Creating A Healing Environment

By Shaheen Islam

There are signs that the Bangladesh health-care facilities (public and private) has reached a limit - where many feel the experience of receiving medical care is de-humanising. Patients see an increasing trend toward care that is cold and impersonal. The fear that health care is rapidly becoming a commodity is getting more intense.

Most of the citizens, who can afford, are leaving for foreign countries for check-ups and treatments. Those who are unable to travel are falling prey in the hands of hospital operational protocols - which has almost reached a state of collapse. The frustration and agonies of the poor - who cannot afford to reach the doorsteps of the institution, is rather mind-boggling. They are being denied the very basics of health care.

Further-more, if the patient succeeds in reaching the OPD or admitted in a hospital- a poorly designed hospital can make way finding very difficult, it can be an experience of dark omen of separation, isolation and rejection. In most cases an admission becomes an “ultimate defeat’- it is felt like not death, but regarded as a ‘living death’. Clearly, the hospital and the health care centres are a frightening and depressing place. It is disliked-indeed; dreaded- by the very group of people it was meant to protect and the communities it was supposed to save. Environmental stessors like: sound pollution, confusing way finding, lack of privacy, preventing personal control over lighting and temperature, poorly designed work areas for the staff, lack of lounge amongst other factors effects the quick recovery of the patients. Poor design works against the well being of patients.

In modern medicine, the OBJECTIVE of the medical treatment is geared toward returning the individual to the pre-existing state of independence and competence.

So what can be done?

Health care operational protocols which include easy access to: medical experts, correct medical information, proper check-ups and diagnosis, treatment, over-all quality management issues etc- should be addressed and effective measures suggested. The Health Care System and the Institutions will require massive re-structuring and development in the new millennium.

As an Architectural Designer, I would like to suggest a well designed physical setting, creating a healing environment in health care settings.
“A healing environment, is one in which the building design does not frustrate care givers efforts to deliver care; the hospital’s operational protocols are flexible enough to accommodate individual patients requests; the architecture offers adequate access to natural light and soothing views; and environmental stessors have been satisfactorily addressed”

The BENEFITS of a well-designed health care setting is that it allows the patient to relax so that medications and therapies may be more effective. Design of the physical environment can improve medical outcomes as well as the quality of life for everyone who works in, visits, or is treated at a health care facility. The power of the built environment will positively affect the quality of health care delivery.

Solutions/Proposals:

The old institutional image should be changed by avoiding long uniform 8’ wide double loaded corridors, dark and ill ventilated spaces, visual contact of frightening equipment etc.

The innovative design for the new millennium should be patient focused care. Patient should be regarded as the centre of the Universe.

In addressing the above points, one can create a built environment that values the physical, psychological and spiritual needs of the human being. Human being, is an animal with a mind-body and soul. The inter relationship between the physiological and the psychological is recognised as the mind/body connection. As research and medical practice show, the gateway to good health starts with a healthy immune system.

“Positive mental and emotional states are pivotal to maintaining and strengthening this immune system”. This can be achieved while designing the built environment, if the designer focuses on the mental and physical stimulation of all the five senses of human being: hear, see, touch, taste and smell.

For example while viewing a garden or an art work- the enjoyment starts with the experience of pleasure, relaxation and relief from tension and stress. A simple and clearly defined way finding gives the sense of control over one-self. Listening to pleasant music can also be therapeutic and relaxing. Plants with familiar fragrances are relaxing; smell of freshly baked or fried garlic in dining spaces helps those who have problem of loss of appetite.

For improving the quality of life, the built environment can help interaction with the community by providing a library/den, tearoom for social gatherings. Quiet prayer room, and space for grieving etc. The target groups should be patients, visitors and health care staff. Architects should be encouraged to work with clients and the community to create cost-effective, low-maintenance, durable environments that evoke the culture of the institution and place value on the human beings that use the facility.

Design that strengthens the mind, body and spirit does not have to cost a lot of money. It can be used as a strategic investment.

Research - Showing mind/body connection:

1. White-coat syndrome: Blood pressure elevates when they visit a doctor’s office, called the white-coat syndrome.
2. Settings and perceptions: Those working in the beautiful room ascribed positive attributes to the faces but those working in the ugly room saw sickness and fatigue in those same faces. Also, those in the ugly room tended to rush through their work and complained of fatigue, headaches, irritability and discontent.
3. Benefits of nature: In many place people are just sitting, waiting to die resulting into boredom. A landscaped courtyard brings variety, and is an antidote to boredom.
   View from hospital bed-
   
   • fewer pain medications used
   • fewer negative evaluations from staff (patient upset, patient depressed)
   • less post operative distress (headaches, nausea)
   • earlier discharge by one day (8.5%)
   View from gurneys - acutely stressed post surgical patients lying on gurneys in a pre surgical holding areas were exposed to several types of ceiling mounted photos-
   
   • those exposed to serene views (primarily water or spatially open views of landscape) had blood pressure rates lower than subjects exposed to aesthetically pleasing stimulating photos (e.g. a sail boarder leaning into the wind) or to a group with no exposure to photos.
   In the absence of direct access to nature (such as beaches and waterfalls), it presents a satisfying miniature slice of nature compressed in space and time. Employees with nature views reported substantially lower levels of job stress, fewer health problems, and higher levels of overall life satisfaction.
4. Nature & art: Appropriate art images for patients well being can have positive benefits in terms of patients well being.
5. Effects of noise: Conversations, alarm, beep, intercom etc hampers healing and curbs productivity. It had adverse effects on patients taking certain antibiotics; noise enhanced perception of pain, and was disruptive of sleep.
6. Colour: Study on warm colour (pink), as opposed to cool (blue) coloured environment showed: - A pink coloured room increased children physical strength and supported a positive mood - A blue coloured room rated themselves as calm and in good moods for most of the patients.

Example:

There is merit to the concept of good design as a strategic investment.

A new children’s hospital built in 1994 in Rhode Island, USA. The following statistics, which were measured approximately four years after occupancy of the hospital, reflect the experience of what good strategic design can do for an institution:

1. Market share increased 20.5% in 3 years.
2. Outpatient/ emergency visits increased by 25% the first year.
3. Inpatient days increased each successive year after opening.
4. Patient satisfaction increased 5.5% after opening.
5. Monthly volunteers grew from 40 to 400.
6. House staff applicants doubled in one year.

In reflecting on the potential reasons for success, a significant component is the building design. The design collaborated with the client. Another element that significantly contributed to and enhanced the success of the building design was the involvement of the hospital’s multiple customers, physicians, nurses, staff member, and other health professionals and also did parents and children. Their involvement went beyond “window dressing”. It was an inclusive process, where everyone in the staff and the community was part of the process and therefore vested in its success. Over 11,000 tiles designed and installed by the school children decorate the corridors.

Inclusive Process:

Finally, we must recognise that while the designed environment has a significant role that directly contributes and enhances therapeutic processes, no one aspect, be it the care providers and the staff, the policies and programming, or the environment attributes, can on its own produce a therapeutic environment.

We are building a healthier world. This world can be very simple, and cost effective, and in context to the Bangladesh settings. Our main goal should be not about living longer, but about living better. Creating a habitat where people can build a rich, nurturing environment helps people live longer and better lives.
“ Architects in partnership with clients have the potential to influence the creation of environments that will foster inspiring architecture that lifts the human spirit for the betterment of human-kind. In this sense, a more hopeful future is within our reach, waiting to be built.”
Janas Salk M.D. (1997).

The author is an Architect and Freelance Researcher.