Heart Healing

heart healing
In search of care sciences and behind the art of healing environment

SOPHY SAPAN LONGE - OLSSON
Supervisor: Peter Frst
Examiner: Krystyna Pietrzyk
Jury: Kristin Schmitt
and Inga Malmqvist
Masters Thesis Report
Department of Architecture
Chalmers University of Technology
SE-412 96 Gteborg,
Sweden
Telephone +46 (0)31-772 1000
Keywords: healing environment, evidence based design,
person centred-care, person centred design,
healthcare interior, hospital design,
smart textiles, hydro-chromic, thermo-chromic,
single patient room, stra sjukhuset.
5
The essence of being human,
I am what I am because of who we all are
Leymah Gbowee
SOPHY SAPAN LONGE - OLSSON, Interior Designer
I grew up in Jakarta, Indonesia place where I acquired a bachelor in Interior Design. I am now
in my second year of the architecture master programme Design for Sustainable Development
at Chalmers University of Technology, Sweden. Completed a course in healthcare design
with the given task to design a Trygghetboende in Tynnered, Gothenburg. Last summer 2012
worked as trainee at Skanska, LEED department.
The theoretical, 4,5 years work experience as an interior designer also my experience living
in Sweden for 5 years has broadened my insight towards interior design and the awareness
of current environmental issues.
Alexander Trimboli . Ann Lolohea . Ann-Marie Lindberg . Anna Gyberg . Anna Jendeby .
Anna Klara Johansson . Anna Sofa Wannerskog . Anna Valtersson . sgeir Sigurjnsson . sa
Stark . sa Wejrot . Axel Wolf . Betty Yao . Bilyana Docheva . Catharina Myers . Carina
Nilbrink . Colette Ram . Coline Girette . Danile Tingdahl . David Edvardsson . David Martinez
. Doxa Gallery . Elphy Limbong . Emil Andersson . Emma Ahlberg . Enida Kratovic . Eva Pirri .
Fabiana Tome . Filippa Lnegren . Galini Afentoulidou . Gunilla Kullinger . Helle Wijk . Henrietta
Emilsson . Inga Malmqvist . Ingemar Olsson . Isabelle de Nil . Jeanette Tenggren Durkan .
Jonas Olsson . Katharina Ayres . Kerstin Dudas . Kirk Hamilton . Kristin Schmitt .
Krystyna Pietrzyk . Lars-Eric Olsson . Laura Flantua . Lena Falkheden . Lisa Bomble . Maja Kovcs
. Magnus Emilsson . Malin Ramstedt . Margaretha Olsson . Maria Tingdahl . Mario Samperante
Kombo . Martti Valkonen . Mellona Lembangna Samperante . Michaela Ekstrand . Mike Apple
. Per William Westin . Per-Olof Sandman . Pertimelso Samperante Longe . Peter Lindblom .
Peter Frst . Pieter Duif Verhoeven . Roger Ulrich . Sandra Strm . Shahrzad . Shea Hagy . Sofa
Larsson . Susanne Grill . Tabita Nilsson . Thomas Walln . Yvonne Smolders . Zefanya Esther .
Thank you, tack, terima kasih!
AKNOWLEDGEMENT
7 6
For my beloved mother, Elphy Limbong.
A blessed soul and a courageous woman with a spirit that I admire.
For my lionhearted brother, Mario Samperante Kombo.
His fought with cancer inspired me!
And for the heart and soul of caring, all nurses at stra hospital.
AKNOWLEDGEMENT
Abstract
ABSTRACT
As evidence about the benefits of healing environments accumulates, health
care organizations are starting to incorporate features into hospital design
that encourage partnership between patients and professional staffs.
Among other things, the research reveals that the quality of the environment
can enhance patient healing process.
This thesis discusses some of the evidence based-design and person-
centred design, also 2 design proposals (major and minor intervention) on
how creating a spatial heart and healing environment can be implemented
in an internal medicine ward in stra hospital.
The project intends to focus on how future healthcare interior with
environments, furniture and tools can be embodied in an artistic and
sustainable way. The aim is to make design decisions of the built environment
on the best available research to achieve the best outcomes and create a
healing environment.

The outcome of the thesis is a 50/50 division of a theoretic written text
and 2 design proposals that demonstrate how the conclusions from the
researches can be implemented into design aspects.
9 8 VISUAL DIARY TABLE CONTENT
Aknowledgement 5
ABSTRACT 7
TABLE OF CONTENT 9
PREFACE 12
Introduction 13
Background 14
Why Healthcare Design is Important 14
Why Evidence Based Design 14
Why Person-Centred Care 14
Why Person Centred Design 15
Delimitations 15
Project Area 15
Gteborg 15
stra Hospital 17
Aims 17
Thesis Structure 18
The Chain of Logic 19
Methodology
Seminar and Workshop 20
Literature Studies 20
Study Visits 20
Self-Reporting Methods 21
Questionnaires 22
Interviews 22
SWOT analysis 22
Observational Methods 22
Blog 23
Creating A Toolbox 23
Design Quality Checklist 23
Diagrams and Figures 23
Drawings and Models 23
NOTES ON READING (The Theoretical Approach)
Healing Environment 25
Evidence Based Design (EBD) 26
Putting the Evidence into Action 27
Key Design Elements 30
Wayfnding 30
Positive Distractions 31
Artwork 31
Lighting 31
Color 32
Textiles and Materials 32
Furniture 33
Product Development 33
The Economic Beneft of EBD 34
Embodied Visions: Science and Art 36
Art versus Science 36
The Impact of Arts on Health 37
Person Centred Care (PCC) 38
Patient versus Person Centred Care 39
Person Centred Design (PCD) 40
The Three Lenses of PCD 41
The Process of PCD 42
The Method of PCD 43
Theory of Supportive Care Settings 44
Relation between EBD and PCD 51
NOTES ON SEEING (Preparatory Research)
Hospital Architecture Revolutions 53
Swedish Healthcare 58
Study Visits 60
Vega House, Gothenburg 60
Sdra lvsborg Hospital, Bors 63
11 10 VISUAL DIARY TABLE CONTENT
Sahlgrenska Hospital, Gothenburg 66
Karolinska Hospital, Huddinge 67
Nya Karolinska Hospital, Stockholm 68
UMC, Utrecht 70
Smart Textiles Library 72
The Diagnosis 73
The Site 74
The Ward 78
Wayfnding Analysis 82
SWOT Analysis 84
Mental Map Analysis 86
NOTES ON HEARING
Three Perspectives 89
Patient 89
Relatives 91
Staff 92

THE TOOL KIT
Questionnaire Results 98
Design Quality Checklist 100
THE DESIGN APPLICATION
Design Vision 105
Design Values 106
Design Proposals 107
MAJOR INTERVENTION
Programming 109
Design Concept 110
Floor Plan 112
Strategy 1 - The Ward 114
Strategy 2 - The Corridor 116
Detail Window and Door 116
Strategy 3 - The Patient Room 118
Single Room Module 120
Single Room Sections 121
Alco-gel Cabinet 123
Staff Water Basin 124
Patient Bathroom 125
Flexible Sofa 126
Double Room Module 127
Double Room Section 127
Accoustic Strategy 128
Patient Bed Pod 129
Perspective Double Bedroom 130
Smart Matrass 130
Hydro-chromic Experiment 132
Patient Bag 133
Strategy 4 - The Staff Working Areas 134
Theme Approach 134
Perspective Nurse Station 137
Perspective Team Area 138
Strategy 5 - The Patient Common Areas 140
Thermo-chromic Experiment 140
Re-design Furniture 142
Perspective Pantry and Dayroom 144
Strategy 6 - The Staff Common Areas 146
Strategy 7 - Service Rooms 147
MINOR INTERVENTION
Programming 149
Floor Plan 150
Design Strategies 152
CONCLUSION 159
APPENDIX 161
ON READING 180
13 12
Preface
W
e recognize hospitals as places of healing and restoration.
The hospital building itself may not reflect such noble ideals.
Imagine that you are sick, in pain and weak and need to stay in
a hospital. You are entering a dark and dreary hospital with very little visual
comfort. Not only are the hallways poorly lit by flickering fluorescent lights,
the walls are painted in strange and slightly sickening shades of green and
yellow. The overall impression that you get when walking down the hallways
is one of depression and hopelessness. And you see the doctor coming to
you with a white smock, syringe and stethoscope. With all his divine power
to keep yours life in his hands you are dependent on him. It makes you even
feeling more fragile, anxiety, have no control and anger.
Needless to say, this highlights the image that a hospital is a place of
death and disease and is in no way beneficial to a patients psychological
health. In such a case, the building forgets its original purpose - to promote
all components of health and actually provides a mentally damaging
atmosphere for its occupants. Different studies revealed this sacred
character of the hospital contribute to the patient hospital-dependence,
depersonalizing him/her as a human being. For this reason, more and more
it is stated the need of humanizing the hospital, to give back to the patient
the confidence and hope which very often proves to be more valuable for
healing than the science remedies, to make as the wonderful human love to
dominate this world of the patients, where everything is anxiety and refuse
(Coe, Rodney M, 1970).
With my Masters thesis, I thus want to underline this subject and bring
fort the discussion to the public and design world. I see the approach of
relationship between patient and healthcare professional as a platform to
discuss and demonstrate my visions of future healthcare.
Introduction
PREFACE
15 14
Background and the design of its premises should rest on a solid
foundation of knowledge. Healthcare designers and
healthcare researchers unite behind a common cause;
the objective of both approaches is to provide better
healthcare environments. Their relationship is symbiotic,
research is necessary to support design, and design is
necessary to collaborate findings and provide settings
for future research (Shepley, pp. 267, 2006).
It is important to underline that in order to get high quality
health facilities architects and designer must understand
the research, interpret the implication, and build a chain
of logic connecting the decision to a measureable
outcome, and reducing subjective decisions (Hamilton,
pp.273, 2006).
The importance of Person Centred Care

As evidence about the benefits of healing environments
accumulates, health care organizations are starting to
incorporate features into hospital design that encourage
partnership between patients and professional staffs
(Person Centred Care - PCC). Furthermore, patients
in general wish to be more involved in their care
and desire better communication with healthcare
professionals. Among other things, the research reveals
Why healthcare design is important
H
uman society is facing a health care crisis
that is affecting patients worldwide. There
is a need for major investments in the future
healthcare facilities. Today Swedish healthcare system
is undergoing rapidly and demands for changes
dependent on a number of factors such as the medical
and medical technology, population growth, changing
values, and thus changes in demand, changes in
illness among the population due age structure and
lifestyles, changing economic conditions, etc. Because
of this development, healthcare providers are forced
to improve the quality of health care, innovation and
performance. Healthcare design is an important factor
to achieve the goals (Chalmers centrum fr vrdens
arkitektur, 2011,authors translation).
The importance of Evidence Based Design
Research has shown that properly designed healthcare
buildings can contribute to more effective care, support
healing and reduce stress for patients, families and
healthcare professionals. Hospitals and other healthcare
settings are important and long-term social investment,
BACKGROUND
that implementation of Person Centred Care in the
hospital setting increases satisfaction of the care,
reduces patient and staff stress, reduce length of
indexed hospital stay (LOS) by 30%, increase patients
quality of life, patient become more independently,
increase social climate between patient and healthcare
professionals (Wolf, pp.41, 2012).
Delimitations
how creating a spatial heart and healing environment
can be implemented in an internal medicine unit in
stra hospitals, Gteborg - Sweden. The project
intends to focus on how future healthcare interior with
environments, products and toolws can be embodied in
an artistic and sustainable way.
Project Area
Gteborg
Gteborg is second largest city in Sweden, located in
Vstra Gtaland region with a population of around
700,000. Due to Gteborgs strategic location on the
west coast, trading and shipping have always played a
major role in the citys economic history.
In addition, manufactures and larger industries are
contributing significantly to the citys wealth. Major
companies such as SKF, Volvo and Ericsson have
created great amounts of employment opportunities
and branded Gteborg as an industrial city.
Today, the region has more than 2000 foreign-owned
companies. That made Gteborg one of the fastest
growing regions of Northern Europe.
Why do Person Centred Design ?

There are many advantages for adopting a person-
centred design approach: the risk of project failure is
mitigated as concepts and ideas are validated with
users throughout the project; designers narrow its focus
onto a smaller number of key features that are specific
to the user needs. It can transform data into actionable
ideas. It can help to see new opportunities, increase
the speed and effectiveness of creating new solutions.
This thesis discusses some of the evidence based
design and person-centred care researches, examples
supporting healing design and a proposal design on
DELIMITATIONS
17 16

Central
Gothenburg
Lillhagsparken
Hospital
Hgsbo
Hospital
Mlndals
Hospital
stra
Hospital
Sahlgrenska
Hospital
3

k
m
5

k
m
Central
Partille
Rgrden
Hospital
N
PROJECT AREA
stra Hospital
stra Hospital is situated in the eastern parts of
Gteborg, around 5 km from the city centre. stra is
one of five hospitals of Sahlgrenska University hospital
which is the largest hospital in northern Europe with
about 2100 beds and 17 000 employees. The research
is mainly housed within stra hospital and it provides
health care in a range of different areas; there are
departments for gynaecology, orthopaedics, medicals,
infections, geriatrics, dermatology, clinical physiology,
surgery, neurology, radiology and physiotherapy. There
are also a maternity clinic, an ear- nose-and throat clinic
and a MS-centre.
As a university hospital, Sahlgrenskas main function
can be described in tree words; care, research and
education. To provide good healthcare for the future, it
is very important that these are closely interconnected
both literally and geographically in order to have a
continuous education of employees and to keep up
with the quick development and innovations.
stra Hospital is facing major changes. The buildings
need to be both upgraded and adapted to the
increasing development of the activities going on in the
health care environment at stra. In 2011 Vstfastigheter
together with Sahlgrenska University Hospital and
Region Service developed a new construction plan
and technical supply plan for stra Hospital. Several
buildings will be added within the area, while many
of the existing ones will be reconditioned. There is an
on going process designing a new Childrens Hospital
in the south and an addition to the existing Womens
Clinic in the east. There is also an on going discussion
of designing a new operation building in the centre of
the area, which will work as a hub for the entire stra
Hospital.
Aims
The aim of the thesis is to make design decisions of
the built environment on the best available research
to achieve the best outcomes of healing environment.
Furthermore, the thesis aims to provide inspirational
ideas how the Evidence Based Design and Person
Centred Design can be used in an existing in an internal
medicine ward in stra Hospital.
AIMS
19 18
Thesis Structure
THESIS STRUCTURE
Connecting to design solutions using Tool Kits
(design quality checklist and questionnaire
results)
Design methods to improve treatments in
healthcare.
Design applications
Applying the design parameters to the
wards.
Based on literature search about evidence based design and person centred care
approaches.
Searching and reviewing books and internet sites about human perception and impact
of environments.
Relation with perception, behavior and emotion.
Interviewing with experts on field of healthcare, person centred care, evidence based
practice, etc.
Studies on atmosphere of ease and environments.
Reviewing data about which qualities of environments affect our behaviors in which
ways.
Study the site strasjukhuset 5th floor, Study visit to few hospitals in Sweden and
Netherlands.
Collecting data by questionnaires (both for staff and patient) and observation.
Analizing the datas from the questionnaires and study literatures.
1
Research
Collect datas 2
Understand
Analyze
3
Checklist
4
Designs
The Chain of Logic
THESIS STRUCTURE
21 20
Methodology
The author used multiple methods to strengthen results.
It can also be helpful to use both qualitative and
quantitative methods. The data gathered from one
method can be compared with the data collected from
another method, so that the results are more supported.
Seminar and Workshop
It is important to get more depth knowledge of the
two approaches (Evidence Based Design and Person
Centred Design). Therefore the author was participated
in 3 days intense an Evidence-Based Practise Workshop
2012 held by CVA Chalmers Architecture. The
workshop was a great success under the leadership
of Kirk Hamilton with Roger Ulrichs involvement. Also
by attended a PCC seminar about gave the author
a broader understanding of person-centeredness and
residential health care from expertise in the field. The
seminar held by University of Gothenburg Centre
for Person-Centred Care (GPCC) and it was two-
way interaction with David Edvardson (Associate
Professor/Director of Research, La Trobe University,
Docent, Ume Universitet) who leaded thelecture
and public (mostly researcher and PhD students).
Literature studies
Regarding literature studies, the author follow Roger
Ulrichs literature systems first by defined questions or
topic. Secondly gave limit to search, for instance: peer-
reviewed, time span of the literatures (last 3 years, 10
years or 20 years for instance), languages (English and
Swedish as examples), and geographic region.
According to Ulrich, peer-review is a process that
research journals use to ensure the articles they publish
represent good scholarship and contain sound findings
or information. If a study or research article appears in
a peer-reviewed journal, this is an indicator of quality.
The author found out articles that been peer-reviewed
from textbooks, journals use repeatable methodology,
focus on a specific study and trusted website (PubMed,
Google Scholar, University Library, etc.).
It is important to use the correct key words and spend
more time on this when searching on Internet, in order
to get the more specific and better articles (Ulrich, 2012).
Next step was to organize and be systematic in order
to focus on the topic and kept on the right track.
Study Visits
The author conducted study visit to 6 different healthcare
METHODOLOGY
in Sweden and 1 hospital in Netherlands for a valuable
source for inspiration. The selection of study places was
made partly due them being implemented evidence
based design or person centred care approach, as
well as giving variation in age, room programming, and
concept.
Self Reporting Methods
In this stage the author accompanied self-reporting
methods together with a fellow student who has the
same topic, Bilyana Docheva.
Questionnaires

Questionnaires formulated to generate a response
both from patient and healthcare professional. The
questionnaires had rating scales and open questions.
The goal of the questionnaire was to understand how
the wards environment can be more supportive to
patients, families and professional in order to create
a healing environment. For more detail information see
Appendix. It was also useful to follow-up questionnaires
with interviews with a focus group of a nurse and an
assistance nurse from the ward to learn a greater depth
and learn why certain responses were given.
Interviews
Interviewing with experts on field of healthcare, person
centred care, evidence based practice, and healthcare
professional (nurse, assistance nurse and physician).
Interviews structured with a list of questions, recorded
and transcribed so the content could be analysed
systematically.
For the interview with the focus group held by using
more interactive interview such utilizing patient room
models, a plan of the ward, different sticker colour
represent of emotion symbols.
METHODOLOGY
23 22
Behavioural mapping

Observation of the daily routine in a medical practice
often makes clear that there are various inadequacies
and opportunities for improvement. This method shows
a movement of nurses and type of interaction. The
method is done in person by following a nurse activity
in two different times (day and night time). The author
used a plan drawing and recorded the movement of
the nurse on it.
Mental mapping
The data collected from the interviews and observation
were illustrated using Kevin Lynch mental map.
The concept of a mental map refers to a persons
personal point-of-view perception of space. In The Image
of the City, Lynch used simple sketches of maps created
from memory of an urban area to reveal five elements
of the city; landmarks, regions, nodes (intersections),
edges (barriers), and paths. What makes Lynchs
findings especially interesting is that the imageable or
memorable features of a space are used by people to
assist wayfinding. Landmarks are memorable locations
that help to orient the navigator; regions are distinct
areas that place him in one part of the environment;
nodes mark points where wayfinding decisions are
made; edges provide the boundaries that separate
METHODOLOGY
SWOT - analysis
Data collection from the interviews were sorted and
grouped. And the author presented it in the SWOT-
analysis, a tool used to clarify the qualities and the
problems within the project site. The analysis provides
programs and organizations with a clear, easy-to-read
map of internal and external factors that may help or
harm a project, by listing and organizing a projects
Strengths, Weaknesses, Opportunities, and Threats.
SWOT can clearly show a program its chances for
success, given present environmental factors.
Observational Methods
Observing the site
To experience and analyse the study site the author
conducted a walk-through evaluation of the ward.
However the author analysed the drawing plan of the
wards in advance. Observation was made in-person
by walking through it, taking pictures and recording
myexperiences. In this method the author also observed
evidence of things in the wards that signify a certain
activity was occurring, or that an element was not
functioning as intended. Things to look for included
informal signs posted, broken items, empty or over-full
storage areas, etc.
one region from another that the individual perceives
as a barrier; and paths consists of any other defined
path of movement.
Mental maps have been used in a collection of spatial
research. Many studies have been performed that focus
on the quality of an environment in terms of feelings such
as fear, desire and stress.
Justified access gamma mapping with labeled spaces

