The Psychological Impact of Hospital Interiors on Patient Recovery
For as long as I can remember I have never liked hospitals; my earliest memory of a hospital was going to see my grandma before she died. The place was small, rowdy, reeked of a strong disinfectant, everywhere was white and it felt like a place people came to die. Even though I’m older, I still avoid going to the hospital. What is it about hospitals that make people feel uncomfortable? What can be done to encourage people to visit when necessary? These questions bugged me till I discovered the uneasy feeling I got when I stepped into hospitals was greatly influenced by the interior design. It got me wondering if I, a visitor felt this way, how much more do the patients? And what the impact of the interior design of the hospitals was on their recovery.
Hospitals are a relatively modern concept. In the past healing was associated with religion. People used to get treatment by visits from healers or visits to holy sites such as cathedrals and temples; the aim was to bring the patients closer to their deities while the healers performed their duties.
Those who sought further treatment had to pay large sums of money to get private visits from doctors and experts, while the poor left their homes to seek medical care. Hospitals then were seen as places of sickness, death, and poverty.
Discussions about the importance of the built environment for the patient’s health and well-being extend as far back as 400 BC with Hippocrates. The ancient Greeks and Egyptians had temples of healing, where individuals from all walks of life could be blessed or have basic treatment. However, the earliest well-recorded example of a building dedicated purely to the treatment of illness and injury comes from Sri Lanka, around 400 BC. Still deeply associated with religion, hospitals for the next 500 years were almost exclusively church-run.
The Impact of Florence Nightingale
By the 19th Century, hospitals were everywhere and with the advancement in medical practices and technology, the perception that people should be treated at home or that hospitals were a place of death and pauperism had faded.
The change in perception also came with an increase in hospital patients, so the wards that initially boasted of access to natural light, large windows and good views could no longer do so due to the sheer number of patients. Hospitals became characterized by long dark corridors, dark, poorly ventilated, and unsanitary wards, confusing signs, and harsh disinfectant smells.
In 1863 Florence Nightingale saw the impact of the terrible hospital conditions, especially the interiors and proposed wholescale changes. In her Notes on Hospitals, she wrote extensively about the importance of natural light, fresh air, and a good view of nature in promoting patient recovery. She claimed that for a patient to heal effectively, their minds and bodies must be cared for and little things like looking out of a window to see the bright colours of flowers in contrast with looking at a blank wall improved recovery. Her changes were implemented, and it saw improved patient recovery and a reduction in cross-infections.
Post-Second World War
However, by the second world war, the needs of hospitals changed from patient-centric centres of healing to centres of efficiency, sanitation, and functionality. Hospitals became machines, optimized to work as efficiently as possible without caring too much about the therapeutic effects of hospital design. People got weary of the new design shift and began to feel uneasy and uncomfortable in these impersonal spaces.
Dutch Architectural Historian said “Hospitals are built catastrophes, anonymous institutional complexes run by vast bureaucracies and totally unfit for the purpose they have been designed for. They are hardly ever functional, and instead of making the patients feel at home, they produce stress and anxiety.”
There are many statements from patients claiming that the ugliness and starkness of these interiors contribute to feelings of despair and hopelessness. American writer Susan Sontag famously said that ugly buildings confirm the idea that illness is a punishment and those who are ill are simply undeserving.
The importance of Interior design
Every space is a sensory experience comprising of different factors, namely lighting, colour, texture, acoustics, and form. Many designers use these factors to evoke certain emotions in people, for example, restaurants and fast-food spots use earthy colours and red to make you feel like eating. Cathedrals are designed to intimidate, to remind you that you are in the presence of a higher power; high head rooms, stained glass windows and the grandness of the structures all contribute to this phenomenon.
Colours
One of the most significant factors in interior design is colour. The perception of colour is mostly cultural, although there are biological effects; for example, red has the shortest wavelength and is the most visible colour on the spectrum, hence, its widespread use as warning signs. Research has also shown that red increases heart & respiration rates as well as elevating blood pressure--that is why it is applied in spaces that encourage activity. A clear example of the cultural difference in colour perception is the image of the colours white and black. In the west and most of Africa, black is associated with death and mourning and white with new birth, purity, and spirituality. The perception of these colours is different in the far east as white is used for mourning and black for sophistication and formality. Therefore, one must be careful in using colours in interior spaces.
White walls & corridors
Why are most hospital interiors white? Some researchers believe white is an ‘empty’ colour and evokes no serious emotions, so it is safe to use in sensitive places like hospitals and mental health facilities. White is also used to ensure cleanliness for patient health as well as conditioning clients confidence in the purity these spaces. Recently, there have been multiple arguments against the indiscriminate use of white in hospital buildings. One of such arguments is that patients staying in a sensory-deprived space tend to feel institutionalized and trapped which may impact recovery negatively. Another argument states that the combination of white walls and fluorescent lights causes anxiety and stress.
As earlier mentioned, colour is not the only factor that affects patients’ psychology in these spaces. In 1984 Roger Ulrich published an article titled “View through a window may influence recovery from surgery” and changed hospital design forever.
Evidence based Design (EBD).
Ulrich’s article compared the positive effect of views of natural scenery on the recovery of patients from surgery to patients in similar conditions who were exposed to a view of a brick wall. He showed that patients with a view of nature had shorter postoperative hospital stays, fewer negative evaluative comments from nurses, took fewer moderately strong and strong medications and had slightly lower scores for minor postsurgical complications in comparison to those with the wall view. Since then, more research has gone into the impact of the physical environment on the health and well-being of patients. Consequently, this resulted in more healthcare facilities becoming healing environments rather than centres of sickness and disease; all these factors contributed to the formation of evidence-based design.
Evidence-based design is a field of design that makes design decisions based on the best information available from research that should result in demonstrated improvements in the organization’s clinical outcomes, economic performance, productivity, customer satisfaction, and cultural measures. EBD has changed how hospitals are perceived and designed; several hospitals are no longer the dreary and haunting spaces they used to be but are now welcoming, relaxing and healing environments.
There is enough data to suggest the psychological impact of hospital interiors is substantial. However, the challenge is in applying this information to the design of hospitals. Many hospitals have diverse needs and patients; therefore, a one-size-fits-all approach is impossible. Some institutions have guidelines for designing healthcare spaces but like various academic fields, these guidelines keep changing due to the presence of new data.
Conclusion
History has shown that healing environments provide the best care for patients; no matter how hospitals strive to be efficient machines, they must put patient well-being first, mentally and physically. Hospital design has evolved over the years, the rise of EBD has seen a paradigm shift in how hospitals are built; while the guidelines keep changing on what makes good hospital design, a few things are constant. Natural light & ventilation, a view of nature, privacy, good wayfinding and warm spaces are vital in promoting patient mental well-being and improving recovery.