the healthcare facilities of the future.

Tsui Ka Chun, Jamie. / "Architecture Department, Chinese University of Hong Kong, Master of Architecture Programme 2010-2011, design report." / Includes bibliographical references (p. 88). / Chapter 00 --- Thesis Statement / Chapter 01 --- Inspirations / Chapter 02 --- Categorization of Infill Structure / Chapter 03 --- Study from 'Flexible Housing' / Chapter 04 --- Strategy - from Structure to Spatial Flexibility / Chapter 05 --- Program & Site Selection / Chapter 06 --- Development of Structural Strategy / Chapter 07 --- Design Exploration / Chapter 08 --- Design Outcome / Chapter 09 --- Special Study / Chapter 10 --- Essay & Conclusion / Chapter 11 --- Reference/Bibliography / Chapter 12 --- Appendix

Doctor of Philosophy (PhD) / This study was conducted to increase our understanding of children and young people’s experience of a hospital environment and to identify the salient attributes of the physical environment in their experience. There were three specific aims: to describe children and young people’s experience of a hospital environment and identify what constitutes a supportive paediatric environment; to examine the role of the physical environment in patients’ feeling of well-being; and to highlight the capacity of participatory research with children and young people to inform evidence-based paediatric design. At this stage, there has been very little healthcare design research carried out with populations of children and young people. Well-being research with children and young people in paediatric environments that identifies the potential supportive attributes in this environment is also very limited. Historically research on children’s health and well-being has been dominated by a focus on the prevalence of disorders, problems and disabilities. More recently, in response to the change to health promotion, positive attributes have been included in well-being and satisfaction measures. At this stage, there are still many fewer positive measures. Within the body of literature that exists in healthcare, healthcare design research, and well-being research, there are only a small number of participatory studies that focus on children and young people’s experience of hospitalisation, and an even smaller number that include children and young people’s experience of hospital environments. The picture that is created by the research that exists is patchy. There is a need for a more holistic understanding of children and young people’s experience of hospitalisation and of hospital environments from their own perspectives. Based on these gaps in current knowledge, two research questions were developed. The first was concerned with describing children and young people’s experience of the sociophysical environment of a paediatric hospital. The second question was concerned with understanding the role of the physical environment in children and young people’s feeling of well-being in a hospital environment. In addressing these questions, the intention was to identify attributes within the hospital setting which collectively comprise a supportive environment for children and young people and which contribute to children and young people’s feeling of well-being in a paediatric setting. The current study was conducted as an exploratory qualitative case study and carried out at the Children’s Hospital at Westmead, in Sydney, Australia. Using participatory research techniques, the sequence of the study included two pilot studies and the main study. The focus was on understanding the experiences of longer-term patients of a paediatric hospital environment. In the main study 25 children and young people, aged between 9-18 years, who had been in hospital for at least a week completed semi-structured interviews in which they talked about their response to the environment of the hospital and their experience of hospitalisation. Data analysis was completed using a combination of concept mapping and thematic analysis techniques. Preliminary findings were used as the basis of a further member-checking task carried out with a further six children and young people before conclusions were reached. The findings reveal that children and young people’s experience of a paediatric setting involves a number of major areas of influence including their personal situation, their social experience, their interaction with the physical environment, opportunities and characteristics of the organisation, and the effect of time. The findings also reveal that children’s feeling of well-being within this experience is linked to their ability to feel comfortable in the environment, to maintain a positive state of mind, and to remain positively engaged with the experience and the environment. This research reveals a dynamic relationship between children and young people and a paediatric environment that children and young people actively manage and shape. It reveals some of the key considerations in children and young people’s experience of hospitalisation. It also reveals why these considerations are important and what role they play in patients’ experience and feeling of well-being. These findings provide the basis for further research and they have implications for future design and research practice in paediatric healthcare settings.