The gamma-analysis is used on building interiors in
terms of the interconnections between spaces. It is a
way to analyze how separate spaces relate to each
other in systems of space (Klarqvist, 1991). The author
clarified the relations between the function groups by
using a matrix of room function and a function scheme
to ensure an effective design planning.
Blog
One way to document my process and to keep track on
the time plan is to create a blog. For me an updated blog
aids as a good motivator to accomplish small deadlines
on a daily basis. This has not only been helpful to keep
my stakeholders updated about the project progress,
but also to anyone who are interested in the project.
Visit the blog: www.therainbowtree.tumblr.com
METHODOLOGY
Creating A Toolbox
Questionnaire Results
The list formulated from the questionnaire and interviews.
results by examining the needs, wants, and behaviours
of the staff and patient to generate with solutions.
Design Quality Checklist
The checklist was developed using Evidence based
Design & Person Centred Care researches, also LEED
Healthcare requirements and recommendations. LEED
is a leading system for environmental certification of
buildings. It takes a holistic approach for identifying &
implementing practical and measurable green building
design, construction, operations & maintenance
solutions. The Checklist was created as a tool for
strategic planning & design programming.
Diagrams and Figures
In order to be understandable easily by people from
different backgrounds, the author created many
diagrams and figures to simplify the findings for the report.
Drawings
Sketching or using computer drawing, illustrational
programs, digital photography.
Models
The use of physical models creates a feeling of the
space at an early design stage.
25 24
Notes on reading
The Theoretical Approach
Creating a healing environment requires systemic
change. A truly transformational design may cost more
to build but may result in far less waste and vastly
improved operational performance, fewer errors, and
in the long term, huge savings over a more conventional
design (Malkin, 2006).
T
he basic components of a healing environment have
been clearly identified. According to Malkin (1992,
p.10; Dellinger, 2010; Malkin, 2006), they include:
Air quality
Thermal comfort
Privacy
Provide adequate and appropriate light exposure
Views of/ access to natures
Visual serenity for those who are very ill
Visual stimulation for those who are recuperating
Positive diversion
Increase social support
Options and choice (control)
Elimination of environmental stressors
(such as noise, glare, and poor air quality)
Healing Environment
Generally, healing environments are considered to be:
A place to heal the mind, body, and soul.
A place where respect and dignity are woven into
everything.
A place where life, death, illness, and healing define
the moment and the building supports those events
or situations (Dellinger, pp.45, 2010).
A healing environment is the result of a design that has
demonstrated measurable improvements in the physical
and/or psychological states of patients and/or staff,
physicians and visitors (Hamiltons workshop, 2012)
Even though such changes might make a facility
more attractive, alone they do not create a healing
environment. Eileen Malone states: Leadership must
make a commitment to the principles behind creation of
the healing environment and ensure that these principles
are incorporated into their entire organizational culture
(Zimring, 2008).
NOTES ON READING
27 26
Evidence-Based Design
EBD is considered as two partially separate phenomena:
1: Cause and effect
The research results that indicate a connection
between the physical environment and its impact on
healthcare outcomes
2: A process
The methodology that describes how research
should be integrated into a planning process. (Lundin,
2012).
More than 400 research studies by The Centre for
Health Design shows a direct link between patient
health and quality of care and the way a hospital is
designed. Here are some examples:
Patient falls declined by 75% in the Cardiac Critical
Care Unit at Methodist Hospital in Indianapolis, Ind.,
which made better use of nursing staff by spreading
out their stations and placing them near patients
rooms.
The rate of hospital-acquired infections decreased
A healing environment can always be identifed by evidence from measurement
and results. On other hand evidence-based design might or might not result in a
healing environment (Hamiltons workshop, 2012)
11% in new patient pavilions at Bronson Methodist
Hospital in Kalamazoo, Mich., that feature private
rooms and specially located sinks.
Medical errors fell 30% on two new inpatient units
at The Barbara Ann Karmanos Cancer Institute in
Detroit that allocated more space for their medication
rooms, re-organized medical supplies, and installed
acoustical panels to decrease noise levels.
T
he evidence is overwhelming: The healthcare
environment, where care is actually provided and
received has substantial effects on patient health
and safety, care efficiency, and staff effectiveness and
morale. Ulrich and Craig Zimring, Ph.D., of Georgia
Tech University, conducted the research analysis for The
Centre for Health Designthe most extensive review
ever done of the evidence-based approach to hospital
design. With their findings, designers now know enough
about the science of hospital design to ensure that
future hospitals can be much more geared to promoting
healing, not just providing treatment.
EVIDENCE BASED DESIGN
Evidence-based design is a natural analogue of
Evidence-based medicine. Evidence-based medicine is
the conscientious, explicit and judicious use of current
best evidence in making decisions about the care of
individual patients (Hamilton and Watkins, 2009, p.77).
According Zimring, just as evidence-based medicine is
revolutionizing health care treatment, evidence-based
design is transforming the healthcare environment.
The approach has so far reached popularity mainly
in healthcare architecture as an effort to improve
patient and staff well being, patient healing process,
stress reduction and safety. It has similarities with
environmental psychology, architectural theory and
behavioural science, which are all relevantly connected
to the subject of a healing environment. It looks at the
building design not only as physical space, but includes
the total sensory environment of sight, sound, touch and
smell (Malkin, 2006). Hence, it is also the main point of
departure in my research
Putting the Evidence into Action
Evidence - based design can improve hospital
environments in three key ways by:
Enhancing patient safety by reducing infection, risk,
injuries from falls, and medical errors.
Eliminating environmental stressors, such as noise, that
negatively affect outcomes and staff performance.
Reducing stress and promote healing by making
hospitals more pleasant, comfortable, and supportive
for patients and staff alike.
B
ased on their review of the evidence, Ulrich and
Zimring make the following recommendations:
Provide patients with single rooms
This change alone will help improve patient safety by
reducing patient transfers, cut the risk of nosocomial
infections, enhance patient privacy, lower stress
for patients and their families, and improve staff
communication with patients. Although the up-front
cost of private rooms is higher, significant savings will
enlarge from lower rates of infection, readmission, and
transfers, as well as shorter hospital stays.
Improve indoor air quality
Several studies have demonstrated that identifying
and fixing air-quality problems, in combination with
single rooms and careful position of hand washing, can
substantially lower infection rates at hospitals. Maintaining
good airquality with well-designed ventilation systems
and air filters to prevent infection also involves careful
design, location &control of environmental elements.
29 28
Reduce noise
Research shows that noise is a major source of stress at
hospitals. At hospitals that took steps to cut noise levels
by using sound absorbing ceiling tiles and flooring,
patients were more satisfied with their care, slept better,
had lower blood pressure, and were less likely to be re-
hospitalized. Likewise, staff felt better about their jobs
and reported improved sleep quality.
Provide better lighting and access to natural light
Looking out at bright light can improve health outcomes,
including depression, anxiety, sleep, and daily rest-
activity rhythms. In one study, hospitalized patients with
unipolar and bipolar disorder whose rooms received
direct sunlight in the morning had significantly shorter
hospital stays than patients whose rooms did not. Poor
lighting also contributes to medication errors.
Create pleasant, comfortable, and informative
environments
Small changes to room layouts, colour scheme, furniture
choice and arrangement, floor coverings, and curtains,
as well as providing informational material and displays,
can improve peoples moods and physiological states.
Several studies have shown that views of nature and
gardens can effectively reduce stress and alleviate
pain through pleasant distraction. Outdoor gardens
with seating also create enjoyable and soothing visiting
environments for patients and their families. One study
found that children hospitalized for psychiatric problems
became much less aggressive when they were placed in
an improved quiet room with pleasant decor, compared
those who were placed in a standard quiet room.
Provide accommodations for family members increase
social support and help relieve stress for patients.
Make hospitals easier to navigate
Its easy to get lost or confused trying to find ones
way in a hospital. Not only is this confusion stressful for
visitors, but it also incurs a cost to hospital. One study of
a major tertiary care hospital calculated the annual cost
of way finding at $220,000 -- mainly due to the time
spent direction-giving (more than 4,500 staff hours) by
people other than information staff. Good way finding
systems include mail-out maps and written directions,
you-are-here maps and directories and key entries,
directional signage at key decision points, reassurance
signs for long paths, and clear identification of rooms.
Design hospitals that help staff do their jobs
Nursing stations are hectic and stressful places where
too many errors occur while updating charts, filling
Healthcare Outcomes
Reduced pain
Reduced patients falls
Improved patient sleep
Reduced patient stress
Reduced depression
Reduced hospital-acquired infections
Improved communication with patient & relatives
Improved patient privacy and confdentiality
Improved social support
Increased patient satisfaction
Decreased staf injuries
Reduced length of stay
Decreased staf stress
Increased staf efectiveness
Increased staf satisfaction
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strong evidence
directly or indirectly evidence
Reduced medical error
Source: Ulrich, 2008
31 30
medication orders, and communicating between shifts.
Several studies have found that providing orderly, well-
lit spaces that are organized around critical activities
by nurses and physicians can reduce medication errors
and reduce staff stress.
Key Design Elements
A
lthough functionality is needed on designing
hospital, it does not mean it needs to look
institutional. Comfort and aesthetics need to play a
large part in the functionality of a room and need to
be considered equally important. Aesthetics are one
of the most subjective component of evidenced-based
design (EBD). Fundamentally, the right aesthetic can set
the stage for an encouraging experience and has a
positive effect on staff, patients, and family. Below here
some of key design elements in order to achieve the
right aesthetic according to McCullough, 2010:
Wayfinding
Visitors want to reach their destination within a hospital
as quickly as possible without confusion or question.
Way finding is a subliminal tool used in healthcare
interiors that delivers an experience free from frustration
and stress for visitors and staff by providing pertinent
and memorable information at critical locations. The
objective is to provide the big picture to the first time
visitor through a variety of cues, including signage,
landmarks, maps, information desks, directories, shape,
colour, texture, light, and sound. Using a consistent and
logical layering of cues creates the best opportunity for
visitors to orient themselves to the facility. The layering
also allows for a variety of people, languages, and
cognitive abilities to absorb and process the information.
Spatial organization is considered the most important
piece of good way finding design because it makes
the space easier to understand. Identifying zones in a
building, creating clear sightlines from vantage points,
and organizing the different areas can promote and
improve way finding.
Linear Strategy: This strategy uses point-to-point
information. For example, using route or linear
strategy, a person would obtain directions from point
A to point B. If they needed to go farther, they would
obtain directions from point B to point C, continuing
in a linear fashion.
Orientation Strategy: This strategy uses sources of
information so individuals can orient themselves. A
map is a good example of this type of orienting
information. An example of an effective way finding
strategy is a large and unique fountain. There can only
be one of these within the building for it to be effective.
The fountain serves as one point in a set of points in
giving directions. For example, go to the fountain, take
a left, and so on, and it can also be used as a point
of reference or pivot point in the orientation strategy.
Lighting is another opportunity to aid navigation.
Based on the level of illumination in an area or
pathway, the designer can deter or encourage its use.
Positive Distractions
Providing positive distractions is crucial in healthcare
planning. Most positive distractions are based on
some form of nature such as water, fishes in aquariums,
gardens, wood patterns and views of the nature
(Jokiniemi, 2012).
They can as well be artificial items such as fireplaces,
internet station, artwork, etc. Art comes in various
forms paintings, sculptures, photography, and so on. It
provides a connection to humanity, an innate wonder
and warmth. (McCullough, 2010).
Artwork
When choosing a piece of art for the hospital
environment, one must consider if it could support
healing process. Abstract art, for instance, should be
avoided in the patient perspective because it can lead
to frustrations when trying to understand the meaning
behind it. Another example if a cancer patient who
recently lost her hair sees a painting in a hospital of
a woman with long flowing hair, this painting could be
perceived as disheartening to the patient and lead to
a negative mindset.
Lighting
Research on 602 patients diagnosed with severe
depression, by Benedetti et al. 2001, found that patients
in rooms with high levels of morning sunlight (east facing
room) had shorter lengths of stay by 3,7 days than
patients in rooms without/less morning sunlight. Sunlight
exposure increases levels of serotonin, a neurotransmitter
known to inhibit pain pathways. By that means fewer
pain-reducing drugs and have shorter hospital stays
than their neighbours in shadowed rooms.
Although natural lighting is ideal, it is sometimes hard
to control and can cause uncomfortable glare and
heat. Window orientation, size, and location and to the
33 32
selection of proper shading solutions like overhangs,
vertical fins, light shelves, or even environmental objects,
including mature trees or nearby buildings should be
take into consideration.
Corridors should be illuminated with a combination of
indirect and direct illumination. A patient being wheeled
down a corridor illuminated entirely by indirect light,
however, does not experience these glare issues.
Color
Although color is an integral part of design, very
little empirical evidence exists to support some of the
popularly held ideas about the effects of color on
task performance, worker productivity, and human
psychology. No evidence suggests a one-to-one
relationship between a color and an emotion. Certain
colors can evoke a sense of spaciousness, but the
perception of spaciousness is attributed to the brightness
or darkness of color and is influenced by contrast effects,
particularly brightness distinctions between objects and
their background (Young, 2007).
Young also concludes the judgment of color in certain
settings is a result of multiple layers of experience.
Analysis of color in any environment means respecting
other kinds of processing forces, such as culture, time, and
location. Since most guidelines and design decisions are
based on personal beliefs, there should not be universal
guidelines for colors in healthcare settings.
Textiles and Materials
The key to a long-lasting aesthetic is using the most
durable and pleasing products available. This is not
always as easy as it sounds and requires a constant
balance between budget and material cost. Many
materials are proposed in the planning phase where
the life-cycle cost of the material is compared to the
first cost.
Using rubber flooring and linoleum flooring has become
popular in the healthcare setting because they are
durable and sustainable, require minimal maintenance,
and are available in European colour trends. Flooring
receives the most wear in a healthcare facility, so
allocating an appropriate budget for that product is
imperative.
Careful planning and selection of materials benefit the
aesthetics in the long run. Material selection and noise
control go hand in hand. Soft surfaces (carpet, ceiling
tiles, fabric wrapped panels, etc.) have a higher rate
of noise absorption. Strategically placed materials
can have a profound impact on the quality of the
experience from the perspective of the staff (easier to
concentrate and fewer incidents of information transfer),
the patient (easier to sleep and/or rest), and the visitor
(the environment is perceived as less chaotic) (Moeller,
2005).
Furniture
When selected and placed well, furniture can foster
collaboration among caregivers, provide support and
comfort, and promote interaction. Just as was the case
with materials, performance and maintenance should
be the first criteria for furniture.
Furniture finishes have a varied range but include wood,
metal, laminate, and composite materials. Consideration
of the area of use can lead the designer to the correct
selection of a finish. Furniture scale (the size relationship
to the interior space) and designer layout are important
factors. The right scale visually fits into the space but
also includes a comfort factor.
Product Development
In the design world, designers often face difficulty when
searching for products to meet each clients individual
needs. Product development stems from a need for
something better. Whether it is the need to work more
efficiently with a new caregiver workstation or the desire
to have textiles that not only look good but work well,
healthcare products are developed to meet the needs
required by the ever-changing healthcare market.
35 34
The Economic Beneft of Evidence Based Design
According Leonard Berry, Ph.D., of Texas A&M University, evidence-based design is not
only good healthcare; its good business sense as well. Smarter hospital architecture
and design can pay for itself by improving service efficiency, patient safety and
satisfaction.
F
able Hospital 2.0 study case states that the payback for implementation of the
evidence based design investment should occur within three years (Sadler, 2011).
Its a reasonable return by any business standard. Design innovations will often bring
important economic benefits, but there is enough variability to make average revenue
estimates unreliable (Goldman, 2010).
According to business case study of Fable Hospital 2.0 have analysed ten design
innovations that are evidence-based and cost-effective. These calculations are based
on specific examples and average costs in US. Leaders of individual projects will need
to tailor their own estimates and analyses to their specific experiences.
The details figure to the right shows approximately some economic benefit of evidence-
based design. Each cost savings calculated based on US published information and
used Sadler and his teams best judgement to attribute a portion of the savings to
evidence-based design improvements and attempted to be conservative. For the
business case in Sweden, the percentage results might be different mainly because of
the healthcare system, economic, and variables differences.
Health Care-Associated
Infections Reduced
20% savings
Patient Falls Reduced
30%
savings
Patient Transfers Reduced
60%
savings
(assumes no reduction in transfers in medical or surgical units)
Nurse Injuries Reduced
50%
savings
Nursing Turnover Reduced
50%
savings
Adverse Drug Events Reduced
20%
savings
Length of Stay Reduced
10%
savings
e-ICU Saving
40%
savings
Energy Demand Reduced
18%
savings
Water Demand Reduced
savings
30%
IMPROVED OUTCOMES AND COST SAVINGS
Source: Sadler, 2011
37 36
IMPACT OF DECISION
low high
DEGREE OF
UNCERTAINTY
high
Objective &
Simple
Discovery &
Original Critical Thinking
Art
Objective &
Demanding
Subjective
& Creative
Science
Source: Hamilton, 2012.
Illustration: Longe Olsson., 2013.
Embodied visions: Science and Art
Art versus Science?
A
re they really as distinct as we seem to assume?
And if they are, what is the distinction? Do we
have a clear definition of each that allows us to see their
separation? The diagram here illustrates the connection
between art and science. My personal understanding
is that the arts and sciences not being as far apart as
they are usually depicted. And nor do I see them as
being opposed. The diagram shows area of maximum
design freedom and domain of highest creativity. It also
shows that when the degree of uncertainty high and
the impact of decision is important, the research need
to be done in order to get maximum results.
The best science requires creative thinking. Someone has
to see a problem, form a hypothesis about a solution,
and then figure out how to test that hypothesis and
implement its findings. That all requires creative thinking,
which is often called innovation. On the other hand,
creativity alone fails to deliver us anything of worth.
A musician or painter must also learn a technique,
sometimes as rigorous and precise as found in any
science, in order that they can turn their thoughts into
a work. They must conquer mastery over their medium.
Do the research
Area of maximum design freedom
Domain of highest creativity
EMBODIED VISIONS: SCIENCE AND ART
research studies demonstrating the beneficial impact
of the environment on health outcomes. Many have
also demonstrated economic savings as well as
higher patient and service user satisfaction levels.
Rheumatoid arthritis sufferers who listened to 20
minutes of their selected music daily reported a
significant reduction in their perception of pain
(Schorr, 1993).
The Study of the Effects of the Visual and Performing
Arts in Healthcare undertaken by Rosalia Staricoff
at Chelsea and Westminster Hospital 1999-2003
found that the length of stay of patients on a trauma
and orthopaedic ward was one day shorter when
they experienced visual arts and live music, and their
need for pain relief was significantly less than those
in the control group; live music was very effective
in reducing levels of anxiety and depression; visual
arts and live music reduced levels of depression by a
third in patients undergoing chemotherapy; and staff
recruitment and retention were improved (Loppert,
2003).
More than 30 rigorous scientific studies show how
exposure to nature quickly decreases stress and
reduces pain, slowing respiration and lowering
blood pressure (Ulrichand Gilpin, 2003).
Same case as a writer works within the rules of grammar
to produce beauty (Mumford, 2012).
According Dr. Mae Jemison, both the arts and the
sciences, are not merely connected but manifestations
of the same thing - they are our attempt to build an
understanding of the universe, and our attempt to
influence things. The arts and sciences are avatars of
human creativity - they are our attempt as humans to
build an understanding of the world around us....
The impact of arts on health
A
rchitecture has always been a blend of art and
science. Although some pieces of evidence are
less rigorous than others, the reality is that there is
a considerable evidence base, internationally, with
hundreds of research studies and evaluated projects
that clearly demonstrate the benefits of using the arts in
health. These are just some of the examples:
Dr Rosalia Staricoffs review in 2004 of the medical
literature for Arts Council England cites nearly 400
papers showing the beneficial impact of the arts on
a wide range of health outcomes (artscouncil.org.uk).
A study by Professors Roger Ulrich and Craig Zimring,
2004 found some 700 peer-reviewed robust
EMBODIED VISIONS: SCIENCE AND ART
39 38
Person Centred Care Approach
T
he core concept of Person-Centred Care (PCC),
is a partnership between the patient (and often
relatives) and healthcare professionals that is based
on respect and dignity (Wolf, 2012). The starting
point is the patients narrative, which is recorded in
a structured manner. From this a mutual care plan is
created, which incorporates goals and strategies for
implementation and short and long term follow up.
The starting point for person-centred care is that humans
are, and should be treated as free and dignified beings.
The characteristics and abilities, which signify a person,
can be confirmed or ignored, reinforced or diminished by
others. Person-centred care stresses that man is free but
mutually dependent. This is the basis for the partnership
between the caregiver and the patient, which can be
expressed as a mutually formed rehabilitation or care
plan. To listen to the patients narrative in a careful
and structured way implies a means of becoming
aware of the individuals self-expertise, abilities and
obstacles to achieving good health (gpcc.gu.se)
Person-centered care highlights the importance of knowing the person behind the patient
as a human being with reason, will, feelings, and needs in order to engage the person
as an active partner in his/her care and treatment (Mounier, 1952).
Patient Centred Care VS Person Centred Care
Patient Centred Care
Most studies of patient-centeredness are carried
out in settings involving visits. According to Barbara
Starfield (2011) patient-centeredness is determined
by the quality of interactions between patients and
clinicians and indicated that they equate patient-
centeredness with communication skills, which are a
fundamental component of the approach to care that
is characterized by continuous healing relationships,
shared understanding, emotional support, trust, patient
enablement and activation, and informed choices.
Person Centred Care
Person centred care is person-focused, not disease-
focused, care over time. To be person-focused, it must
be accessible, comprehensive (dealing with all problems
except those too uncommon to maintain competence),
continuous over time, and coordinating when patients
have to receive care elsewhere. The essence of person
focus implies a time focus rather than a visit focus. It
extends beyond communication because much of it.
PERSON CENTRED CARE
Is concerned primarily with
the evolution of patients diseases
Is concerned with the
evolution of peoples experienced health
problems as well as with their diseases
Morbidity is a diseased state, disability, or poor health
due to any cause.
Comorbidity is either the presence of one or more
diseases
Generally refers to interactions in visits
Refers to interrelationships over time
Maybe episode oriented Continuity. Considers episodes as part of life
course experiences with health
Generally centers around the
management of diseases
Views diseases as interrelated phenomena
Comorbidity. Often considers morbidity as
combinations of types of illnesses
Generally views morbidity as number of
chronic diseases
Generally views body systems as distinct Views body systems as interrelated
Uses coding systems that refect
professionally defned conditions
Uses coding systems that also allow for specifcation
of peoples health concerns
Patient VS Person Centred Care
Source: Starfield, 2011
PERSON CENTRED CARE
41 40
relies on knowledge of the patient (and of the patient
population) that accrues over time and is not specific
to disease-oriented episodes. Physicians and patients
working together to reach mutual decisions often require
a long-standing relationship. Patients are more likely to
follow medication regimens if they share their physicians
belief about causes of health outcomes. This is unlikely to
be the case when visits are with practitioners not well
known to patients (and vice versa).
With grants from the Swedish government, the University
of Gothenburg established Gothenburg Centre for
Person-centered Care (GPCC), an interdisciplinary
research core center for the study of PCC in long-term
illness. The centers overall aim is to systematically and
comprehensively investigate PCC from the perspectives
of the person with long-term illness, the health care
professional involved in the care of that person, and the
health care organization providing the structure for that
care (Ekman, et al, 2011).
According to Hansens study (2011) of interventions in
context (such as social interactions between people and
their physical, material and institutional surroundings)
demonstrated the setting as context becomes impor-
tant when considering the effect of the intervention.
Person Centred Design (PCD)
P
erson-centred design is a subset of person-centred
care, focusing service delivery on persons and the
care setting. The hypothesis behind these concepts
is that the manners whereby the physical settings for
the delivery of health care are planned, designed,
and managed affect both the quality of the persons
experience, quality of care, the cost, including patient
safety (Zimring et. al., 2006.).
Illustration : Longe Olsson, 2013.
PERSON CENTRED CARE
DESIRABILITY
FEASIBILITY
VIABILITY
What do people desire?
What is technically and
organizationally feasible?
What can be financially viable?
The Three Lenses of Person Centred Design

