February 26, 2019

Supportive Environmental Design Factors for Rehabilitative and Healthcare Facilities

Senior citizen and healthcare worker

While media attention is often focused on Millennials taking over as the largest generation of adults in the U.S., we must not forget that the Baby Boomers are still a significant part of our population. In 2016 (the latest U.S. Census data available), Boomers totaled an estimated 74.1 million. As they age and require more medical services, we’re bound to see some much-needed attention on the environmental design of rehabilitative and healthcare facilities.

This is an area of great interest for me personally, but also professionally—as the core concepts are applicable in many environments. In fact, I’ve completed four research studies on healthcare-related topics over the past six years, and I continue to research the topic. Inspired by Roger S. Ulrich’s evidence-based design (EBD), my focus has been on how to improve supportive environmental design factors for rehabilitative and healthcare facilities. In past studies, the elements I have researched are: room size, privacy, organization, controllability, flow of activity, lighting, presence of widows, type of window views, color texture or type of finishes, patterns, artwork, air and ventilation, aromas, noise, music, temperature, type of furnishings, horticulture, and more. All can be facilitating or hindering to patients.

Rebuilding lives is the main goal of a rehabilitative center. Thousands of people enter rehabilitation hospitals each year to restructure their lives, learn new skills, and regain independence after they become physically challenged. Depending on the nature of the disability or illness, a person may need to relearn simple tasks, from dressing to driving, in an entirely new way. The importance of the built environment in the healing process may not be fully understood, but the environment can facilitate positive responses from patients with respect to personal rehabilitation and recovery goals.

Stress is a major component. People face stress every day as they go about their daily routine. Now think of a patient that has difficulty in their daily routine due to an accident or stroke. There are many obstacles to healing, and the number one obstacle is stress. Stress decreases our immunity and affects our mental strength. Unsupportive design has effects that cause added stress and therefore works against the healing process. Characteristics of certain environments have an effect of arousing the system, and hence, bring the stress response into play. They include:

  • Excessive overcrowding / lack of privacy
  • Isolation
  • Excessive heat or cold
  • Lighting
  • Noise

Reducing environmental stress speeds recovery

There are many environments that can cause or add stress. But, that stress can be reduced within a supportively designed environment in three ways:

  1. Sense of control: As early as 1991, Ulrich talked about a sense of control with respect to physical and social surroundings. These surroundings concern a human's need for control of the environment and the need of self-efficiency with respect to the situation. Uncontrollable environmental conditions are usually stressful. Waiting rooms, lobbies, and nurses stations all are areas that can be improved to give users a stronger sense of self-reliance.
  2. Social support: Access to social support is defined as frequent or prolonged contact with family, friends, other patients, and staff who are helpful, caring, or otherwise supportive. For example, providing chairs in patients’ rooms allows longer, more frequent visits from their support network.
  3. Positive distractions: Research in environmental psychology suggests that human well-being is usually fostered when the physical surroundings provide a moderate degree of positive stimulation, that is, a level of stimulation that is neither too high nor too low. For instance, a landscape view from window or indoor plants.
Outdoor space with greenery and comfortable seating
Access to natural light and plants help reduce stress in medical facilities.

Healing is a journey, an experience of crossing over the threshold, regenerating, small increments, large progress, passing through the gateway to a second chance of life that grows with sight, sound, touch, taste, smell, and love from one's own spirit.

A healing environment must treat the whole person—body, mind, and spirit. Our senses must react to each environment. Therefore, the environment must promote healing and give an uplifting experience. How do we do this? Our senses need to be activated. Let’s take a closer look…

  • Sight: Typically when we design environments, we think about color and light related to sight. Soothing colors, types of patterns, and familiarity for the users are all important considerations. Each of these effects the patient and can generate either positive or negative outcomes.
  • Hearing: Finding ways to reduce unpleasant noises is certainly important but so is adding sounds of nature that give an inner strength to patients... think of a waterfall, a gentle breeze, or ocean waves. Repetitive sounds or small surprises such as birds chirping can ease a patient’s spirit.
  • Smell: Many designers don't think of bringing natural scents into the environment. There are many experimental research studies on how aromas can impact hospitals.
  • Taste: In environmental design, we can improve a patient’s appetite by incorporating colors and scents that trigger their taste buds.
  • Touch: Generally, humans like to touch our environment. Upholstery may have smooth or rough textures. Plants may be silk or real. Wood grain may be polished or natural. If you observe users of any environment, you will see them touch elements in their surroundings more so than not.
Colorful medical facility lobby
Colors and textures can create stimulating environments for patients.

Think of our senses as pieces of a puzzle. When designing medical facilities, it’s important that we look at each piece and relate it to what is truly appropriate for stimulation and recovery. And in doing so, we can apply the three principles of supportive design.