The Military Health System (MHS) is a worldwide network of healthcare facilities and personnel. The healthcare facility inventory is aging and requires extensive facility management, renovations and replacement construction to maintain the environment of a high quality of care. Recent developments in sustainability and evidence-based design (EBD) have created additional requirements for the design and construction of facilities. These areas of design emphasis, sustainability and EBD, are developing best practices according to the respective theory. Existing facilities in the MHS have been directed to undergo restoration and modernization by Department of Defense (DoD) civilian leadership. Governmental directives have mandated that these restorations and new construction complies with current building codes and that EBD design features be included in healthcare facility planning. The hospital building type has changed over history due to innovations in building technology, such as HVAC and steel frame construction, as well as healthcare initiatives, such as treatment of tuberculosis and the mentally ill. The design concepts of environmental sustainability and EBD are currently altering the hospital typology. Building professionals have found significant differences in facilities that are categorized as evidence-based and those noted as sustainable. The future of successful healthcare designs relies on a balance of these concepts. The hospital building type has one of the highest energy intensities out of all commercial building types. Hospitals have become more energy intense due to the evolution of the deep-plan hospital. The design of the building envelope is the most lasting feature affecting the energy use of a hospital, due to its service-life typically equaling the life of the facility. The building envelope design consists of the shape of the building, material selection, as well as its orientation. This research demonstrates the relationship between incorporating positive building occupant features, such as increased day lighting and views of nature, and efficient energy design choices. The use of energy simulation software and early design collaboration between multiple professional disciplines is recognized as critical to optimal design solutions.

The entrance space of a hospital has formed an effective period of hospital life since it has reflected the scope and the image of the entire facility. Therefore it has directly influenced by the new formation of healthcare facilities on preserving and growing role of the community health instead of threatening the illnesses. Since entrance space is apart from the other spaces in the facility that has shaped by the restrictive nature of the medical technology, the space most efficiently implement these new objectives more than any space of the entire facility. However, entrance spaces of hospitals in Turkey are still bothered with many insufficiencies and displayed a problematic panorama. Therefore, this thesis has obtained the problems of main entrance space, and has analyzed it with a consistent form of criteria to gather new solution proposals. In order to serve for this purpose, the present Turkish health care environment has explored and entrance space has been analyzed around new emerging concepts that reflect the changing ideals of the community. To present the problems and solution proposals about this specific place sufficiently, they are also evaluated through design and performance criteria. The essence of coping with the stress created by the environment with healing potential is emphasized. As a result, this thesis is expected to influence further researches, new hospital main entrance space designs as well as the renovation of older ones.

As cited in literature, the history of hospital design in both practice and theory is rife with proposals that lay claim to improving efficiency. The aim was to obtain not only lowest possible construction, maintenance and operational costs, but also highest possible patient satisfaction,comfort and privacy. Nested within this outlook, the design of hospital nursing units has claimed considerable priority. Significant in such an endeavour is timely feedback to the designer, especially as quantitative assessments of what has been achieved so far with respect to planimetric efficiency / i.e. utility value of built floor area, both in terms of its allocation to served, serving and circulation spaces and the relative proportions of these. Its particular focus was on the nursing units of public facilities in T&uuml / rkiye. The study was carried out on a random sample of hospitals operating under government jurisdictions. Sample size was roughly determined as 33%. The material consisted of production drawings. Data derived from these comprised planimetric measurements regarding their nursing units and of various germane ratios calculated. Analysis of variance, distributional aspects, scatter charts and t-tests were used to evaluate this data according to a number of relevant factors. Results for ratio of primary spaces to secondary spaces showed that there were significant differences by constructional area per bed, while other variables showed a central tendency that was independent of the factors considered. It was concluded that while the method used was appropriate to the assessment in question, further developments and investigations were needed to determine the causes underlying such differences.