T
he reason this process is called person-centred is
because it starts with the people we are designing
for. The Person Centred Design process begins by
examining the needs, dreams, and behaviours of the
people we want to affect with solutions. The design
process is to listen to and understand what the users
want - the desirability lens. Once a range of what is
Desirable have identified, the later phases of the
process design is to view the solutions through the
lenses of feasibility and viability.
Source: IDEO Toolkit
DESIRABILITY
VIABILITY FEASIBILITY
Start here
The solutions that emerge
at the end of the Person-Centered Design
should hit the overlap of these three lenses;
they need to be Desirable, Feasible, and Viable.
PERSON CENTRED DESIGN
43 42
The Process of Person Centred Design

The process of Person-Centred Design goes through
three main phases: See, Hear, and Create.
The process will move concrete observations about
people (the users), to abstract thinking as uncover
insights and themes, then back to the concrete with
tangible solutions. Uncovering insights is about bringing
visibility and clarity to previously hidden meaning.
For example, a combination of an observation and quote
from an interview yielded the following sample insight:
Observation: Physician rooms are outside the ward,
isolated, and have no transparancy. Patient treatment
plans are often changed. Ineffective communication
between staffs.
Quote: The major barrier of implementation of person
centred care is the doctor.
Insight: Separation room between physician and nurses
might works as a hinder for effective communication
between staffs.
SEE
Starts by observing the physical environment and
examining behaviours of the users.
HEAR
Collecting stories (that may contains strength,
weaknesses, opportunities and threats) and getting
inspiration from people during the hear phase. And then
is to translate informations from people into frameworks,
opportunities, and solutions. This will move together from
concrete to more abstract thinking in identifying themes
and opportunities, and then back to the concrete with
solutions and design applications.
CREATE
The create phase will begin to realize the solutions
through implementation planning. The goal is to always
have the people you are designing for in mind.
The Method of Person Centred Design

According to IDEO Human Centered Design ToolKit:
Empathetic Design
Creating solutions through empathy is a way
for the design team to blend their expertise with the
on-the-ground needs of people. Empathy means
deep understanding of the problems and realities of
the people you are designing for. It is important to do
research across many different groups of people and to
walk in their shoes before the Create phase.
Abstract
Concrete
H C
By understanding people deeply, empathic design
can lead to both appropriate and more breakthrough
solutions. But this method challenges the design team
to not just understand the problem mentally, but also
to start creating solutions from a connection to deep
thoughts and feelings.

Share stories
Telling stories is about transforming the stories
we heard during research into data and information
that we can use to inspire opportunities, ideas and
solutions. Stories are framed around real people and
their lives, not summaries of information.
Stories are useful because they are accounts of specific
events, not general statements. They provide us with
concrete details that help us imagine solutions to
particular problems.
Identify Patterns
Making sense of the research is accomplished
by seeing the patterns, themes, and larger relationships
between the information. This process can be messy
and difficult at times, but ultimately very rewarding.
Seeing the patterns and connections between the data
will lead you quickly toward real-world solutions.
Source: IDEO Toolkit
45 44
Theory of Supportive Care Settings
T
he authors goals are to investigate factors that
can increase physical environment, persons
emotional burdens around health and wellness
and empower individuals, from healthcare staffs to
patients. Design experiences that enable people to
achieve physical, mental, and emotional balance.
5 main factors of sensing an atmosphere of ease
according Edvardssons research, 2005:
1. Experiencing welcoming in the environment
Expectedness
Experiencing that others are aware of and prepared
for ones arrival by having made arrangements and
knowing ones name, but also knowing the reason
for ones coming. Several studies show that it makes
persons feel more relax, less stress and anxiety.
The author suggest facilities that can support this for
instance: Reception area close to entrance door,
where a staff can stand by and welcoming when
persons arrive, someone sees them, greets them
with a smile, takes their hand, introduces him or
herself to them, and shows an interest in them.
Visible
According data interview, to be seen and to be able
to see are quite important factors both for staff and
patient. Implementation in design can be
transparency wall of the staff area can be seen
as a warm welcome. Another example, patient
room door with a small window that gives visual
interaction for patient through outside the door and
also for staff to keep on eye on the patient.
Accompaniment
Being accompanied and showed around are
considered important. A creative and functional
design of the wall, ceiling or floor can be use to
guide persons to understand better way finding in
the ward. Create an area for relatives in a ward
and/or patient room.
2. Recognizing oneself in the environment
Familiar environment
Experiencing an environment containing traces of
familiar objects. On his paper, Edvardsson given his
examples, being surprised by the beauty of objects
such as flowers, curtains, art, views from windows
and handcrafted furniture could add a meaningful
content to the day.
The less like a hospital it feels like,
the better I feel.
By designing the ward with home-like, not reminding
them of a traditional hospital environment will give
THEORY OF SUPPORTIVE CARE SETTINGS
Expectedness
Visible
Accompaniment
47 46
positive effect both staff, patients and visitors. By
providing the hospital with many different activities
as a positive distraction will reduce persons pain.
Facilities such as library, games room, garden, art,
TV and talking about interests and topics apart from
treatment and disease are also examples of being in
a familiar environment.
Calm environment
Where loud alarms, telephones, screaming voices
and unfamiliar noise are absent, and where
movement is in a calm and comfortable pace
contribute to experiences of being able to follow
ones own rhythm. Edvardsson discovered that
movement of staff contains symbolic meanings
influencing patients decisions to call for assistance.
Movement in a serene and seemingly relax pace
would be a signal for human encounters, which
encourage asking of questions or ringing of bed
alarms. Architectural designs of hospitals influence
interaction, behaviour and rhythm. At the medical
ward, which consists of one long corridor with few
chairs and tables, participants rarely spent time in
the corridor. On the other hand shorter corridors,
and more places to meet, sit and talk, persons are
often seen interacting in more relax and calmer.
3. Supporting social relations in the environment
Staying in contact
Represents an individuals possibilities of remaining in
touch with family and friends, for example, by having
access to a phone or having space to receive visitors
without feeling as if they are in the way.
Making new contacts
Represents having someone to talk to, as well as
forming personal bonds from the sharing of time
and experiences together. Care setting can support
creating and maintaining social relations. Places
with comfortable chairs and sofas in and outside the
patients rooms will foster interaction between staff,
patients, and relatives and thus supported creating
and maintaining social relations in the environment.
4. Experiencing a willingness to serve in the environment
Doing a little extra
Represents people putting in an extra effort to
enhance the experience for others. Doing a little
extra also represents the subtle qualities of peoples
way of being when doing what they do. It stands
for an adding of thoughtfulness and concern to the
design, the support individual attitude of not merely
caring for but also caring about others. Its not about
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Familiar space Activities Nature is beautiful
Calm environment
Staying in contact
Making new contacts
Doing a little extra
49 48
systemic change. Its not about huge, ridiculous things
that we need to do. Its about tiny things that can
make a huge amount of difference.
For instance: Decorated the ceiling, a fabulous
empathic solution for people. Changing the floor
going into the patients room so that it signified,
This is my room. This is my personal space.
Corporate white boards, so that relatives can write
messages to the patient. So, tiny solutions that made
a huge amount of impact. So this is not particularly a
new idea, kind of, seeing opportunities in things that
are around you and snapping and turning them into
a solution. The author personally think that its a nice
way of re-framing the ordinary.
Receiving a little extra
Refers to experiences of being surprised by being
offered something without having to ask, without
demands for giving something in return, and without
experiences of being a burden. As an example,
creating a tool for patients to express their gratitude
for the staff. It can be a white board or hang papers
full of gladitude and gratitude words. The more
people connecting with the concept of taking active
action to find things that are small, the more we can
bring comfort and confidence to those needing the
encouragement to seek their own and from this initial
step, empower people to look higher and further in
their gladitude.

5. Experiencing safety in the environment
Understanding what happens
States to being able to understand ones experiences,
for example, by being involved in care as a significant
other, knowing the course of events as a member
of staff, or as a patient receiving information in a
language one could understand. It is crucial to
provide a physical environment that can help staff
to work efficiently, properly and to avoid error. For
instance: by providing staffs office with good lighting
(90-150 foot candle illumination), decentralized
nurse station, modularity design, single patient room
can help to decrease medical error.
Being in safe hands
Its important for patients to feel that staffs are
competent. Being in safe hands also involved being
able to trust that needs and requests will be safe
because you can trust them. Being in safe hands also
involved the physical environment. It was found that
the way in which the physical environment was cared
for was perceived as an indicator of how persons
H< H?
?I: ?IB
H: HB
H< H?
?I: ?IB
H: HB
Ceiiling design Personalization
Gratitude walll Views to nature and daylight
Place for relatives Good lighting and daylight in staffoffice
51 50
Fresh air
Easy to maintain
Clean and tidy storage room
Active and healthy life
would be cared for at the ward; a chaotic and filthy
environment symbolized a similar care (Edvardsson,
2005). For example, the facilities that are neat and
clean make people feel safe with the care. By
carefully choose materials that are easy to clean
therefore reduce infection can be one example
for this category. Also by providing the ward with
decentralized storage room that big enough to fit
all the medical equipments will support the ward
cleanliness.
Relation between EBD and PCD
B
oth person-centred design and evidence-based
design approaches to improve the quality of
healthcare are grounded in and require crossing of the
disciplinary boundaries of clinical practice, architecture
and its allied disciplines, environmental psychology,
behavioural science, which are all relevantly connected
to the subject of a healing environment. Evidence-
based design is viewed as the ways of delivering
design solutions that improve person-centred care,
including improved health outcomes. Both EBD
and PCD strengthen each other approaches. The
illustration to the right shows the relation between
evidence based design and person centred design.
EBM EBD
PCC PCD
Illustration : Longe Olsson, 2013.
Theory Process
EBM: Evidence Based Medicine
EBD: Evidence Based Design
PCC: Person Centred Care
PCD: Person Centred Design
RELATION BETWEEN EBD & PCD
53 52
Notes on seeing
The Preparatory Research
Hospital Architecture Revolutions
T
hroughout western history, the place where
the sick have been cared for has transformed.
These healing environments have ranged from
the home, to the church, and then developed
to what we now understand as hospitals.
The prehistory of hospital architecture
Limiting the definition of a hospital to a building
especially designed for healthcare, the first examples
probably appeared in ancient Greece. The hospital
of antiquity emulate the model of the classical temple,
which hardly suprising, since the concept of healing was
closely linked to religious tites and rituals.
Later, the Catholic Church became the most powerful
provider of health care, and monastic orders were the
caretakers for the sick rather than religious centers.
Many of these buildings were structured around large
central courtyards with smaller secondary courtyards
delineated by the wards. Many of these hospitals
resembled schools within the urban landscape, and this
building form permeated the urban hospital landscape
through the 19th century (Burpee, 2008).
HOSPITAL ARCHITECTURE REVOLUTIONS
55 54
The frst revolution
The hospital is the first building that was completely
determined by scientific and philosophical
concepts. Medical doctors were deeply involved in
revolutionizing the hospital, the reformers believed
that health primarily came, not from medical solutions,
but from creating a pure, natural environment that
provided clean air (Wagenaar, pp.29, 2006).
In the late 1700s The pavilion system became a very
influential form (Burpee, 2008). As medical science
progressed, the architectural environment that was seen
as the hospitals single most important healing feature
gradually lost importance. Now, the pavilions reflected
the growing specialization in the medical world, each
harboring its own dicipline and operating as a small
hospital in its own right, merely sharing collective facilities
(the kitchen for instance) with the other pavilions.
The second revolution
Nightingales approach to creating a healing
environment for patients not only looked at the physical
surroundings, but also looked at the social welfare of
her patients. She focused on providing patients with
access to natural light, air, landscape, attention to diet,
as well as a cleanly, sanitary environment.
The inclusion of environmental factors that contribute
positively to healing in preference to any other design
element represents the foundation to evidence based
design, a contemporary movement and influence in
hospital building today (Wagenaar, 2006).
The invention of the X-ray machine was a great invention
of medical technology but on the other hand changed
the character of the hospital. Eventually this led to a
social turn around: as soon as hospital developed into
the pinnacle of medical science and technology. As a
consequence, the hospital service became out of reach
for the poorest classes.
57 56
Revolution of hospitals
Source: Wagenaar, Cor (ed.). 2006.
Illustration: Longe Olsson, 2013.
The third revolution : hospitals for the masses
Hospital architecture became synthetic: a combination
of three functionally very distinct parts patient
wards, a concentration of facilities for the medical
treatment of the patients and outpatient wards.
Clearly expressing the functions of these different
parts, the International Style in hospital architecture
culminated in a series of types that are often named
after the letters they resemble: the T-type, K-type, etc.
Through time, with the progression of diagnostic and
treatment facilities, this platform has gotten bigger
and taller. Mega hospitals are limiting access to the
aspects of natural air, light, and view that Nightingale
attributed to her patients well-being. Designers
and builders maximized the machine-like efficiency
of hospitals without evaluating how these changes
in form related to human health, stress, and comfort.

