Hospital Buildings: An Under-Appreciated Art (and Science)

White, stark, cold, unfamiliar, metallic — this is how hospitals are described. A paragon of healing and comfort portrayed as anything but. Given that many facilities today boast beautiful hotel-esque environments, perhaps the image of the aloof hospital setting is a vestige of the past. After all, in the late 19^th and early 20^th centuries hospitals were focused, not on patient comfort, but on something far more rudimentary: patient survival.¹

As medical students, we are taught how to build relationships so that patients feel more comfortable and “at-home”. It is useful to examine the role of the environment (the patient’s room) in achieving this same goal. Nowadays, hospital rooms are designed to create, quite literally, a patient-centered environment.² However, this architectural focus on psychosocial well-being was not always the norm. When public hospitals became favored over home-care in the late 1800s, physicians noticed high mortality rates that were linked to infection. Thus, hospital design became an important consideration, structured around infection control.¹ Initially, these design changes came in the form of minimizing patients per room, installing handwashing sinks, and providing proper ventilation and sunlight.   Later, they included the isolation of contagious patients, installation of HEPA filters, and private rooms and bathrooms wherever possible.^1,3 In fact, when Johns Hopkins hospital was being built in the late 1800s, the building plan chosen from five potential plans was one centered around infection control, namely appropriate ventilation and separation of patients.⁴ Perhaps this militant focus on sterility and stark cleanliness gave hospitals the unfortunate reputation of being uncomfortable.

Patient satisfaction was not standardly quantified until the 2000s when the Hospital Consumer Assessment of Healthcare Providers and Systems survey was developed and administered randomly to adult inpatients.⁵ Since then, studies have identified important elements in hospital design that improve patient and staff stress levels, increase satisfaction, shorten lengths of stay, and minimize infection, falls and medical errors. These include designing acoustics to reduce noise pollution, harnessing natural light, and utilizing music, artwork and color in patient rooms.^6,7,8,9,10 For instance, when Perkins&Will recently designed Sheikh Zayed Tower/Bloomberg Children’s Center, they collaborated with landscapers, artists and engineers to create a structure that not only houses patients, but actually heals them, factoring in psychological benefits of natural sunlight, visual stimuli (bold colors/artwork) and green spaces.¹¹ This paradigm shift in hospital architecture from function to holistic care is evident in literature published; papers before the 2000s focus on streamlining workflow and ensuring disinfection, while papers after the 2000s start to quantify how design elements emphasize patient-centered care. The art of hospital design has evolved, now employing great names in architecture to create masterpieces that truly deliver on a hospital’s mission of serving as a paragon of healing and comfort.

Next time you enter Zayed, note the soothing blues and greens of the glass curtain as the sunlight filters through the windows. Take a moment to appreciate the complexity of the architectural choices for holistic healing: blue and green accelerate relaxation and reduce sleepiness,¹² sunlight promotes recovery,⁹ terrazzo floors dampen noise,¹¹ and much more.

Bright, colorful, warm, comfortable, soothing — with the transformation of hospital architecture into a full-fledged art and science comes a transformation in our understanding of these houses of healing.

References

1. Noskin, G. A., & Peterson, L. R. (2001). Engineering infection control through facility design. Emerging infectious diseases, 7(2), 354.
2. Bates, V. (2018). ‘Humanizing’ healthcare environments: architecture, art and design in modern hospitals. Design for Health, 2(1), 5-19.
3. Lankford, M. G., Zembower, T. R., Trick, W. E., Hacek, D. M., Noskin, G. A., & Peterson, L. R. (2003). Influence of role models and hospital design on the hand hygiene of health-care workers. Emerging infectious diseases, 9(2), 217.
4. https://www.hopkinsmedicine.org/about/history/history2.html
5. Siegrist Jr, R. B. (2013). Patient satisfaction: history, myths, and misperceptions. AMA Journal of Ethics, 15(11), 982-987.
6. Zimring, C., Joseph, A., & Choudhary, R. (2004). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity. Concord, CA: The Center for Health Design, 311.
7. Cameron Nelson, M. P. P., West, T., & Goodman, M. C. (2005). The Hospital Built Environment: What Role Might Funders of Health Services Research Play?.
8. Joseph, A. (2006). The role of the physical and social environment in promoting health, safety, and effectiveness in the healthcare workplace. Concord, CA: The Center for Health Design.
9. Joseph, A. (2006). The impact of light on outcomes in healthcare settings. Center for Health Design.
10. Joseph, A., & Ulrich, R. (2007). Sound control for improved outcomes in healthcare settings. The Center for Health Design, 4, 2007.
11. https://www.archdaily.com/243120/the-johns-hopkins-hospital-perkinswill
12. Minguillon, J., Lopez-Gordo, M. A., Renedo-Criado, D. A., Sanchez-Carrion, M. J., & Pelayo, F. (2017). Blue lighting accelerates post-stress relaxation: Results of a preliminary study. PloS one, 12(10), e0186399.

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