In the hospital building, where patients seek medical treatment and hospital staff provide continuous support, creating a healing environment is an imperative. However, it appears that the ultimate aim to create a healing environment is not given due attention by healthcare designers. Patients’ negative experiences of the existing physical environment of a hospital building describing as depressing, confusing, dull, little natural light, stressful, noisy causing sleep deprivation, anxiety, isolation and physical restraint were noted in many studies of the built environment. Most of these criticisms are also experienced by the patients in the case studies of hospital buildings in Malaysia, particularly on thermal (too warm) and visual (glare) discomfort. Therefore, the term ‘Healing Architecture’ is adopted to invoke a sense of a continuous process; creating an environment physically healthy and psychologically appropriate for patients’ well-being. A majority of the literature on the healing environment has reached a consensus that the physical aspects of built environment could contribute indirectly to the health outcomes of patients and staff in a hospital building. These include shorter length of stay, reduced stress and increased patients’ satisfaction. Among the physical aspects, daylighting is considered one of the most influential factors to achieve visual comfort contributing to a healing environment. The thesis aims to explore daylighting performance of a four-bed ward by means of a parametric study of design variables in order to achieve the visual as well as thermal comfort in creating a healing environment. Conflicting issues of ‘physical to physical’ (e.g. daylight vs. solar heat gain) and ‘physical to psychological’ (e.g. daylight vs. undesirable glare) are analysed. With the theme of daylight and health, previous studies related to the factors of the physical environments in hospital buildings that influence health outcomes are reviewed. The physical factors affecting daylighting to achieve visual comfort are also analysed. Reviews of the project briefs of the completed public hospital buildings in Malaysia are also conducted and seven hospitals are selected as the case studies to investigate daylighting conditions of the existing four-bed ward environment. Triangulation by means of analyses through questionnaire, measurement and computer simulation is the method adopted for the investigation. Available simulation programs are reviewed for suitability and compatibility of the study. The simulation software (validated) used for the study is Integrated Environmental Solutions – Virtual Environment (IES–VE). Based on the qualitative and quantitative analyses, it can be concluded that visual comfort in the existing four-bed ward environments of public hospital buildings in Malaysia is not achieved. Factors contributing to the failure are that the conflicting priorities (i.e. ‘physical vs. physical’ and ‘physical vs. psychological’) were not analysed by healthcare designers when designing a window (size and position), there is clear evidence of glare and daylighting design failed to meet the daylight factor (DF) requirement of 1% at the (innermost) bed-head. The finding is that a healing environment in the four-bed ward is not achieved. The results of the analysis also confirmed that the key physical factors affecting daylighting in the hospital ward are orientation, window design (size and position), external shading device, glass transmittance and indoor surface reflectances. Parametric studies of daylighting design variables on the ‘base case’ unit are formulated in order to find the remedy as well as to arrive at design guidelines. The Subang TRY weather data set is used and examined and found the two worst conditions days of the year: the hottest (day 60) and the cloudy (day 299). Evaluation criteria for measuring thermal as well as visual comfort are established to critically analyse the consequences of the variants in the permutations. A total of 186 simulations are run to appraise the comfort condition of the computer model of the four-bed ward environment. The simulation of daylighting conditions in a four-bed ward environment would take into consideration the magnitude of solar heat gain of one exposed wall (opaque wall and glass window) for the two selected worst days of the year and the ‘best’ orientation (other enclosing elements are taken as adiabatic). The results of the parametric study are analysed by adopting the process of elimination for the selection of variants. The variants of design variables that satisfy the evaluation criteria for comfort criteria set in the study are identified. Design recommendations are made and guidelines on how best to achieve visual comfort through daylighting design strategies in the hospital ward environment in the future are established. The findings arrive at two crucial conclusions in creating a healing environment. Firstly, visual comfort can be achieved through appropriate daylighting design.The second is that in order to achieve visual comfort in the four-bed ward environment there is a need to find a balance between the acceptable magnitude of solar heat gain and satisfying the requirement of daylighting (i.e. the acceptable limit of glare not exceeding a luminance ratio of 10 and 1% DF).