The fourth revolution : empowering the patient
Modern society, fully planned and controlled,
appeared to limit peoples personal life by subordinating
almost everything to bureaucratic institutions were
unaware to the personal concerns of the people
they served. In the hospital similar attitudes prevailed.
Patients were not treated as person, but rather as a
collection of possible diseases, all of which were the
exclusive domain of medical specialists.
The ffth revolution : returning the hospital to the
people
The institutionalized healthcare system, all over the world,
are facing fundamental changes, allowing the hospital
to thrust aside its character as an isolated, secluded
fortress where the medical world controls according to
its own rules and conventions. Healthcare professionals
still tend to focus on the disease within the person
rather than on the person with the disease (Wolf, 2012).
The fifth revolution should initiate a return to the basic
principles of decent management, empowerment of the
patient, de-institutionalization, and the courage to re-
conceptualize healthcare. Will the traditional hospital
disintegrate and be decentralized and become more
aware of its real functional requirements and its position
as a social institution? Will it succed in breaking down the
mental barriers between necessary and recreational
health promotion? Can it be transformed into a luxurious
department store? There is no way to tell. The only
certainty is that this it a propitious time for fundamental
change and it has only just begun (Wagenaar, 2006).
59 58
Swedish Healthcare
T
he Swedish healthcare system is undergoing rapid and dramatic changes
simultaneously with a period of heavy investment in new healthcare buildings.
These changes are dependent on a number of factors such as the medical
and medical technology, population growth, changing values, and thus changes in
demand, changes in illness among the population due age structure and lifestyles,
changing economic conditions, etc.
Large parts of the Swedish healthcare buildings are from 60s and 70s. These
timeworn care facilities require extensive renovations or new construction to adapt
todays demands. Therefore many of Swedens county councils/regions planned
and invested in construction of wards. Now it is a unique opportunity to build using
evidence based design in order to these new buildings perform for approximately
30-40 years. Because of this development, health care providers are forced to put
pressure on developing the quality of health care. Healthcare Architecture in Sweden
is today recognized as an important factor to achieve these goals
Since the 1980s, many Western European countries have tried to reduce the number
of hospitalized care beds in hospitals to transfer care to other health care facilities
and homes. Meanwhile, hospital stays have become shorter and more specialized,
those on the wards tend to be more severely ill and require more intensive care.
These changes have resulted in a decrease in the number of hospital beds and a
decreasing average length of stay. Sweden has changed from international to have
one of the highest number hospital beds/1000 inhabitants to one of the lowest.
SWEDISH HEALTHCARE
The increase in chronic diseases and many frail elderly people, who are treated
outside the hospital rather than in long-term hospitalization, means that an increasing
number of them are, many repeated entries for the year. Today is single patient room
becoming standard in new and renovated buildings. This places new demands on
staffing and organization of care and the design of the ward and its support facilities.
This, in turn, constant demands for changes in buildings and premises, alterations
that need to be carried out without disrupting ongoing care operations. Health
care buildings with general layouts and flexible, rebuilding friendly technical building
systems and installations are equipped to handle with this.
T
he planning for the care of buildings in Sweden today is also characterized
by decentralization. Knowledge about health care buildings in Sweden
have followed the changes in health care policy from a more centralized to
a decentralized structure. Through decentralization that took place during the
latter part of the 1900s also reduced the need for central support and control of
healthcare construction. SPRI (Healthcare Planning and Restructuring Institute) who
had previously been responsible for research and development in the field of heath
care building was closed down in the 90s. A further reason for the closure was the
conviction that Sweden in recent decades had built the number of hospitals that
were needed in the predictable future. With SPRIs closure was transferred primary
responsibility for knowledge development and planning of healthcare buildings to
individual counties. They have developed their own planning processes, tools and
central coordination. Benchmarking and sharing knowledge are often lacking.
What is also missing is the systematic management of research-based knowledge
(Chalmers centrum fr vrdens arkitektur, 2011 translate by author).
SWEDISH HEALTHCARE
61 60
Study Visits
Vega house, Gothenburg
V
ega house in Vegagatan 55 was introduced to the
author as a reference when she discussed person
centred care with Dr Helle Wijk, Associate professor
at Gothenburg University. According Wijk, the elderly
housing has quite strong approach of person centred care.
Built in 1896, it was a beautiful grand brick house, but
unfortunately demolished in the 1968. And on the same
place was built a new Vegahusen that divided into
three buildings with room for 138 residents. The houses
are newly renovated with bright modern apartments.
The operation is run by Stiftelsen lderdomshemmet in
Gothenburg.
In comparison with other elderly houses is that the
caregivers encourage residents to be active and make
their own decision. Physical environment in the house
also support the approach by providing with spaces
for many different activities such as a library, mini spa,
public restaurant, reminiscence room, winter garden, etc.
Qualities of the physical environment:
Rooms are generic and wide open make it possible
to rearrange the furniture and modify furnishings to
create the stimulation of all the senses, promote social
interaction and hence the willingness to participate in
the activity.
Activity room is located with a large opening towards
the central stairwell.
Most of the spaces are accessable. It is possible to
move around the room while sitting in a wheelchair or
walking with a walker
Good lighting and daylight.
Way finding in the building can be improve.
A spa with a tilting tub. It makes it easy to get in and out
even if residences need to transfer from a wheelchair
to the tub using a lift.
A library decorated in a traditional way. The room
can feel solemn but the layout planning makes it difficult
to move around and get close to the table if youre in
a wheelchair or walking with a walker and the heavy
bulky furniture make it difficult to change about.
Eating is a basic need of the senior. A quality of the
senior wants to senior housing to provide. The dining
room at Vega house is open seven days a week, not
only for residence but also for public. This allow for many
different people with different backgrounds to meet.
STUDY VISITS
spa with tilting tub
dining room on the ground level seating area in the pantry
common seating area
STUDY VISITS
63 62
Various activities with different theme often organized
in the dining room, where not only food and programs
varied, but the environment as far as possible. The
common areas generally designed to be easily modified
and used flexibly.
The garden is divided into different themes. The staffs
try as often as possible to open up the small wooden
building and offer something good to eat. This event
is very popular and attracts many of the residents to
come out and spend some time in the garden.
There is a reminiscence room on each floor, decorated
in the old style. These rooms are used for groups of
residents to gather. The interior of the room stimulate
activity through a link with a collective pictures of the
past to awaken memories and associations of the senior
as a group while the interior of the residents apartment
reflects the persons life in the present day.
Mixed old furniture from the old building and new
furniture.
The physical environment that can be improved:
Design of the corridor still has a hospital looks like by
change the colour and material of the wall and floor
can make a different atmosphere.
The library planning is not well planned and is not
accessable for wheelchair.
reminiscence room
piano in the dining area
STUDY VISITS
Sdra lvsborg Hospital, Bors
T
he Te-house is the new care facility at Sdra
lvsborg Hospital. It was completed in 2010. The
new care facility is a symbol of the development that
has been going on within the hospital in recent years.
The patient perspective was the starting point in the
planning of the Te-house and the development of the
care and the activities that the facility is intended
to support and make possible. In the work of both
designing the premises and choosing work models they
have put on the patients spectacles and have worked
at all times from the patients perspective. They want the
patient perspective to permeate all work done there.
Generally it doesnt feel like a hospital, and patients
therefore do not feel like theyre patients or that theyre
unwell, the design of the building its self-promoting
health and wellbeing. Even the staff has expressed that
they feel more cheerful and happier at work.
Qualities of the physical environment:
One of fundamental ideas is to unify the care given
to the patient. Every care unit is divided into three
identical modules where 7-8 patients receive care from
a cross-professional team. The traditional nurses office
the model
bright and wide corridor
STUDY VISITS
65 64
has been replaced by workstations that are located
centrally in each module to put the care staff close to
the patients for whom they are responsible.
In order for the care staff to have more time with
their patients, service staff handles stocks of linen,
pharmaceuticals and other material. Decentralization
of storages minimized the walking distance for the staff.
To reduce the risk of care-related infections, falls and
contribute to greater integrity for the patient, the T
house has 126 private rooms and there is room for two
patients in most of them if more capacity is needed.
Each of the rooms is equipped with patient lift, room
environment control, TV, adjustable chair for relatives
and an adjacent bathroom. Windows with low sill
window allowed wider visual contact for patient when
lying down in the bed. Sound reducing floor and ceiling
material application minimized the noise transmission.
The choice of environmental friendly material has also
been crucial because of the demand to have a non-
toxic indoor environment.
To reduce the risk of loneliness and create possibilities
for patients to meet, there are both small lounges in
the modules and a large central lounge with a wide
window bring a great daylight. The room provides with
a book shelf in each of the floors.
Furniture in the common room comfortable use by all,
including obese individuals. And also furnished by an
easy to maintain and loose textile.
Having the staff participating in the design process
has been of great importance to create an environment
that is both beautiful to look at, as well as practical that
fulfils all needs and hospital regulations. The response
from the patients has been positive.
By using different material on the ceiling and floor to
distinguish different areas in the hospital. Art elements
work as a landmark for a better way finding.
The chair provided in the patient room is not a very
relaxing for relatives to stay couple nights over.
Hard to find out the lights control.
Exposure of cables on the patient room wall should be
hiding for get more a home likeness.
Position of the bathroom better in the fore hand of the
patient bed.
By being in the hospital, the author learnt that the
smallest means, such as only adding colour, material
chosen to the physical environment can enrich the
whole experience of a hospital environment.
STUDY VISITS
art work
relative sitting area
path to the museum
kafetaria on the ground floor
reception area
view to corridor from the patient room
67 66
Sahlgrenska Hospital, Gothenburg
T
he ward moved into the building in June 2009. It
divided into 4 modules (3 teams and 1 physiotherapy)
and distinguish by different colour themes. The ward
has total 23 beds provide with single, double and triple
patient rooms. Every room has each own WC/Shower.
Qualities of the physical environment
Wood finishing on the door, wall panel gives warmth
atmosphere in the ward.
Big wide window and balconies in common rooms.
Transparency in staff area.
High ceiling level in the patient rooms
Small details in design can be extremely vital. For
instance, the dot sizes of glass film on of the reception
window screen make people feel dizzy when they
are moving. If the size of dots were smaller, would
work better.
Need more flexible space for the staffs and medical
students.
Staffs pantry is located inside the ward with
transparency toward corridor, gives incompletely
relax ambiance when the staff taking a break.
glass film on the reception window screen
activity area reception area
staff pantry room wall art in the corridor
STUDY VISITS
Karolinska Hospital in Huddinge, Stockholm
K
arolinska Hospital in Huddinge, Stockholm
was built 1972. The hospital facade may look
depressing, but inside the ward was surprisingly
great. It was planned in 2005 and finished 2011.
The interior of the ward is similar with the one in stra.
The core in the middle divided the ward into two
corridors. It has 2 light shafts that give a great quality
to the ward. Other facilities are Internet caf, common
kitchen, dayroom, wheelchair storage, silent room, etc.
The ward provides with 24 beds (2 double beds and
20 single rooms) with a big accessible WC/D (6,2
m2) in each room. In the patient room there are bed
for relatives that build in the room wall, multifunctional
chair that function not only for seat but also sleep and
wheelchair.
The staff works in team consist of physician, nurse,
assistant nurse and students. In total there are 40
personals. One thing that the ward missed is flexibility
for the ward to grow. Since the planning in 2005, the
ward grows pretty speedily. Now days the areas for
the staff feel to small and can not fit the work need of
the staffs.
hidden single bed for relative
transparancy in the patients pantry area
staff pantry area internet cafe
corridor area
STUDY VISITS
69 68

New Karolinska Hospital, Stockholm
T
he new Karolinska hospital, will be open at the end
of 2016. One of the project goals is to provide highly
specialised healthcare and conduct basic research,
patient-focused clinical research and education.
Others goals are attractive human environments with
high architectonic values, efficient care process and
optimised utilisation of resources, general solutions that
permit continuous development of activities, a clear role
in the city, and sustainability perspective on all levels.
The programme area will be 228.000 m2 treatment,
41.000m2 laboratory, 17.000 tech support, 7.000 patient
hotel, 1.200 parking area and in total BTA 320.000 m2.
The New Karolinska Solna University Hospital has
been subject to the procurement process as a PPP
project (Private Public Partnership). The benefit of the
model is that the risk of delays as well as increased
costs are minimized when these risks are transferred to
the contractor to a large extent. Also, the contractor
(Skanska) is responsible for facility management for
an extended period of time after the completion of
buildings. This ensures that long-term and life-cycle
perspectives are implemented in the building process.
Another benefit is that the procurement model allows
for innovation, i.e. that the contractor has the possibility
to implement better solutions, new technology and
improvements during the building process.
Building concept consist of core building (treatment and
research), mantle building (support zone education/
administration) and links (public environment). The guiding
principle is the patient always first where the patients
safety, integrity and comfort are at the centre. Patients
will meet a state-of-the-art hospital where planning and
design have always been based on what will be best
for them. For example, all in-patient rooms will be single
rooms with shower and toilet and a bed for relatives to
spend the night.
NKS will be part of the future care system that is
based on all parts of the system interacting with
each other. The demanding, highly specialised care
at NKS is complemented by extended emergency
hospitals and specialist care outside the emergency
hospitals. Information services such as the Care Guide
(Vrdguiden) and communication between patients
and care providers will lead to a more efficient care of
the patients actual needs.
STUDY VISITS
entrance hall
single room for all inpatients heliport
emergency department
STUDY VISITS
71 70

Intensive Care Centrum, UMC Utrecht
T
he University Medical Center Utrecht (UMC Utrecht),
established in 1999, is a joint venture between three
institutions: the Academic Hospital Utrecht (AZU), the
oldest academic hospital in the Netherlands established
in 1817; the Wilhelmina Childrens Hospital (WKZ), named
after Queen Wilhelmina and established in 1888; and
the Medical Faculty Utrecht (MFU). The UMC Utrecht
is one of the largest healthcare organizations in the
Netherlands, with about 10,000 employees and
over 1,000 hospital beds. Its core activities are built
on gaining and sharing in order to ensure the highest
level of patient care, research, education and training.
The Society of Critical Care Medicine (SCCM)
has awarded the prestigious ICU Design Award to
the University Medical Center (UMC) Utrecht and
the Amsterdam firm of Valtos Architects for their
implementation of the Intensive Care Department at
UMC Utrecht. The ICU was built on the top of existing
building (90s) and took 5 years of planning. It consists of
4 ICU combined in 1 floor. .
UMC Utrecht has a modern ICU with 36 beds. Each room
is equipped with the latest technologies. All patients are
nursed in a separate room and have plenty of natural
light and views. The single room offer every patient
privacy, tranquillity and space. Each room hangs a clock
and planning board (the day, date and name of the
nurse and doctor) that ensures the patient orientation.
Decentralized staff areas and storages. Facilities with
great design of 6 hotel rooms for relatives, 4 inner
gardens, sufficient daylight and view to nature, dayroom,
staff pantry, 4 extra rooms that can be transform into
ICU in the future, if needed. It has concept sound of
silence to provide the ICU with a peaceful environment;
therefore there is no alarm in the ICU instead the staff
has a special pager.
I was really impressed by every single design in the ICU,
it was thoughtful and a really person centred design
great example. It is not only focus on the patient centred
care but also focus on the staffs. Staffs only do what
they educated for in order to get maximum results. For
instance; nurses take care patient only, logistic staffs
handle supply, etc. The ICU dont add more money for
the job specialisation, what they do is just re-shifting
budget and stay on the budget.
STUDY VISITS
waiting area
staff pantry
inner garden
staff station
ICU reception area
patient room
73 72
Smart textiles library, Bors
T
he Textile Material Library is an information centre
of all sorts of innovative textile materials and
product samples. It constitutes a natural resource and
sounding board for product development-related
challanges in the creation process from idea to finished
textile applications and products. The Textile Material
Library provides an interface and a market-window
between the academy, research and industry where
many highly skilled professionals can share thoughts,
ideas and problems to be solved (smarttextiles.se).
It has many sorts of innovative textile materials such as
thermo-cromic print, translucent concrete, paper carpet,
medical mask, glow in the dark curtain, electronic textile,
etc. The materials inspire author with ideas that might
use for the project.
On the picture to the left is a cotton thermo-cromic textile.
The sample have been made by reversible and water-
based Leuco dye-based thermo-chromic pigments with
27C as activation temperatures.
These inks are temperature sensitive compounds,
developed in the 1970s that temporarily change color
when heated/chilled.
innovative textile samples
thermo-chromic textile
STUDY VISITS
The Diagnosis
Chronic heart failure (CHF)
C
HF is a disease where the heart pumps less blood to
the body, typically taking a long time to develop. If
people have heart failure the heart has lost the ability to
pump in enough blood to meet the bodys needs. The most
common cause of heart failure is coronary artery disease.
Other causes that damage our heart and lead to heart
failure include:
High blood pressure
Diabetes
Diseased, infected or damaged heart valves
Diseased, infected or damaged heart muscle
Irregular heartbeats (arrhythmias)
Heart defects
Poisons or substance abuse
Lung diseases
Breathing problems during sleep (sleep apnea)
Treatments For Heart Failure
Treatments for heart failure include medications,
lifestyle changes or an extreme heart failure heartbeat
assisting devices or surgery.
Diuretic medication reduces the swelling in persons
body by increasing the amount of urine produced by
persons kidneys.
ACE inhibitors are medications that allow persons
blood vessels to expand. This helps decrease persons
blood pressure and prevents further damage to the
heart by making it easier for the heart to pump blood.
Beta-blockers are medications that blocked the effects
of stress hormones on persons heart. Although beta-
blocker slow downs persons heartbeat, they are mainly
used to protect the heart muscle from the long-term
damage caused by stress hormones.
Preventive measures to keep the heart healthy need
some lifestyle changes including: exercising on a regular
basis, maintaining a healthy weight, quitting smoking,
limiting salt and alcohol, and eating a heart healthy diet.
THE DIAGNOSIS
75 74 THE SITE
The Site
T
he hospital area was built during the years 1968-1978. A few buildings
have been built in the area after that time, such as the psychiatric
building from 2007. stra is characterized by the houses in park-
principle. The 6-10 story lamellas with supporting 1-2 story buildings are the
most common and dominant building type. The higher buildings are made
with prefabricated concrete element with exposed ballast of Danish sea
stone. The buildings have dark horizontal window strips on the facade and
stands in sharp contrast to the green surroundings. The lower parts are
covered in with dark green reflective glass sheets.
stra Hospital consists of several buildings spread out on a sloping land.
The main entrance is located in the northwest with close connection to the
majority of the public transport. The main entrance is used by most people,
both personnel, patients and visitors. From the main entrance people are
further being referred to other parts of the hospital.
Parking facilities will be spread throughout the area while the ambulance
will enter the area from the east where it has access to all the complexes
emergency establishments. Many of the aging facades need to be
modernised due to the increasingly high-energy demands from the region.
THE SITE
77 76
Tram stop
Main entrance
PK (Psychiatric Clinic)
IK (Infection Clinic)
KK (Womens Clinic)
The project building
CK (Adult Clinic)
MC
SH (Service Building)
Emergency
New Childrens Hospital
Existing Childrens Hospital
1
2
3
4
5
6
7
8
Parking
Bus stop
Tram stop
Main entrance
PK (Psychiatric Clinic)
IK (Infection Clinic)
KK (Womens Clinic)
The project building
CK (Adult Clinic)
MC
SH (Service Building)
Emergency
New Childrens Hospital
Existing Childrens Hospital
1
2
3
4
5
6
7
8
Parking
Bus stop
N
N
THE SITE
THE SITE
main entrance CK building - stra Hospital
dark green reflective glass sheets inside garden
corridor to the main lift to the ward seating area in main lobby seating area close to cafe
prefabricated concrete element with
exposed ballast of Danish sea stone
79 78 THE WARD
The Ward
T
he project is implemented in the internal medicine
unit (Avd. 352A) stra Hospital. It is located in the
fifth floor of the southern part of the CK building.
In the fifth floor there are 4 different wards with 2
different managements access by lifts in the middle of
the building. There are 2 different lifts, the main one is
used by most of visitors and the other one is lift for bed
transportation.
The ward handles persons with heart and liver diseases,
gastroenteritis and eating disorder. During 2012, 1178
patients were admitted at the ward compare with
diabetes unit 995 patients. At the ward the average
length of hospital stay is 5,6 days and at diabetes unit
6,7 days. A day at the ward costs approximately 5600
sek (Wolf,2012).
N
4 pat
Shaft
Stair
Electrical
WC
WC
Nurse
station
Nurse
station
Day room
1 pat 1 pat
4 pat 1-2 pat
Corridor
Treatment Sanitation Waste
Powder
room Shower
WC WC
WC
WC
Day room
Exp
Tel
Nurse station
Corridor
WC
WC
WC WC Tel
Lift hall
4 pat 2 pat 2 pat
Shaft
Ofce
Ofce Exp
WC
Shaft
Conveyor
Schakt
Transp Station
Transp Station
Staf
pantry Exp
Meeting room
Exp Exp Meeting room
Waiting room
Stair
Shaft
Electrical
Ofce
Meeting
WC
WC WC
WC
Shower
Medicine
room
D
e
p
a
rtm
e
n
t b
o
u
n
d
a
ry
4 pat
1 pat 1 pat
4 pat 1-2 pat Day room
Exp
4 pat 2 pat 2 pat
Exp Exp Exp
Ofce Treatment Sanitation Waste
Shower
room
Shower
room
352 A
352 B
Single Room
20 m
2
Double Room
20 m
2
4 beds
35 m
2
Inside of the unit there are 3 rooms of 4 beds, 3 rooms
of 2 beds and two of single patient rooms. Only the
single rooms have a private bathroom. In total there are
20 patient beds.
THE EXISTING FLOOR PLAN
THE EXISTING PATIENT ROOM MODULE Only the single rooms are equipped with attached sink and restroom, however there are
no shower possibilities. All of the rooms have a window view to the outside, and still it is
only one of the patients in double rooms and two in the four bed rooms that could enjoy
the view. Curtains are the main space separating methods and they are used all the time.
More capacity of patient room is needed; some cases patients stay in an office room,
a treatment room or share room with other 4 patients in a small room. They dont have
chooses due the lack of spaces.
double patient room patient chair
curtain separating the space patient door room
THE WARD
81 80
S
taff rooms, storages (clean and waste), services room mainly located
in the middle core separated the two wards into two corridors with
no sufficient daylight and fresh air. The great problem in those rooms
are have no enough strorages.
Corridor has standard hospital width (2,5m) and there are two sided small
storages in corridor wall that can be open from the patient room as well.
Wall paintings covering the white and ivory painted wall, uncomfortable
work environment. lack of storage room, outdated furniture, insufficient
light sources.
There is a common kitchen room in the southern part of the ward that
is shared with the other ward (diabetes, avd. 352B). It has good quality
with a big wide window toward south offers views to nature. What missing
is an atmosphere of ease and possibility for activities. It has not enough
storage considering that it should serve for both of the wards (40 people).
The ward has a medical room that connected to the other ward. It has
bright wall color and adequate lighting. and has higher ceiling height than
in the corridor. Sound pressure isolating doors provided for a quiet escape,
and supported the needed proper medication storage temperature.
There are few environment qualities in the ward but overall atmosphere is
depressing, old and untidy.
THE WARD
art work in the corridor patient dayroom
seating room in the end of corridor common pantry area common pantry area
physician rooms are isolated nurse station long corridor
manager room nurse station window nurse station
dayroom
83 82
?
?
?
?
1
2
3
?
4
?
?
4 pat
Shaft
Stair
Electrical
WC
WC
Nurse
station
Nurse
station
Day room
1 pat 1 pat
4 pat 1-2 pat
Corridor
Powder
room Shower
WC WC
WC
WC
Day room
Exp
Tel
Nurse station
Corridor
WC
WC
WC WC Tel
Lift hall
4 pat 2 pat 2 pat
Shaft
Ofce
Ofce Exp
WC
Shaft
Conveyor
Schakt
Transp Station
Transp Station
Staf
pantry Exp
Meeting room
Waiting room
Stair
Shaft
Electrical
Ofce
Meeting
WC
WC WC
WC
Shower
Medicine
room
D
e
p
a
rtm
e
n
t b
o
u
n
d
a
ry
4 pat
1 pat 1 pat
Exp
4 pat 2 pat 2 pat
Exp Exp Exp
Ofce Treatment Sanitation Waste
Shower
room
Shower
room
N
THE WARD
Wayfnding Analysis
T
he ward is on the fifth level. The main access to the ward is by the main visitor lifts. Generally
wayfinding in the existing ward is used linear strategy - straight pathway, which quite
easy to understand. But still there are few spots that can be improved for more effectively
navigable especially in the node areas. From the wayfinding mapping above shows areas where
wayfinding can be improved. Nodes mark points where wayfinding decisions are made. Its
important to provide memorable informations (landmarks) at critical locations (node areas) for
better wayfinding. Landmarks are often physical structures such as a signage, artworks, maps,
human sources of information (information desks), directories, shape, color, texture, light, and
sound. Using a consistent and logical layering of cues creates the best opportunity for visitors to
orient themselves to the ward.
65 m
Paths
Nodes
Landmarks / signs
Unclear way finding
Edges
(see pictures to the right) 1-4
?
14 m
WAYFINDING MAPPING
2 1
4 3
On the map marks present which areas that have no signage (see picture 3) or Some spots
have not provide with a clear information access that it needed. For instance, many buttons in the
beginning of the main entrances, but there are no information which one to press (see picture 2).
Also the size of the signs above the ward entrances are not big enough to be able to see from 14
m length distance (see picture 4), which give ineffective way finding. Another disadvantage of the
way finding is in the end of the ward corridor, to the common area. There is no sign appeared in
the common area that gives sign that the room is for both of the wards. One has no clue if they
are allowed to use the common area or to pass through to the other ward.
Paths
Nodes
Landmarks / signs
Unclear way finding
Edges
?
Paths
Nodes
Landmarks / signs
Unclear way finding
Edges
?
THE WARD
85 84
T O
W S
Stressful noise in the whole ward
Corridor: Long, unattractive and fast phase corridor. There is no room for everything
Patient room: ugly, cold, rough. Have no enough patient rooms
Multi-bed patient room: are not accessible, too small spaces, no privacy, curtain
covered the view, sink position is to tight, no privacy, no spare room, no sound prof,
terrible lighting, no ability to rest properly due to noises, hard way for good night sleep,
uncomfortable place for relatives, radio station often not work, no sense of control or
patients personalization.
Nurse station: is not sufcient there is no space for the staf to work comfortably and be
efcient, have no sufcient lighting, no fresh air
Kitchen area: Sometimes stafs use it for meeting, which make patient hesitate to go
there. Trolleys are everywhere, doesnt have enough storage
Medicine room: no enough storage
Furniture: Use a mobile station - many distractions, outdated furniture,
Stafs Need: A calm place with relaxing music, nice view, beautiful art and place to seat,
where the can relax, but still have the opportunity to stay aware if a patient is in a need
Culture: Belief that they have practice the approach
Physician rooms: are isolated, have no views of nature
Bathroom: outside the patient room - risky to fall, infection, more work for the staf.
Have no enough storage, disorganised.
Patient room: Big window, a lot of daylight
Kitchen area: with a good view and many opening,
patient and staf can meet there.
Furniture: mobile station - closer to patient, more efec-
tive
Communication: staf - staf with mobile phone or
computer system
Medical room: less interruptions from sound and noise,
good lighting.
Stafs pantry: Outside the ward area but close enough
Stafs obstruction: every 4 minutes, report on the end of the day medical error, load
of work, no control, unpredictable things happens, no rest time
Healthcare management system: relatives cannot stay over, decision always change all
the time,
Technology: Missing link in the IT system, everyone get every message
Culture: Extremely difcult to change culture, behaviour and habit
If is not unnecessary/urgent, stafs prefer that relatives dont stay over. Its because
patients tend to more spoil when relatives are around.
Technology : IPAD
Social: Gratitude of patients, some one to listen, working
closer with patients
Room needed: single patient room, a place to do some
activities as a positive attraction
Zoning: Decentralize work area
Future plan: to change the building faade can be a great
reason reorganized the layout of the ward, provide the
ward all the rooms that needed, to have balcony for get a
fresh air.
Education: PCC
THE WARD
SWOT - Analysis

Data collection from the interviews were sorted and grouped in the SWOT-analysis below. The analysis provides
programs and organizations with a clear, easy-to-read map of internal and external factors that may help or
harm a project, by listing and organizing a projects Strengths, Weaknesses, Opportunities, and Threats. SWOT
can clearly show a program its chances for success, given present environmental factors.
dark and unorganized toilet area storages in the toilet area medicine room
toilet room seating area in the patient room 2 sided door storage cabinet supply room
shower room staff common pantry room
87 86
D
e
p
a
r
t
m
e
n
t
b
o
u
n
d
a
r
y
4 pat
Shaft
Stair
Electrical
WC
WC
Nurse
station
Nurse
station
Day room
1 pat 1 pat
4 pat 1-2 pat
Corridor
Shower
room
Shower
WC WC
WC
WC
Day room
Exp
Tel
Nurse station
Corridor
WC
WC
WC WC
Tel
Lift hall
4 pat 2 pat 2 pat
Shaft
Ofce
Corridor
Corridor
Ofce Exp
WC
Shaft
Conveyor
Schakt
Transp Station
Transp Station
Staf
pantry
Exp
Meeting room
Waiting room
Stair
Shaft
Electrical
Ofce
Meeting
WC
WC WC
WC
Shower
Medicine
room
Entrance
Many obstructions
More quite space
Dark area
Unsafe spot, slippery, many fall cases
Need more storages
Too small and tight area
Unattractive area
Good daylight
Trolleys parking
Noisy area
Have no views to outside
Have view to outside
Adequate lighting
4 pat 1 pat 1 pat 4 pat 1-2 pat Day room Exp 4 pat 2 pat 2 pat
Staf
dayroom
Nurse
station
Staf
breakfast
room
Shower
room
352 A
352 B
MENTAL MAPPING
THE WARD
N
Mental Mapping - Analysis

The data collected from the interviews with staff and the author own observation
were illustrated using this mental map below. The concept of a mental map refers to
persons personal point-of-view perception of space that focus on the quality of an
environment in terms of feelings such as fear, desire and stress.
THE WARD
89 88
Notes on hearing
The Preparatory Research
Three Perspectives
Involving patients, families & professional staff in the
innovation design process to deepen the value of
solutions and accurately uncover needs, issues and
values.
Patient perspective
T
he average stay of a patient is about a week but it
can vary depending on complications and individual
factors. Most of the patients who have CHF and liver
diseases are elderly, on the other hand for eating
disorder patients are average teenager. Generally,
patients spend most of their time in the patient room
with low mobility, defined as being limited to a bed or
chair. According to Brown, 2009 mobilization of older
adult patients occurs infrequently, with only 27% of
patients walking in the hallways during hospitalization.
From the observation discovered that most patients
prefer to open the door almost all the time. Since most
of the time they are lying on bed in will nice to see
something going on in the corridor and they feel safer
because they know someone can see them.
While being treated in the state of recovery the patients
are quite fragile and vulnerable for stress, confusion and
anxiety. The patient needs to believe and be motivated
that they will recover and they will have life to come
back, this can be enhanced by the familys presence
and staffs encouragement. The patients can have family
visiting from morning until 22.00.
On the matter of the patient understanding, some of
the most stressful factors are the lack of privacy, no
ability to rest properly because of noises, uncomfortable
area for relatives, the absence of personalization since
there are many people in the same room.
THREE PERSPECTIVES
91 90
4 pat
Shaft
Stair
Electrical
WC
WC
Nurse
station
Nurse
station
Day room
1 pat 1 pat
4 pat 1-2 pat
Treatment
Sanitation Waste
Powder
room
Shower
WC WC
WC
WC
Day room Exp
Tel
Nurse station
WC
WC
WC WC Tel
Lift hall
4 pat 2 pat 2 pat
Shaft
Ofce Exp
WC
Shaft
Conveyor
Schakt
Transp Station
Transp Station
Staf
pantry Exp
Meeting room
Waiting room
Stair
Shaft
Electrical
Ofce
Meeting
WC
WC WC
WC
Shower
Medicine
room
Day room 4 pat
1 pat 1 pat
4 pat 1-2 pat Exp 4 pat 2 pat 2 pat
Ofce Treatment
Powder
room
Shower
Storage
room
D
e
p
a
rtm
e
n
t b
o
u
n
d
a
ry
Nurse station
Staf
dayroom
Nurse
station
Staf
breakfast
room
N
More than 16 hours/day
30 minutes - 3 hours/day
15 minutes - 1 hour/day
Less than 15 minutes/day
What do you miss in the physical space of the room?
Calm and peace.
Theres a lot of noise all the time.
anynomous patient in internal medicine ward, stra
PATIENT CIRCULATION MAPPING

THREE PERSPECTIVES
Relatives perspective
A
ccording to the interview with staffs, mostly the family
and friends are the motors that drove patients to go
to the hospital. They are emotional and psychological
victims of the same injury that affects the patients.
From a health care seminar at Chalmers, 2012
discovered that :
All the relatives express that when they are in the
unit, they wish to be close to the patient. The relatives
need to be so close to the patient that they can touch
him/her and participate in the daily care.
Interaction does not only consist of words, but to a
large degree of touch.
If relatives are not very close to the patient, then they
prefer not to be in the hospital area.
The spaces for relatives in the units are primarily used
to spend waiting time.
Most relatives prefer waiting areas close to the ward,
from where they can keep an eye on what goes on.
Previous studies have shown:
Patient pain is reduced and physiological outcomes
improve as a direct result of social support from
nurses, families and significant others in the hospital
environment.
In Finland, researchers found that in 193 bypass
grafting patients, when inner-hospital social support
was high, the patients experienced less fear and
anxiety.
Social support in regards to patient-family social
interaction helped patients physiological outcomes
and enhanced patient progress.
Family presence and their social support through
touching, talking, and surveillance helped patients to
deal with their treatments better and facilitated their
clinical progress.
Social support for families also reduces family stress
in addition to patient stress, and enhances a familys
satisfaction of a particular hospital (Ulrich, 2008).
THREE PERSPECTIVES
93 92
The typical work shift (6.45-15.30)
Arrival
Changing clothes
Receiving briefing
Studying a report from night shift
Filling up with supplies and medication
Controlling 5 patients with a nurse in a team
(urine & blood samples, blood pressures,
medicine, etc)
Doctors around
Patient care/ daily maintenance
(washing, cleaning or shaving)
N
Serving breakfast (patient room or dayroom)
Throwing garbage to the waste room
Staff breakfast
Discussing patients cases with a nurse
A cleaning staff around
Lunch staff (11.00-11.45 or 11.45-12.30)
Handling patients
Booking patients food
Serving lunch (patient room or dayroom)
Controlling patients
Staff briefing
Writing journal
Going home
65 m
1
2

m
1
2

m
The figure above is a rough sketch showing the movement of an assistance nurse
during a shift. Such a diagram is typically daily routine, with lots of spaghetti representing
wasteful movement. Total average the nurse walking distance was around 10 km.
THREE PERSPECTIVES
Staff perspective
The state of employees
T
here are few different types of employees that
working within the ward: nurses, assistant nurses,
doctors, cleaning and maintenance staffs. Some of
them work more frequently than others in the ward.
Space in the rooms is not sufficient there is no space
for the staff to work comfortably and be efficient, there
is no room for the relatives, and quite often there is
not enough room for the patients themselves. The same
account for the corridor space, there is no room for
everything and there is hardly space for the patient.
The corridor is the main path walk for the staff and it
does not feel at all that is for the patient.
For the caregivers to be able to maintain their ability to work
it is vital that they manage to keep their professionalism
and distance while still being emphatic and friendly when
dealing with the patients and relatives. The healthcare
staffs working with the patient would be burned out
from stress and have harder time to cope with grief if
the staff patient relationship would be compromised.
Care staff and patient relationship
Visual communication and the possibility for nurse to
see the patient state before they summarize it for the
physician are extremely important.
A journal written for the patient called team decision,
which is on understandable language for the patient
is given to each hospitalized person. While performing
treatment and diagnosis on the patient it is important
to communicate and discuss it with the patient (why
they are in the hospital, what is their current condition,
what is the healing plan, and when they are expected
to be checked out).
Most nurses prefer that patients with acute condition
to be close to the nurse station, therefore they can
keep an eye on them constantly.
Care staff and patients relatives relationship
If the condition of patient not critical/acute, staffs prefer
that relatives dont stay over. Its because patients tend
to more spoil when relatives are around. And also if the
visitor are stressed it might transfer to the patient who
are even more needs encouragement.
THREE PERSPECTIVES
95 94
4 pat
Shaft
Stair
Electrical
WC
WC
Nurse
station
Nurse
station
Day room
1 pat 1 pat
4 pat 1-2 pat
Powder
room Shower
WC WC
WC
WC
Day room
Exp
Tel
Nurse station
WC
WC
WC WC Tel
Lift hall
4 pat 2 pat 2 pat
Shaft
Ofce Exp
WC
Shaft
Conveyor
Schakt
Transp Station
Transp Station
Staf
pantry
Exp
Meeting room
Waiting room
Stair
Shaft
Electrical
Ofce
Meeting
WC
WC WC
WC
Shower
D
e
p
a
rtm
e
n
t b
o
u
n
d
a
ry
4 pat
1 pat 1 pat
Exp
4 pat 2 pat 2 pat
Exp Exp Exp
Ofce
Shower
room
Shower
room
Nurse
station
Staf
dayroom
Staf
breakfast
room
Medicine
room
N
More than 2 hours/day
1 hours - 2 hours/day
15 minutes - 1 hour/day
Less than 15 minutes/day
Short cut access
to the other ward
The map shows a simply version of the previous staff flow. The figure shows assumption
numbers of how many minutes or hours the staff spends in the each room functions based
on the observation. The staff spends more time in multi-bedroom than in single bedroom.
Clearly it shows that the staff constantly walking and the corridor is the main pathway.
It generally illustrates staff main flow from: patient room waste room supply room
- patient room - nurse station and it repeats continuously. The map also shows the
centralization of the storage lead to inefficient working. Also more walking could result in
nurse fatigue and frustration, and therefore lower quality of patient care.
30 m
65 m
THREE PERSPECTIVES
STAFF CIRCULATION MAPPING
Staffs : in their own words
Some of answers from the staff questionnaire about
the existing physical environment in the internal medicine
ward, stra hospital.
Tight
Messy
chaotic
Long corridor
Bright
Ugly
Empathy
EASY TO FIND
Sterile
has no room for help aid
Smelly
stressful
has no meeting room
no privacy
LACK OF
STORAGE ROOM
noisy
too small
4 beds room doesnt works!
Muddy
Structured
Cold
THREE PERSPECTIVES
97 96
The toolkit
The Toolkit
I have used the result of the questionnaires and design quality checklist
as the tool kits. The tool kits function as a guide tool for planning and
designing the project. The data gathered from the questionnaires
compared with the data collected from literature studies, and however
the results are supported each other.
Questionniare Results
T
he results from the questionnaires both from patient and healthcare
professional is formulated in the figure on the page 98. The process
began by examining the needs, wants, and behaviours of the staff
and patient to affect with solutions. For more detail informations of the
questionnaire see Appendix.
Design Quality Checklist

T
he checklist was developed using Evidence based Design
researches, Person Centred Care researches, industry standards,
LEED Healthcare and Facility Guideline Institute requirements
and recommendations. LEED is a leading system for environmental
certification of buildings. The strength of LEED is that it takes a holistic
approach for identifying and implementing practical and measurable
green building design, construction, operations and maintenance
solutions. The author has summarized all the literature studies into the
checklist.
DESIGN QUALITY CHECKLIST
99 98
S EE H EAR C REATE
PHYSICIAN ROOMS are outside
the ward, isolated and have no
transparency.
Patient treatment plans are often
changed.
Ineffective communication
between staffs.
The major barrier of implementation
of person centred care is the
doctor.
Team area for the physician and
nurses instead of separation
workspaces could support for the
more effective communication
between staffs.
OFFICE AREA that located in the
middle core and the corridor area
have no sufficient daylight and fresh
air.
Staffs feel stressful.
Daylight gives a positive impact to
patient recovery process and reduce
staff stress level.
Relocate team area
Provide transparency walls, doors
and windows will transfer light to
the corridor and brighten up the
ward. It will reduce staff and patient
stress level.
THE CORRIDOR was often full of
help aid, chaotic, and too tight. The
existing corridor length is about 50
m straight without any possibility to
seat in between. The long corridors
that are often times predictable,
however, increase the distances
travelled by nurses daily, which can
ultimately lead to nurse fatigue
given their long hours and it means
lower quality care.