In the hospital building, where patients seek medical treatment and hospital staff provide continuous support, creating a healing environment is an imperative. However, it appears that the ultimate aim to create a healing environment is not given due attention by healthcare designers. Patients’ negative experiences of the existing physical environment of a hospital building describing as depressing, confusing, dull, little natural light, stressful, noisy causing sleep deprivation, anxiety, isolation and physical restraint were noted in many studies of the built environment. Most of these criticisms are also experienced by the patients in the case studies of hospital buildings in Malaysia, particularly on thermal (too warm) and visual (glare) discomfort. Therefore, the term ‘Healing Architecture’ is adopted to invoke a sense of a continuous process; creating an environment physically healthy and psychologically appropriate for patients’ well-being. A majority of the literature on the healing environment has reached a consensus that the physical aspects of built environment could contribute indirectly to the health outcomes of patients and staff in a hospital building. These include shorter length of stay, reduced stress and increased patients’ satisfaction. Among the physical aspects, daylighting is considered one of the most influential factors to achieve visual comfort contributing to a healing environment. The thesis aims to explore daylighting performance of a four-bed ward by means of a parametric study of design variables in order to achieve the visual as well as thermal comfort in creating a healing environment. Conflicting issues of ‘physical to physical’ (e.g. daylight vs. solar heat gain) and ‘physical to psychological’ (e.g. daylight vs. undesirable glare) are analysed. With the theme of daylight and health, previous studies related to the factors of the physical environments in hospital buildings that influence health outcomes are reviewed. The physical factors affecting daylighting to achieve visual comfort are also analysed. Reviews of the project briefs of the completed public hospital buildings in Malaysia are also conducted and seven hospitals are selected as the case studies to investigate daylighting conditions of the existing four-bed ward environment. Triangulation by means of analyses through questionnaire, measurement and computer simulation is the method adopted for the investigation. Available simulation programs are reviewed for suitability and compatibility of the study. The simulation software (validated) used for the study is Integrated Environmental Solutions – Virtual Environment (IES–VE). Based on the qualitative and quantitative analyses, it can be concluded that visual comfort in the existing four-bed ward environments of public hospital buildings in Malaysia is not achieved. Factors contributing to the failure are that the conflicting priorities (i.e. ‘physical vs. physical’ and ‘physical vs. psychological’) were not analysed by healthcare designers when designing a window (size and position), there is clear evidence of glare and daylighting design failed to meet the daylight factor (DF) requirement of 1% at the (innermost) bed-head. The finding is that a healing environment in the four-bed ward is not achieved. The results of the analysis also confirmed that the key physical factors affecting daylighting in the hospital ward are orientation, window design (size and position), external shading device, glass transmittance and indoor surface reflectances. Parametric studies of daylighting design variables on the ‘base case’ unit are formulated in order to find the remedy as well as to arrive at design guidelines. The Subang TRY weather data set is used and examined and found the two worst conditions days of the year: the hottest (day 60) and the cloudy (day 299). Evaluation criteria for measuring thermal as well as visual comfort are established to critically analyse the consequences of the variants in the permutations. A total of 186 simulations are run to appraise the comfort condition of the computer model of the four-bed ward environment. The simulation of daylighting conditions in a four-bed ward environment would take into consideration the magnitude of solar heat gain of one exposed wall (opaque wall and glass window) for the two selected worst days of the year and the ‘best’ orientation (other enclosing elements are taken as adiabatic). The results of the parametric study are analysed by adopting the process of elimination for the selection of variants. The variants of design variables that satisfy the evaluation criteria for comfort criteria set in the study are identified. Design recommendations are made and guidelines on how best to achieve visual comfort through daylighting design strategies in the hospital ward environment in the future are established. The findings arrive at two crucial conclusions in creating a healing environment. Firstly, visual comfort can be achieved through appropriate daylighting design.The second is that in order to achieve visual comfort in the four-bed ward environment there is a need to find a balance between the acceptable magnitude of solar heat gain and satisfying the requirement of daylighting (i.e. the acceptable limit of glare not exceeding a luminance ratio of 10 and 1% DF).