Tight and small space, too long,
ineffective space, noisy, boring
design, too small storage
Shorten the corridor by adding 4
junctions and place to seat.
Provide spaces for trollies and
help aids in the corridor area.
QUESTIONNAIRE RESULTS
S EE H EAR C REATE
Have no enough of PATIENT
ROOMS. Some cases patients
stayed in the office room, treatment
room/should squeeze with other 4
patients in a small room. The existing
patient rooms are too small both
for patients, relatives and staffs to
move around.
Ugly, cold, rough.
Have no enough patient rooms.
Patient in the double room happier
than in the single room. There is
always someone to talk in the
multibed rooms.
4 beds room doesnt works, not
support patients good night
sleep, too tight, no privacy.
There is no room for everything.
From the questionnaire results, I
discovered that single bedroom
gives better outcomes for persons
than double bedroom (see appen-
dix).
Single Patient Room to increase
inner-staff/patient communication,
better infection control, increase
patient satisfaction, increase
privacy, environmental control/com-
fort, increase social support and
decrease in medical errors.
Also provide another option,
double bedroom for people who
prefer not to be alone in the room
and anticipation to overcapacity.
RELATIVES AREA in most the
patient room is too tight and there
is no possiblity to have a comfort-
able place to stay overnight.
Relatives visitation is important for
the patient : 60% answered very
important and 30% important.
Relatives wish to be close to the
patient.
Relative area that close to
patient bed to increase social
interaction helped patients physio-
logical outcomes and enhanced
patient progress.
Common area for patient and
relatives to do activities and it
functions as a positive distraction.
QUESTIONNAIRE RESULTS
101 100
Space Types Users Evidence Level
Yes ? No
Reduce healthcare associated infections
x Quality 1 Single person room PR P +++
x Quality 2 Private toilet with shower and disinfection PR P
x Quality 3 Effective control measures during construction WW P, F, S ++
x Quality 4 Maximize HEPA (99.97%) filtration for appropriate hospital areas WW P, F, S +++
x Quality 5 Use UVGI on drip pans and cooling coils in ventilation systems PR P, F, S
x Quality 6 Well-maintained and -operated ventilation systems WW P, F, S ++
x Quality 7 Windows that open WW P, F, S
x Quality 8 Conveniently placed sinks, hand washing liquid & alcohol rubs PR, CS, SS, FS P, F, S ++
x Quality 9 Reduced furniture surface contamination WW P, F, S
x Quality 9.1 Surfaces are easily cleaned, with no surface joints or seams
x Quality 9.2 Surfaces are nonporous and smooth
x Quality 9.3 Materials for upholstery are nonporous
Yes ? No
Reduce person falls and associated injuries
x Quality 1 Single person room PR P +++
x Quality 2 Acuity adaptable rooms PR P ++
x Quality 3 Private toilet PR P
x Quality 3.1 Toilet door width PR P
x Quality 3..2 Bed exit alarm PR P
x Quality 3.3 Toilet on headwall PR P
x Quality 3.4 Handrail into toilet PR P
x Quality 3.5 Ceiling mounted lift into toilet PR S +++
x Quality 3.6 Non slip flooring PR P
x Quality 4 A family zone in patient room PR P, F +++
x Quality 5 Decentralized nurse station SS, CS S
x Quality 6 Decentralize staff support spaces (supplies, medications) CS
x Quality 7 Furniture features are ergonomic, safety, adjustable PR, CS, SS P, F, S ++
x Quality 7.1 Chair seat height is adjustable
x Quality 7.2 Chair has armrests
x Quality 7.3 Space beneath the chairs foot position changes
x Quality 7.4 Chairs are sturdy, stable and cannot be easily tipped over
x Quality 7.5 Rolling furniture includes locking rollers or casters
x Quality 7.6 Chairs have no sharp or hard edges that can injure patients who fall/trip
x Quality 8 Use carpet and rubber floors where appropriate WW P, F, S ++
D
E S I
G
N
H
C
Y
T
L A U
Q I
E C K
T
L
I
S
P : Patient
F : Family
S : Staff
PR : Patient Room
FS : Family Space
SS : Staff Space
CS : Circulation Space
WW : Whole Ward
+++
++ : Good
+ : Low evidence
: Strong evidence
Yes ? No
Decrease medication errors
x Quality 1 Decentralized nurse station
x Quality 2 Modurality design
x Quality 3 Adequate lighting levels in staff work areas CS, SS S ++
x Quality 3.1 Lighting fixtures provided 90-150 foot candle illumination CS, SS S
x Quality 3.2 Medication safety zone have an adjustable 50 watt high intensity lamp
x Quality 4 Provide adequate space for private work to minimize distractions CS, SS S ++
x Quality 5 Single patient rooms PR P
x Quality 6 Acuity adaptable rooms PR P ++
x Quality 7 A family zone in patient room PR P, F +++
x Quality 8 Good accoustic
Yes ? No
Improve communication and social support to patients and family members
x Quality 1 Provide a family zone in the patient room PR P +++
x Quality 2 Provide waiting rooms, lounges, and private family respite spaces
x Quality 3 Flexible, moveable and ergonomic furniture features FS F
x Quality 3.1 Flexible furniture and flexible groupings
x Quality 3.2 Wide size and age variations of furniture are supported FS F
x Quality 4 Acoustic
x Quality 5 Visual privacy are supported
x Quality 6 Non-instutitional design
Yes ? No
Improve communication and social support to patients & healthcare professionals
x Quality 1 Single person room
x Quality 2 Warm welcome environment (Non-instutitional design)
x Quality 3 Decentralize staff support spaces (supplies, medications) CS S ++
x Quality 4 Provide visual connections to facilitate information seeking & interaction PR, FS, SS P, F, S
x Quality 5 Improve wayfinding cues CS S
x Quality 5.1 Facilitate expectedness and openess in reception area
x Quality 5.2 Provide physical environment with good visibility
x Quality 5.3 Support accompaniment in design
x Quality 6 Provide a common space for patients, staffs and relatives
x Quality 7 Thoughtfulness in design that enhance care service
Yes ? No
Decrease patient, family member and staff stress and fatigue
x Quality 1 Single person room with private family area PR P, F +++
x Quality 2 Personalization of patient environment PR P +++
x Quality 3 Views of nature and secure access to nature CS P, F, S +++
x Quality 4.1 Orient patient rooms to maximize early-morning sun exposure PR P +++
x Quality 4.2 Provide interior light wells to allow for natural light in interior spaces FS, CS P, F, S
x Quality 4.3 Provide large windows for access to natural daylight in patient rooms PR P ++
x Quality 4.4 Provide natural light in as many occupiable spaces as possible WW P, F, S +++
x Quality 4.5 Provide high lighting levels (1,500 lux) for complex visual tasks CS S ++
x Quality 4.6 Provide windows in staff break rooms and all family areas FS, SS S ++
x Quality 4 Adequate light
103 102
Yes ? No
Decrease patient, family member and staff stress and fatigue
x Quality 5 Controllability of (lighting system, thermal comfort, glare) PR P ++
x Quality 6 Patient, relatives and staff privacy
x Quality 6.1 Provide a visual barrier between staff and family space in the patient room PR F
x Quality 6.2 Provide high acoustic ratings for confidential conversation CS P +++
x Quality 6.3 Provide private family spaces, either in or outside the patient room PR, FS P, F
x Quality 6.4 Provide private staff areas other than the staff break room CS S
x Quality 6.5 Use high-performance, sound-absorbing ceiling tiles WW P, F, S +++
x Quality 6.6 Consider sight angles of confidential document rooms for visual privacy PR P
x Quality 7 Materials suggest a link to nature WW P, F, S
x Quality 8 Strive for a comfortable and welcoming, non-institutional, visual aesthetic WW P, F, S ++
x Quality 9 Furniture is tested for safe and comfortable use by all
x Quality 10 Provide multiple spiritual spaces and haven areas FS P, F
x Quality 11 Provide positive distractions (art, music, etc.) WW P, F, S ++
Yes ? No
Improve sleep
x Quality 1 Single person room with private family area PR P, F +++
x Quality 2 Provide family sleeping space in patient rooms PR F
x Quality 3 Comfortable beds and bedding PR P, F
Quality 4 Reduce Noise WW P, F, S +++
Yes ? No
Improve staff effectiveness, efficiency and communication
x Quality 1 Study layouts & workspace ergonomics to maximize work efficiency WW
x Quality 2 Decentralized nurse station
x Quality 3 Decentralize staff support spaces (supplies, medications) CS S ++
x Quality 4 Provide private staff areas other than the staff break room SS S
x Quality 5 Provide flexible work spaces that accommodate a multitude of staff tasks CS S ++
x Quality 6 Provide spaces for interactive team work of varying sizes CS S ++
x Quality 7 Furniture is easily adjustable to individual workers ergonomic needs
x Quality 8 Design enables care coordination and information sharing
x Quality 9 Materials are sound absorbing
x Quality 10 Provide visual connections to facilitate information seeking & interaction PR, CS, SS P, F, S
Yes ? No
Maximize spatial standardization and flexibility
x Quality 1 Same-handed patient rooms PR P, S
x Quality 2 Standardize nurse station designs throught the nursing unit CS, SS S
x Quality 3 Standardize nursing floor layouts WW S
x Quality 4 Standardize treatment and exam room designs CS S
Yes ? No Improve environmental safety
x Quality 1 Used low-emetting Volatile organic compounds (VOC) & Perfluorinated compounds (PFCs) WW P, F, S
x Quality 2 Use materials with no PBDE or phthalates WW P, F, S
x Quality 3 Use not more than one: PBDE, PFA, urea-formaldehyde, phthalate and plasticizers WW P, F, S ++
x Quality 4 Use 100% lead and cadmium-free roofing, wiring and paint WW P, F, S
x Quality 5 Install low-mercury florescent lamps WW P, F, S
Yes ? No
Improve access and reduce spatial disorientation
x Quality 1 Provide visible and easily understood signage (theme approach) WW P, F, S
x Quality 2 Use common language in signs with logical room numbering WW P, F
Yes ? No
Represent the best investment
x Quality 1 Furniture features are durable, safety, and adjustable
x Quality 1.1 Integrate new with existing furniture for facility renovation projects
x Quality 1.2 Provide casters or glides to reduce floor damage
x Quality 1.3 No protuberances that may damage walls
x Quality 1.4 Manufacturer provides results of safety and durability testing
x Quality 1.6 Manufacturer includes a warranty appropriate to use
x Quality 2 Flexible design that support changing
WW P, F, S
WW P, F, S
CS S
WW P, F, S
WW P, F, S
WW P, F, S
Yes ? No
Maximize Technology Integration
x Quality 1 Adequate technology and data connection in all staff support spaces SS, CS S
x Quality 2 Data connections in all circulation spaces to allow for functional flexibility F, S
x Quality 3 Provide data connections in all family spaces FS F
x Quality 4 Provide the ability to conduct bedside data entry PR F, S
x Quality 5 Provide technological flexibility to enable changing models of care CS S
105 104
Design application
A great architect is not made by way of a brain
nearly so much as he is made by way of a cultivated,
enriched heart.
Frank Lloyd Wright
Design Vision
The future
Hospital organizations seek superior performance.
An architect ultimately has a responsibility to
design buildings that are sound in all aspects --
structurally, psychologically, and emotionally.
Evidence from science blended with art of architecture.
In June 2012, on an Evidence Based Practice
workshop Kirk Hamilton reported that a
highly respected physician claimed only 15%
of current medicine is based on evidence,
so Hamilton speculated that only 5% of
potentially useful evidence might be available
for architecture. EBD (science) itself is not
the answer to good architecture. Intuition
is a powerful and necessary tool that has
to be used, but used with a great caution!
(Lundin,2012)
The essential of human values and the complementary
support of technology.
Technology is constantly improving in
healthcare. The ideas of creating a healthier
hospital go hand in hand with creating a
partnership between the patient (and often
relatives) and healthcare professionals that is
based on respect and dignity. Returning the
hospital to the people and for the people has
just begun.
1
2
human
care love
warmth
trust
lively
spirit
social
technology
professional
support equipment
health
science
art
3
DESIGN VISION
107 106
Design Values
D
esign focused for people is an important pillars symbolizing
my design values. Person-centred design. It may integrate
technology and economics, but it starts with what humans
need, or might need. What makes life easier, more enjoyable? What
makes technology useful and usable? But that is more than simply
good ergonomics, putting the buttons in the right place. Its often about
understanding culture and context before we even know where to start
to have ideas. Design relate to their surrounding, cultural diversity,
innovation, and sustainable development.
Design is people
Jane Jacobs
DESIGN VALUES DESIGN PROPOSALS
Design Proposals
I propose 2 design proposals, major and minor intervention for the
renovation of the internal ward in stra Hospital.
The Major Intervention
T
he Major proposal is keeping the core of the structural building
like shafts, column and vertical communications, but it is required to
tire down the whole interior walls in order apply the ideal space
and room functions that is needed to get maximum results that support
healing process of patients and more effective work environment for the
staffs.
I propose to expand the area of the ward twice size bigger than the
existing one in order to fit more of single bedrooms, and it means taking
over the area of another ward will lead to changes in the management
system. The intervention also demands a high cost investment of money.
On the other hand, the design can pay for itself by improving service
efficiency, patient safety and satisfaction, as mentioned in the chapter
The Economic Benefit of Evidence Based Design.
The Minor Intervention
T
he second proposal is considering technically, organizationally
feasible and financially viable by limiting the cost of intervention.
Some of applicable interior solutions in the major intervention
such as furniture or product, etc could be implemented in the minor
intervention depending on the budget.
109 108
Major
intervention
MAJOR INTERVENTION
PATIENT ROOM
Waiting room
Single (16) and double (5) patient rooms
Patient lavotory with disinfection (21)
PATIENT COMMON AREA
Dayroom
Pantry
Mini library and winter garden with balcony
STAFF AREA
Reception room
Manager room
Team rooms (4)
Medicine rooms (2)
1.1
1.2
1.3
2.1
2.2
2.3
3.1
3.2
3.3
3.4
29 m
2
367 m
2
173.5 m
2
21 m
2
59 m
2
112 m
2
9,5 m
2
17 m
2
90 m
2
25,5 m
2
1.1
2.2
2.1
2.3
1.2
1.3
4.1
3.1
3.3
4.2
3.2
5.2
3.6
3.4
3.5
3.7
3.8
3.9
4.2
5.1
5.3
Sterilisation rooms (2)
Supply rooms (2
Meeting & multifunctional room
Relax room
Trolley storage room
STAFF COMMON AREA
Conference room with balcony
Dayroom with balcony
SERVICES
WC (3)
Waste disposal rooms (2)
Technical room
CORRIDOR
3.5
3.6
3.7
3.8
3.9
4.1
4.2
5.1
5.2
5.3
32.5 m
2
25.5 m
2
25 m
2
6.5 m
2
11.5 m
2
38 m
2
59 m
2
14.5 m
2
16 m
2
3.5 m
2
420 m
2
PRIVATE SEMI PRIVATE
SEMI PUBLIC/
SERVICES
PROGRAMMING UNIT 352A
111 110
In between
WHY?
Work efficiency, increase safety and working
satisfaction
HOW?
Decentralize nurse stations into 4 divisions and
decentralize storages
Pliability
WHY?
For future needs.
HOW?
Room planning in grid and module
Follow the structural core of the building
(columns, shafts, vertical communications)

$$ $
+ -
Design Concept
Be seen
WHY?
Ease atmosphere, better way finding for all users, more
safety feeling
HOW?
Transparant or translucent wall., Less wall, open work
spaces, Transparant patient door

$$ $
+ -
Matahari
WHY?
Daylight is an essencial element in healthcare, which
is contribute to healthier persons and more efficient
recovery process.
HOW?
Big wide window, low sill window, transparancy

$$ $
+ -

$$ $
+ -
MAJOR INTERVENTION
Bring greenery inside
WHY?
Mostly for its healing benefit
HOW?
Balcony garden (winter garden)
Redesign, Reuse and Recycle
WHY?
Good for environment
HOW?
Redesign existing furnitures
Reuse goods that have qualities
Use materials that can be recycle or from

$$ $
+ -

$$ $
+ -
Zoom in
WHY?
To find the solution from the details
HOW?
Putting oneself in the position of the person

$$ $
+ -
Shared space
WHY?
Encourage people to meet, do activities together,
where interactions and conversations
can naturally emerge.
HOW?
Create common spaces such as an activity room,
winter garden, mini library, seating area, etc
$$ $
+ -
MAJOR INTERVENTION
113 112
352 A
352 B
MAJOR INTERVENTION
FLOOR PLAN MAJOR INTERVENTION
Scale 1 : 250 N
Staff area, 243 m
2
Common patient area, 192 m
2
Services, 34 m
2
Common staff area, 97 m
2
Corridor, 420 m
2
Patient area, 540.5 m
2
MAJOR INTERVENTION
115 114
The design of the patient doors
transfer light to the corridor and brighten up the ward.
Section of the corridor.
MAJOR INTERVENTION
Scale 1 : 250 N
Strategy 1 :: Let the sunshine in
FUNCTION: THE WARD
CONDITION: Patients rooms and common areas have abundant of daylight through
the window, but office area that located in the middle core and the corridor area have
no sufficient daylight and fresh air.
PROPOSAL: Its important to get sufficient daylight to reduce stress and pain. By
providing transparency walls, doors and windows will brighten up the ward (see
the picture to the left). It will give a positive impact to patient recovery process and
reduce staff stress level. The doorframe made by wood for a warmth welcome, non-
institutional ambiance, good visual and timeless aesthetic. A translucent glass panel
door allows daylight transfer to the corridor and still provides patient dignity. Adding
a person nametag on the patient door instead of number. A contrast colour between
handle and the door panel will be really helpful for people with eye problems. (see
detail patient door). Providing the ward with big, deep and low window sill designs in
most of the room (see detail window).
MAJOR INTERVENTION
117 116
DETAIL WINDOW
Scale 1 : 50
DETAIL PATIENT DOOR
Scale 1 : 50
Olsson Svensson
DETAIL WINDOW
Scale 1 : 50
DETAIL PATIENT DOOR
Scale 1 : 50
Olsson Svensson
DETAIL WINDOW
Scale 1 : 50
DETAIL PATIENT DOOR
Scale 1 : 50
MAJOR INTERVENTION
Scale 1 : 250
Strategy 2 :: Shorten the corridor
FUNCTION: THE CORRIDOR
CONDITION: According to the survey, the staffs stated that the existing corridor was
often full of help aid, chaotic, and too tight. The existing corridor length is about 50 m
straight without any possibility to seat in between. And the walk distance for the staff
to walk pass to the other ward is approximate 40 m through the powder room and/or
the pantry area. The long corridors that are oftentimes predictable, however, increase
the distances travelled by nurses daily, which can ultimately lead to nurse fatigue given
their long hours and it means lower quality care.
PROPOSAL: The strategy is to shorten the corridor by adding 4 junctions in every 915
m length; providing seating area where people can do activities and providing small
storages for trollies and help aids in the corridor area. Total corridor area is around
423 m
2
.
N
MAJOR INTERVENTION
119 118
Single patient room module
Double bedroom module
MAJOR INTERVENTION
Scale 1 : 250
Strategy 3 :: 26 beds and 62% single patient room
FUNCTION: THE PATIENT ROOM
CONDITION: Inside of the unit there are 3 rooms of 4 beds, 3 rooms of 2 beds and
two of single patient rooms. Only the single rooms have a private bathroom. In total
there are 20 patient beds. Generally the ward needs more of patient rooms. Some
cases patients stayed in the office room, treatment room/should squeeze with other
4 patients in a small room. The existing patient rooms are too small both for patients,
relatives and staffs to move around.
PROPOSAL: Research has documented several key accomplishments that the private
patient room brings to a hospital: increased inner-staff/patient communication, better
infection control, increased patient satisfaction, increased privacy, environmental control/
comfort, increased social support and decrease in medical errors (Cullinan, 2010). Also
the staff questionnaire results strengthen the facts that single bedroom gives better
outcomes for persons than double bedroom (see appendix). Therefore, I propose mainly
single patient room, 16 beds. But also 5 double bedrooms to give another option for
people who prefer not to be alone in the room and anticipation to overcapacity. In
total 26 patient beds with total area of patient room is 540 m
2
.
N
MAJOR INTERVENTION
121 120
SECTION C-C
Scale 1 : 50
1. Provide a family zone in the patient room
2. Private toilet with shower and disinfection
3. Conveniently placed sinks, hand washing liquid,
dispensers and alcohol rubs
4. Hidden ceiling lift into toilet
5. Visual privacy are supported
6. Non-instutitional design
7. Views to outside
8. Large window sills to get maximum of daylight
9. Low window sills allow residents to look out when
lying in bed
10. Controllability of lighting system, thermal comfort,
glare
11. Sound-absorbing ceiling tiles
12. Rubber sound absorbent flooring with wood
motif.
13. Possibility to put TV and computer system
14. Adapted for wheelchair use
SECTION C-C
Scale 1 : 50
Quality of the patient room
MAJOR INTERVENTION
SINGLE ROOM MODULE
Scale 1 : 100
C C
D
D
SECTION D-D
Scale 1 : 50
SINGLE ROOM MODULE
Scale 1 : 100
SECTION D-D
Scale 1 : 50
MAJOR INTERVENTION
123 122
Staff area
Relatives area
Patient area
Bathroom with disinfection
Window design with angle. It gives
possibility to look outside while a
person seating on the chair, create
more space and an interesting
facade.
Position of the bed allows patient
to see through all over the patient
room.. View to the window, relatives
seating area, door area and wall
with a clock and white board for time
orientation, information and personal
message.
A private bathroom with disinfection
close to the patient bed.
Total area per single bedroom is 17,5
m
2
and 5,5 m
2
private bathroom.
MAJOR INTERVENTION
Here is a view from outside the patient room. This is a
sketching of storage and alco-gel cabinet. The panel for the
alco-gel station is in eye-catching colour that can be seen
easily. As a reminder,and a polite way to insist on cleanliness.
Alco-gel Cabinet
MAJOR INTERVENTION
125 124
Provide the staff area in the patient room
with enough storages to keep sanitation
stuffs and equipments that are needed for
more organize and tidier
Staff Water Basin
MAJOR INTERVENTION
Private bathroom is designed with handrail, non-slip and
easy to clean rubber flooring. The adding wall behind the
closet (vtrumskassett) functions to gives extra room for more
comfortable for person who helps a person to use the toilet.
Patient Bathroom
MAJOR INTERVENTION
127 126
Flexible sofa for relatives that can be use as bed as well by pull
down the two armrests in order to get more space to sleep.
The sofa made from white-pigmented ash wood. The white
pigment protects the wood from discolouration and easy to maintain
and clean.The fabric is used anti-fungal, anti-microbial surface
protection and prohibits the growth of bacterial and associated
odours, infection and cross contamination.
Flexible sofa
MAJOR INTERVENTION
DOUBLE ROOM MODULE
Scale 1 : 100
E E
SECTION E-E
Scale 1 : 50
DOUBLE ROOM MODULE
Scale 1 : 100
SECTION E-E
Scale 1 : 50
MAJOR INTERVENTION
129 128
Staff area Relatives area
Patient area Bathroom with disinfection
This sketch illustrates an acoustic strategy for
patient bed pod. The ceiling design help the
sound wave direct to bed rather that crossing
the room. So the volume between staff and
patient can be reduced.
The bed pod design helps to promote
a calmer environment, better privacy and
communication between patient and staffs in
double room.
Total area per double bedroom is 28,2 m
2
and
6,2 m
2
private bathroom.
Position of the bed opposite to each other allowing
both beds to have views to outside through low
window sills.
What do you miss in the physical
space of the room?
Calm and peace.
Theres a lot of noise all the time.
anynomous patient in internal medicine ward, stra
MAJOR INTERVENTION
The patient bed pod consists of a bed panel,
lighting, hidden ceiling lift, and small wardrobe.
Hidden ceiling lift produced by a company
called Integralift. It is a new safe patient handling
solution that enhances workflow efficiency, safety
and offers an aesthetic alternative to ceiling lifts.
The hidden ceiling lift consists of: 1) vertical cabinet,
2) top cabinet, 3) vertical structure, 4) lifter, 5) lifting
bar, 6) remote control, 7) sling and 8) down lights.
3
6
7
2
5
4
1
8
Patient Bed Pod
MAJOR INTERVENTION
131 130
Perspective Double Bedroom
All the patient room use rubber sound absorbent
flooring with wood motif. It provides a quiet,
extremely comfortable walking surface and resist
most chemicals. Low maintenance and no waxing
help reduce life cycle costs
Acoustic material for the furniture, ceiling tiles,
suspended ceiling to help reduce noise
Curtain for privacy
Place for relative
Low window sill
Positive or funny words written on the ceiling
could encourage person to think about good
things that can make them smile.
Dressing up the bed panel full of medical
equipment with nature figure for example, could
be slightly softening the institutional atmosphere.
Hidden ceiling lift
MAJOR INTERVENTION
133 132
Smart Matrass
This experiment gave me
a conceptual idea for an
intelligent matrass that cover
by hydro chromic can indicate
when fluid passed through
the hole site by changing
colour. Its immediately a
visual indicator telling nurses
that the matrass has been
compromised.
1 2
3 4
Here is my experiment using hydro-chromic ink that react to
moisture. There are two layers of ink on top of each other. When
moisture/water is applied, the top hydro-chromic layer goes clear
revealing the colour underneath.
MAJOR INTERVENTION
By provide a tool for patients where they can
shows their personal photo. It helps caregivers see
one, not as a patient, but as a person precious
to their family. The bag should be easily place on
any bed rail and wheelchair. Hand sanitizer, a
medical information card, notepad and pen, and
a TV remote control cover should be inside the
bag. A printed words on the bag as reminder for
patient and staff to always clean the hands.
Patient Bag
If someone are hard of hearing, or are allergic
to latex, they can post the message in the clip. It
gives safety feeling. Patient can put their personal
stuff such as glasses, hearing aid, etc close to their
reach. It shows the name that patient prefer to call.
One can display a favourite photo or the
answers to the questions on the card such as
Whats thing really make you laugh. What is your
favourite place? This tool helps staffs to get know
patient more as a person.
MAJOR INTERVENTION
135 134
Autumn
Summer
Winter
Spring
Use theme approach for the staff teams area and
the whole ward to provide visible and easily understood signage.
Simplicity in selection of textiles and materials, without being too cold,
creates a calmer space thats simple and easy to understand.
The theme appproch might encourage patients to walk in the
corridor instead of just lying in the bed,
to experience different seasons theme in the ward.
MAJOR INTERVENTION
Scale 1 : 250
Strategy 4 :: Decentralized staff team areas
FUNCTION: THE STAFF WORKING AREAS
CONDITION: Staff rooms in the middle core have no sufficient daylight and fresh air. The
ward has 2 division of nurse stations, but the centralized of storages (waste and clean)
increase the distance travelled by nurses. It means low work efficiency. Its good for
nurses, who get to spend more time on direct patient care and less time running around.
That leads to higher job satisfaction. Happy nurses are also engaged nurses. Research
shows that organizations in all industries that have a high level of engagement among
their employees can outperform their competition by 20%. (Herman Miller Healthcare,
2010).
PROPOSAL: One of the questionnaire results about the major barrier of implementation
of Person Centred care was doctors. It was the third most answered after lack of time
and staffs. After compared it with the interview results. I have found out that one of
the real problems is a communication problem. Therefore, I suggest having a teamwork
space, instead of separation work areas between nurses and physicians. This could
help for a better communication between staff and staff. Decentralized staff team area
into 4 teams with big window to get sufficient daylight, air and view. Decentralized
workstation and storages, 2 in the middle core. Staff areas consist of 1 reception, 4
team areas, 1 private office room, 2 meeting rooms, 1 relax room, 2 supply rooms, 2
disinfection rooms, 2 medicine rooms, and 1 manager room.
N
MAJOR INTERVENTION
137 136
Perspective Nurse Station
It has view to outside and provide with adequate
daylight to reduce stress
Transparency wall of the staff areas are not only
to transfer light into corridor but also can be seen
as a warm welcome for the visitors
Season theme for better way finding and visibility
Acoustic materials for floor, ceiling and furniture
Adjustable desk and chair to reduce person falls
or injuries
There are 4 nurse stations in the ward
MAJOR INTERVENTION
139 138
Perspective Team Area
Facilitate the ward with an interactive teamwork
space for nurses, physicians, and candidate
students.
Sufficient daylight to reduce stress
Position of the white board that may contain of
confidential informations should be hidden from
public view
Acoustic materials for floor, ceiling and furniture
Adjustable desk and chair to reduce person falls
or injuries
There are 4 team areas in total 90 m2, each
room is around 22,5 m2
MAJOR INTERVENTION
141 140
Thermo-chromic textile is integrated into the design. This sample has
been made by reversible and water-based thermo-chromic powder
mixed with transparent ink. Activation temperature is below 22C. When
the temperature is cooled the pigment goes from original colour - dark
blue - back again to original colour.
MAJOR INTERVENTION
Scale 1 : 250
Strategy 5 :: Bring the outdoors inside
FUNCTION: THE PATIENT COMMON AREAS
CONDITION: The common kitchen room in the southern part of the ward that is shared
with the other ward has a good quality with a big wide window toward south offers
views to nature. Unfortunately the location is unseen from the corridor and there is
no sign giving a clue for visitors or patients about the space. What missing also are
atmospheres of ease, possibility for activities, possibility to get fresh air and more
storages for food trollies.
PROPOSAL: Bring the outdoors inside to create a connection with nature by building
balconies for winter garden. The winter garden toward south has great qualities to get
daylight and nice views to nature to support patients healing process. It also facilitates
the ward with a place to do activities and also functions as a positive distraction to
help distracting people from their negative feelings into a tolerable or even relaxing
and enjoyable feeling. By providing a transparency in the end of corridor through the
winter garden allow the space to be seen by visitors. Another strategy is to locate
common area for patients and relatives in the centred and make it as the heart of the
ward. The dayroom has direct connection to the pantry in the middle. The openness
and transparency of area surrounding makes the spaces look bigger.
N
MAJOR INTERVENTION
143 142
before after
Redesign the existing chair
I have chose this chair, because of the design is quite timeless and have
armrests. And its pretty easy to redesign, which means low cost. I came out with
rocking chair design. Why rocking chair? According researcher when rocking,
blood pressure falls and respiration slows. Rocking causes a reduction in anxiety
and depression. Nancy Watson, director of Center for Clinical Research on Aging,
reported a decreased need for anxiety and depression medication in those who
she observed.
I suggest placing the rocking chair in the winter garden.
MAJOR INTERVENTION
Perspective of the rocking chair
MAJOR INTERVENTION
145 144
Perspective Pantry & Dayroom
MAJOR INTERVENTION
147 146
Scale 1 : 250
Strategy 6 :: Bridging the staff communication
FUNCTION: THE STAFF COMMON AREAS
CONDITION: Staff pantry has no view to outside, any fresh air and out-dated furniture.
PROPOSAL: Conference room and staff pantry are located outside the ward area.
They have access to balconies allow abundantly of daylight and fresh air. These spaces
use together with the other ward on the same floor as a communication bridge.
N
MAJOR INTERVENTION
Scale 1 : 250
Strategy 7 :: Decentralized services & storages
FUNCTION: SERVICE ROOMS
CONDITION: The impression of the ward generally is chaotic. Its mainly because of the
ward lack of storage and the place is too small. The centralization of the supply storage
increases staff walking distance.
PROPOSAL: Therefore by placing 5 storages along the corridor will help to increase
staff efficiency and work satisfaction. Also by providing 4 spots for food trollies will
keep the corridor tidy, organized and clean from obstructions. Service areas such as 3
toilets both for visitors and staffs (2 are accessible toilets), technical room, cleaning and
waste room. Healthcare professionals main focus are to take care patient and other
division should do the other tasks For instance; logistic staffs handle supply, cleaning
department handle waste etc.
N
MAJOR INTERVENTION
149 148
Minor
intervention
MINOR INTERVENTION
PATIENT ROOM
Single (4), double (6), 4 bedroom (6)
Patient lavotory, shower, powder room
PATIENT COMMON AREA
Dayroom (2)
Common Pantry
Mini library
STAFF AREA
Reception room (352A- 352B)
Manager room (352A- 352B)
Team rooms (4)
Medicine rooms (2)
Sterilisation rooms (2)
Supply rooms (2)
Meeting & multifunctional room
WC (2)
STAFF COMMON AREA
Dayroom
Conference room
Expedition
SERVICES
Technical room
Trolley storage room
CORRIDOR
MINOR INTERVENTION
1.1
1.2
2.1
2.2
2.3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
418 m
2
83 m
2
38 m
2
41 m
2
19 m
2
17,5 m
2
34 m
2
118 m
2
26 m
2
26 m
2
39 m
2
28 m
2
4 m
2
35 m
2
25 m
2
180 m
2
3,5 m
2
8,5 m
2
290 m
2
4.1
4.2
4.3
5.1
5.2
Programming 352A - 352B
151 150
FLOOR PLAN MINOR INTERVENTION
Scale 1 : 250
352 A
352 B
MINOR INTERVENTION
N
Staff area, 301 m
2
Common patient area, 98 m
2
Services, 3,5 m
2
Common staff area, 240 m
2
Corridor, 290 m
2
Patient area, 501 m
2
MINOR INTERVENTION
153 152
Scale 1 : 250
Scale 1 : 250
Keeping the two wards
just like it is now and
minimazing design
intervention for the
economic point of view.
Expanding the wards
area to fit
more of staff areas.
Scale 1 : 250
352 A
352 B
The peach area is a
common area for all staffs
in the same the floor.
MINOR INTERVENTION
Scale 1 : 250
The darker purple area
shows the area that
no change and the
light purple has either
changed function or an
interior structural change..
Scale 1 : 250
Shorten the corridor into
2 squares with seating
area and 2 small junctions
for passing through to the
other ward.
Scale 1 : 250
Patient room area
consists like the existing
one, 20 beds each wards,
total 40 beds.
MINOR INTERVENTION
Design Strategies
155 154
Applying the same
strategy like the major
intervention for the
patient room.
DETAIL WINDOW
Scale 1 : 50
DETAIL PATIENT DOOR
Scale 1 : 50
Olsson Svensson
Scale 1 : 250
Installing LED-ceiling tiles
in the treatment rooms
that have no view and
access to outside.
It helps patient calmer
and more relax.
4 2 2 1 1 2 4 4
The door made by wood for warmth welcome,
non-institutional ambiance, and good visual and
timeless aesthetic.
Put a person name on the patient door instead
of number. I really think its one of the difference
approach between patient and person centred
care.
A contrast colour between handle and the door
panel will be really helpful for elderly people.
A translucent glass door panel will make the
corridor brighter.
3 four bedroom, 3 double
bedroom, and two single
bedroom per each ward.
MINOR INTERVENTION
4 2 2 1 1 2 4 4
4 BEDS PATIENT ROOM
Scale 1 : 200
DOUBLE BEDS ROOM
Scale 1 : 200
SINGLE PATIENT ROOM
Scale 1 : 200
Installing bed pod in the double
and four-bed room
for patient dignity
MINOR INTERVENTION
157 156
Scale 1 : 250
Decentralized supply,
disinfection and medicine
room into 2 divisions.
Make a change in
storage system into more
compact one to save
space.
Adding meeting rooms and
multifunctional room.
Decentralized teamwork
area.Transparency in the
work area for a warm
welcome to visitors.
Adding reception area
close to main door,
thereby removing the
patient or visitor stress of
not knowing where to go
in unfamiliar surrounding
Creating experience flows
by implementing season
theme approach.
MINOR INTERVENTION
Staff common rooms such
as day room, conference
room, expedition rooms
that also use by other
wards in the same floor.
Another strategy is to
make the common room
as the heart of the ward.
Combine the patient
pantry and day room for
bigger open atmosphere.
Adding extra storages for
trollies and wheelchairs in
the service areas.
MINOR INTERVENTION
159 158
Illustration: (Longe-Olsson, 2013)
U
nderstanding peoples experiences and needs demands ways to also capture
their environmental context and conditions. This includes the pace, rhythm and
flow of activities and behaviour as well as specific contextual qualities of multi-
sensorial experience.
As care settings expand beyond the hospital to include new areas, so to do research tools
need to develop to effectively capture and communicate the diverse qualities that shape
the experiences people have when staying in, working in and visiting these spaces.
With the realization that design could positively impact peoples healthcare experiences
by also considering the healthcare environment itself, design research techniques were
integrated to enrich and deepen the level of contextual research. Conclusively, research
is necessary to support design and design is necessary to collaborate findings and provide
settings for future research (Hamilton, 2012).
I believe we should have a deeper understanding of the components that make up our
world, and right now, we dont know enough about these high-tech composites our future
will be made of. Smart materials are hard to obtain in small quantities. Theres barely
any information available on how to use them, and very little is said about how they
are produced. So for now, they exist mostly patents only universities and corporations
have access to (Mota, 2012). My expectation is that the thesis will encourage people to
know more about smart materials and make experiment with materials. The more people
experiment with materials, the more researchers are willing to share their research, and
manufacturers their knowledge, the better chances we have to create technologies that
truly serve us all.
I also hope to spread more the understanding of Evidence Based design and Person
Centred Design outside healthcare interior. I believe, the positive aspects that I have
highlighted in my thesis are not only to create a healing environment for patient, but also to
improve general health settings, could be in home, offices, or schools.
Conclusion
CONCLUSION
161 160
Appendix
Feature Visions for Healthcare Housing and Work
HOSPITAL ARCHITECTURE AS AN ACTIVE MEDICINE
We are architect students at Chalmers doing our thesis about
how the environment could be adapted to support a person-centered care.
The goal of this project is to understand
how the ward environment can be more supportive for patients, families, and staf.
This is an inquiry form that will not have any impact on your job.
Your participation in the survey is completely voluntary
and you can at any time choose to cancel without giving reasons.
If you have any questions, please contact
Bilyana Docheva eller Sophy Sapan Longe Olsson
email: bilyana@student.chalmers.se, sophy@student.chalmers.se
The questionnaire will be available for a perioud of two weeks.
Once the questionnaire is completed please submit it to the head of ward no later than 6 March 2013.
Integrating architecture as a vital healing element in patient treatment -
bridging the gap between research, users and architects
Bilyana Docheva
Sophy Sapan Longe Olsson
1/6
STAFF QUESTIONNAIRE RESULTS
163 162
PART 1 : BACKGROUND INFORMATION
Date :
Your age (circle one) :
Position :
How long have you been employed in the ward :
under 30 30-39 40-49 50-59 60+

less than 1r 1-3 r 4-10 r more than 11 r
PART 2 : INVOLVEMENT WITH PATIENT CENTERED CARE
How long have you been involved with the process of PCC?
Have you worked in another care development project before?
What is the essence of patient centered care?
Can you describe any changes in your routines since the implementation of person-centered care?
Do you see any improvements with the new approach?
What are the major barriers which stand in the way of implementation of PCC principles?
2/6
PART 3 : PHYSICAL ENVIRONMENT
3.1 THE DESIGN OF THE PATIENT ROOM: SINGLE ROOM DOUBLE ROOM
agree disagree strongly disagree
Please rate the following
statements by marking in this way:
strongly agree
supports private conversations
support the patient's feeling of safety
21 5 1 4 12
14 3 4 16 1 4
3/6
increases patient satisfaction of care
facilitates patient personalization
adjustment
infuences patient recovery
reduces patient isolation
reduces patient stress level
supports patient's chance for a good
night's sleep
allows for a good communication between
you and patient
reduces your stress level
prevents work injuries
prevent medical errors
increases your work satisfaction
allows for good professional collaboration
increases the time you can spend with
the patients
provides a better environment for relatives
reduces the risk of of infection
has adequate day light source
has sufcient lighting for various needs
3.1 THE DESIGN OF THE PATIENT ROOM: SINGLE ROOM DOUBLE ROOM
strongly agree
9 6 9 10 1 3 3 1
11 8 8 8 2 2 3
15 9 6 5 6
6 3 13 13 1 2 2
1 2 4 9 12 9 3
8 9 10 12 1 1 2
20 9 1 4 8
20 9 1 3 5
8 13 6 5 7 3
8 6 8 8 5 4 1 1
10 10 9 8 1 1
10 11 10 8 1 2
4 3 11 13 3 3
6 9 8 8 1 5 3 2
14 8 7 4 7 1
18 11 3 5 4
4 6 4 7 2 2 4
165 164
4/6
3.1 THE DESIGN OF THE PATIENT ROOM:
allows visual contact with the patients
has views of nature
has access to physical contact with nature
reduces stress caused by noise
3.2 THE DESIGN OF THE WORK SPACE :
supports staf collaboration
makes it easy to move
supports staf's perception of time (day and night),
place and person
ofers views of nature
gives adequate daylight
reduces stress caused by noise
gives opportunities to control the environment
(light, temperature, equipment)
3.3 THE DESIGN OF THE CORRIDOR :
makes it easy to fnd in the ward
SINGLE ROOM DOUBLE ROOM
strongly agree
12 4 3 8 4 8 2
4 9 7 7 4 5 5
2 7 1 1 12 6 12
10 11 9 6 2 2 1
7 13 3 4 3 9 2
4 11 6 1
3 4 10 4
4 5 9
2 4 11 4
3 3 12 1
3 4 8 6
3 2 6 8
5 9 8
2 4 14 1
6 11 4
+ -
+ -
How does the environment of the work place supports your work performance?
Does the physicality of the work place supports or prevails the process of collaboration on diferent levels:
staf - staf
staf- patient
patient- relatives
staf- relatives
If you would like any changes or additions in the physical space, what would they be? In what way will they
support afect your work routine?
5/6
3.4 THE DESIGN OF THE KITCHEN :
supports relationship between patient and staf
supports relationship between patient and relatives
is attractive (feel, appearance, atmosphere)
has views of nature
PART 4 : OPENQUESTIONS
strongly agree
4 2 13 1
3 7 11
2 7 11 1
3 4 10 3
10 10 1
10 9 2
4 3 14
+ -
167 166
Thanks for your participation!
Once you have completed the questionnaire,
please submit it to the head of ward no later than 6 March 2013.
6/6
How would you describe the importance of the physical environment for the patient?
How the physical design in the ward afects the patients recovery?
Describe the ward with fve words (at least three of the words are adjectives).
From the physicality of the ward, please describe the importance of the corridor as your work space?
What in it do you view as an obstruction, and what function well as it is?
If any, please defne the diference in recovery outcome in patient between single and double room?
How could the patient room stimulate the involvement of relatives?
Other comments about the patient room environment
When do you use the common kitchen area?
please submit it to the head of ward no later than 6 March 2013.
6/6
How would you describe the importance of the physical environment for the patient?
How the physical design in the ward afects the patients recovery?
Describe the ward with fve words (at least three of the words are adjectives).
From the physicality of the ward, please describe the importance of the corridor as your work space?
What in it do you view as an obstruction, and what function well as it is?
If any, please defne the diference in recovery outcome in patient between single and double room?
How could the patient room stimulate the involvement of relatives?
Other comments about the patient room environment
When do you use the common kitchen area?
Ages:
Under 30 years 8 = 38 %
30 - 39 years 6 = 28.6 %
40 - 49 years 3 = 14.3 %
50 - 59 years 2 = 9.5 %
60+ 1 = 4.8 %
Staff Questionnaire Result
How long have you been employed in the ward?
Under 1 year 2 = 9.5 %
1 - 3 4 = 19 %
4 - 10 11 = 52.4 %
Over 11 4 = 19 %
How long have you been involved with the process of
PCC?
Under 1 year 2 = 9.5 %
1 - 2 10 = 47.6 %
3 - 5 1 = 4.8 %
Over 5 years 0 = 0 %
No answer 11 = 52.4 %
Have you worked in another care development project
before?
Yes 4
No 5
No answer 2
Open Question
Distributed = 41
Answered = 21
(13 nurses, 4 ass. nurses, 1 specialist nurse and 3
physicians)
169 168 STAFF QUESTIONNAIRE RESULTS
What is the essence of patient centered care?
26.5 % Patient is involved
14,7 % Assume patients problems and needs from their
stories
11.8 % Relationship between patient and staff
8.8 % The person behind the diseases
8.8 % Have the same goal
8.8 % Patients in focus
5.9 % Follow up
2.9 % 2.9 % Work on patients desires
2.9 % Do little extra
2.9 % Better contact/ communication with patients,
2.9 % No answer
Can you describe any changes in your routines
since the implementation of PCC?
11.1% More structure in monitoring
11.1% Spend longer time for arrival conversation
7.4 % Neutral, have only been working with PCC
7.4 % Find private place to talk with patient
7.4% Listen differently and more
3.7 % Better method for patient
3.7% More consideration of patients wishes
3.7 % Nurse and assistant nurse work for the same goal,
3.7% Easier to see patient need, resources and barriers
3.7% More preparation, make early plans
3.7% Use patients stories more
Do you see any improvements with the new
approach?
23.3% Patients satisfaction,
10% Shorter length of patients stay,
6.7% Make the process of discharge information easier
and smother,
6.7% More structured/ early planning, how long
patients stay will be,
6.7% Deep understanding of patients situation/
problems/ needs,
6.7% Doctor/ nurses should spend more time with
patients,
6.7% Better cooperation between staff,
3.3% Holistic image of patients,
3.3% Easier to rehabilitate,
3.3% Staff feels that patients recover,
3.3% Better plans for patient and staff,
3.3% Finding new solutions,
3.3% More infoldment for relatives,
3.7% Rather less routines
7.4% Decide together a preliminary prescription date-
3.7% Consistent team decision
3.7% Better to handle patients expectation/ goal/
concept/ activities levels
3.7% Person in focus
7.4% No answer
What are the major barriers which stand in the
way of implementation of PCC principles?
24.2% Not enough with time, stressful
12.1% Lack of staff
9% Senior physicians change patients treatment and
plans often
6% Old routines
6% Patients confusing (dementia)
6% Double documentation
6% Fear of change
3% Lack of private room for conversation
3% Single patient room
3% Everyone in the same corridor
3% No room for private conversation
3% Large galleries
3% New way of thinking for patients, not used to set
goals and have wishes,
3% Some patients dont have ability to explain their will,
3% Medical tasks often as a first priority
3% Journal system, doesnt work in reality
3% No answer
How does the environment of the work place
supports your work performance?
27.8% Lack of space/ tight hustle for efficient working
8.3% Long and tight corridor which force you to travel
a lot
5.6% Will be smother if the accessibility to patient room/
drug room/ help aid is close to each other
5.6% Good lighting
5.6% Lack of storage room
5.6% Messy environment
5.6% Havent enough with computers
2.8% Good ventilation
2.8% Strategist placement, less stress
2.8% Toilet should fit at least 2 persons
2.8% Doesnt effect much
2.8% Brighter corridor
2.8% More pleasant
2.8% No extra beds in rooms
2.8% Beautiful colours
2.8% Make you feel better
2.8% Big problems with 4 bedroom, not single/ double
2.8% Lack of space to sit with patients and talk
2.8% Big enough
5.6% No answer
3.3% Easier to taking care a patient group,
6.7% No answer
Does the physicality of the work place supports
or prevails the process of collaboration on
different levels:
Staff staff
52.4% Barrier: no meeting room; tight space, the
workplace is not good; need staff private room; need
bigger, brighter, good ventilation; the space is too small
to read a journal and working with computer; 4 beds
room is too tight.
38% answered Help
9.5% No answer
Staff patient:
66.6% Barrier: tight space; should have more of single
patient room; be private; 4 beds too tight; sensitive to
talk with patient.
23.8% Help
9.5% No answer
Patient relative
66.6% Barrier: single room should be bigger; tight
space; should have few meeting rooms, need a place
for the relative; 4 beds are not good; private room for
conversation/ do activities; the dayroom is too small & noisy.
23.8% Help
9.5% No answer
Staff relative
71.4% Barrier: No chance for a conversation;
tight space; conversation private area; hard to find a
place for private conversation.
19% Help
9.5% No answer
If you would like any changes or additions in the
physical space, what would they be? In what
way will they support affect your work routine?
15.3% No 4 beds room (max 2 beds)
8.2% A few private rooms for conversation
4.7% Single room
4,7% Better working area
4.7% Better storage area
3.5% Bigger patient room
3.5% Toilet in the room
3.5% Bigger spaces
3.5% More computer
3.5% Dimmer
3.5% No musculoskeletal injuries
3.5% Bigger and more patient WC
2.4% Less stress
2.4% Better working table
How would you describe the importance of the
physical environment for the patient?
19% Recharge, take arrest, recovery
14.3% Tight and untidy environment means unhappy
patients
9.5% Cozy, lighting, daylight, plants
9.5% Should have possibility to talk with staff
5.2% Important
4.8% Possibility to express than more talk
How the physical design in the ward affects the
patients recovery?
47.6% Yes
23,8% Big impact
14.3% Affect some agree
9.5% No answer
4.7% Not so much
2.4% Place for patient and relatives
2.4% Welcoming environment/ interior
2.4% Better solution than curtain between beds
2.4% Quite working area for documentation
1.2% Brighter
1.2% Better common area for patients
1.2% Nicer lighting 1.2% Dont need to turn off and on
all the lights at the same time
1.2% Effective working time
1.2% Less infection
1.2% More time for patients
1.2% Daylight
1.2% Less overcrowded
1.2% Not any long corridors
1.2% Doctor inside the ward, to increase communication
as a team
1.2% Medicine trolley close to the expedition
1.2% A bigger place for important help aids (gloves,
apron, wipes)
1.2% Ceiling lift in all the patient room
1.2% Better ventilation in the patient room
1.2% Plain colour of curtain
1.2% Better chairs for patients
1.2% Lighting at the window of patient room
1.2% Controlisation
1.2% A bigger, more modern and complete examination
room
4.8% More attractive environment, encourage people
to move around
4.8% Stimulating, inviting
4.8% Balance between stimulation, calm and peaceful,
4.8% For rehabilitation, comfortless, feeling that is it fresh,
4.8% Unhappy, hard to sleep, hard to talk with staff in
4 bedrooms
4.8% Dont know
2.6% Used to it
2.6% Big window in the end of the corridor
2.6% More colour/ painting
2.6% Easy to find
2.6% Doctor expedition outside the ward
Doesnt work so well
31.6% No room for help aid
23.7% Tight and small space
7.9% Too long
2.6% Ineffective space
2.6% Hard to find dayroom/ wc for patient
2.6% Noisy
2.6% Boring design
2.6% Too small storage
2.6% No answer
2.9% Stressful
2.9% Noisy/ high volume
2.9% Ugly
1.4% Empathy
1.4% Easy to find
1.4% Sterile
1.4% Inconsiderate room
1.4% Hard to work
1.4% Smelly
1.4% No privacy
1.4% Nice
1.4% Fairly modern
1.4% Good function
Single bed room
11.4% Variety depends on person, some recovery better
by contact with other and some wants to be alone
8.6% For person who are really sick
8.6% Quite
8.6% Sleep better
8.6% Isolated
2,9% More space for relatives
2.9% More safe
5.7% Some patient become more passive
5.7% Private
2.9% Good for old and young
Describe the ward with five words
18.6% Tight
8.7% Messy, chaotic
8.6% Long and tight corridor
7.1% Light
5.7% Positive atmosphere
5.7% Old
5.7% Good community
4.3% Dark
4.3% Muddy
4.3% Structured
2.9% Cold
Corridor
Works pretty well
7.9% Ok
6% Radio, TV, internet
3% More electrical outlet
3% The problem is 4 bed rooms
3% Sad
3% White
3% Tight
3% Hard to work, too many help aids
3% Single room with bathroom
3% Ceiling lift
3% Sliding door
3% Private wc/ shower
3% Separate rooms for men and female
When do you use the kitchen?
29.6 % Bring drink or something else for patient
18.5 % Setting food court
18.5 % Breakfast, lunch, dinner
18.5 % Make coffee
11.1 % Not often
7.4 % Almost never
3.7 % Heat up food
3.7 % To mobilize patients
3.7 % Cleaning the refrigerator
3.7 % Would like to have oven and stove
3.7 % Meeting staff
3.7 % Conversation with patients if its empty
3.7 % When its tidy
3.7 % Often, every break
3.7 % Never
2.9% Satisfaction
2.9% Quite lonely
2.9% Dont know
2.9% No different
Double bed room
8.6% Good social contact
5.7% Meet with others
2.9% Best
2.9% Happier
How could the patient room stimulate the
involvement of relatives?
33.3% Dont know
25% Natural places for meetings
12.5% Private single rooms that are big and beautiful
8.3% Information board
8.3% Private sink, wc, shower in each room
4.2% Books/ files of facts
4.2% No stimulation, not so good to visit
4.2% Help aids
Other comments about the patient room
environment
30.3% No more comment
9.1% Bigger spaces
6% Old bed, wanted the one with remote control
6% Better lightning
6% Bad place for help aid
175 174
This is an inquiry form that will not have any impact on your daily care.
Bilyana Docheva
1/4
This is an inquiry form that will not have any impact on your daily care.
Bilyana Docheva
1/4
PATIENT QUESTIONNAIRE RESULTS
2/4
1.1 THE DESIGN OF THE PATIENT ROOM (mark with a cross) :
support safety
facilitates your personalization adjustment
supports your chance for a good night's sleep
allows for a good communication between
you and stafs
provides a better environment for relatives
has adequate day light source
has sufcient lighting for various needs
allows visual contact with the patients
has access to physical contact with nature
1.2 THE DESIGN OF THE CORRIDOR :
SINGLE
stimulates your mobility
MULTIBEDS
strongly agree
1
1
2 2 2 1
1 4 2
1
1
1
1
1
1
1
1
1
1
1
4
2 1
2 4 1
1 6
3 3 1
2 3 1 1
1 3 1 2
1 4 2
3 3 1
1 4 2
1 4 2
1 2 1 3
1 4 1 1
4
3 2
3 2 2 1
1 7
100%
62,5%
37,5% 62,5%
37,5%
0%
+ -
177 176
3/4
1.3 THE DESIGN OF THE KITCHEN :
supports relationship between patient and staf
supports relationship between patient and relatives
has views of nature
DEL 2 : FRGOR
What is your daily routine while in the hospital?
What makes you feel good in your daily routine in the ward?
What do you miss in the physical space of the room?
If you would like any changes, additions which you fnd vital in the physical space, what would they be?
strongly agree
1 1 4
2 2 2
2 2 2
2 1 3
2 1 3
4 2
4 1 1
50%
50%
50%
50%
100%
62,5%
62,5%
50%
50%
50%
50%
0%
37,5%
37,5%
+ -
4/4
Please describe patient room, using fve words?
Other comments about the patient room environment?
How important for you are relatives visitation?
Where do you usually meet with relatives while in the hospital?
When do you use the common kitchen area? For what kind of purpose?
please submit it to the staf no later than 6 March 2013.
4/4
Please describe patient room, using fve words?
Other comments about the patient room environment?
Where do you usually meet with relatives while in the hospital?
When do you use the common kitchen area? For what kind of purpose?
please submit it to the staf no later than 6 March 2013.
179 178
Distributed = 10
Answered = 9 - 1 error = 8 persons
(single room = 1 persons, double room = 4 persons,
both single and double = 1 person and 4 bed room =
2 persons)
Patient Questionnaire Result
What is your daily routine while in the hospital?
1: No answer.
2: Wait for medicine.
B: Wait for breakfast medicine, go out for a walk in the
nature, lunch, be around the hospital, caf/ kitchen/ his
new room, take a rest, go to toilet, no fixed routine.
4: Take a rest, wake up, control/ sample, breakfast, take
a rest, lunch, take a rest, control, take a rest, dinner, take
a rest, sleep.
Open Question
What makes you feel good in your daily routine
in the ward?
1: Feel safe close to nurses, own toilet/ shower, internet
connection, good reading lamp, TV.
2: The nice treatment from staff, friendly staff, other
person who I share room with, when the food is served
at certain time.
B: Nothing, except the thought of coming home.
4: Feel that the staff cares, TV.
What do you miss in the physical space of the
room?
1: coffeemaker, microwave, TV that works, modern bed
2: electric outlet close to bed, internet connection, to
contact family via webcam, shower/ WC, calm
B: calm and quiet
4: TV, lightning in normal strength
If you would like any changes, additions which
you find vital in the physical space, what would
they be?
1: Bed, TV and radio with headset control
2: Be alone, WC inside for hygienic reason, nothing to
change, few of electrical outlet on headwall.
B: Acoustic, better ventilation, its stressful to move
around, especially when you are sick
4: Better ventilation control
Please describe patient room, using five words?
1: Old bed, no radio, TV dosent work properly, light,
big window, comfortable bed
2: Noisy for other patients, little bit tight, cold, white,
sterile, tasteless, nice space, small, cosy, well equipped,
no privacy
3: Open, disclosure, irritating, noisy
4: Sterile, bright, nice view, tight, bright, boring,
sensitively, tight, sterile
Other comments about the patient room
environment?
1: Big reading chair, boring environment
2: The bed needs to clean more often, no daylight on
his/ her spot
3: The room is often open, cold, feel disclosure and
constantly noise
4: No answer
60% Very important
30% Important
10% No answer
Where do you usually meet with relatives while
in the hospital?
33.3% Day room
26.7% Patient room
20% Cafeteria
20% Kitchen
When do you use the kitchen?
40% Never
20% When I want to eat
20% Meet relatives
10% When I want to drink
10% When I want
181 180
On reading
References
Apple, Mike. (2012). A Handbook on Facility Follow-Up & Examples of its Application in Evaluating
Intensive Care Patient Rooms. Gothenburg: Chalmers University of Technology.
Asksen,Jenny. (2012). Designprocess frn ett aktivitetsperspektiv-en bredare syn p tillgnglighet.
Gothenburg: Chalmers University of Technology.
Benkel, Inger, M.S.W., Ph.D.; Helle Wijk, R.N., R.N.T., Ph.D. and Ulla Molander, M.D., Ph.D. (2012). Hospital
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Ones Need for Support. Journal Of Palliative Medicine, Volume 15, Number 1. Mary Ann Liebert,
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Brown, Cynthia J., David T Redden, Kellie L Flood, Richard M Allman (2009). The underecognized epidemic
of low mobility during hospitalization of older adults. Birmingham/Atlanta: The American Geriatrics Society
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at Chalmers Architecture.
Chaudhury, Habib; Atiya Mahmood and Maria Valente. (2003). The Use of Single Patient Rooms vs.
Multiple Occupancy Rooms in Acute Care Environments. Canada: Simon Fraser University.
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Process of Patient Room Modules (Longe-Olsson, 2013)

Heart Healing - in Search of Care Sciences and Behind The Art of Healing Environment

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