rehab design for sleep

1. Adapting the
Rehabilitation
Environment to
Optimize Sleep
- a design lens
Prof Evonne Miller
@evonnephd
Director, QUT Design Lab
Co-Director, HEAL – CEQ
Queensland University
of Technology
HEAL: the transformative power of design and designers, in
collaboration with clinicians and consumers
https://research.qut.edu.au/heal/

3. About Me: Professor of Design Psychology
& Director of QUT Design Lab
@evonnephd
e.miller@qut.edu.au
Forthcoming 2023 Edited Springer Book: How designers are transforming healthcare

4. WHY CARE ABOUT DESIGN & ARCHITECTURE IN HEALTHCARE?
“Architecture: does it matter? Architects tend to think architecture matters. Not everyone does. To many
people, buildings are expensive, but not very interesting. Its what goes on inside them that matters.
The argument continues that it’s better to have a good teacher (or craftsperson, parent, designer, manager
etc ) [CLINCIAN] in an ugly shed, barrack, pre-fab, tower-block, flat etc., than a poor one in a beautiful
room. But few of us are exceptionally good or exceptionally bad; we’re middling, so we need support”
We need to think of the architecture - the design, experience and interactions within
the built environment - as a PARTNER in the care [sleep] experience
Christopher Day (2014). Places of the soul: architecture and
environmental design as healing art. Routledge (p.1).
Take-home message…. design to enable/support (not restrict) the care experience

5. TODAY
PART 1: Overview of HEAL –
design-led innovation in
healthcare
PART 2: Apply a design-lens to
the challenge of sleep
in hospital context
CEQ supported Healthcare Excellence AcceLerator (HEAL) initiative
HEAL 15+ HHS, spanning multiple design disciplines
Spatial: Architecture, Landscape, & Interior Architecture
Experiential: Interactive, Industrial, Fashion, & Visual Communication
https://research.qut.edu.au/heal/

6. CEQ supported 35+ HEAL Projects, 15+ Qld HHS, 2020-2023
Spatial: Architecture, Landscape, & Interior Architecture
Experiential : Interactive, Industrial Design, Fashion, & Visual Communication
https://research.qut.edu.au/heal/
PART 1: HEAL

7. Driving Ideas
Co-Design
& Design Thinking
Workshops –
from 6-100+ people
DT/CD
underpins all
HEAL projects

8. QUT-Led: A/Prof Jen Seevinck, Prof Evonne Miller,
Kirsten Baade, & Gillian Risdale
Playful Placemaking at
Queensland Children’s Hospital

9. QUT-Led: Prof Marianella Chamorro-Koc, Dr Rafael Gomez,
Isabel Bryam
Prototypes for Child-Friendly PPE

10. QUT-Led: Dr Manuela Taboada, Thalia Bruner, with Sean
Maher and Kirsty Leo
Animating Cultural Safety

11. QUT-Led: Prof Lisa Scharoun, Prof Evonne Miller,
Zoe Ryan
Redesigning Visual
Communication to Reduce
Urine Contamination

12. QUT-Led: Evonne Miller, Lisa Scharoun, Ruari Elkington, Shane Pike
Re-designing how prisoners
request and access health services

13. Hospitals are not
home – they are
noisy, stressful, busy,
and unfamiliar
environments.
Adapting the Rehabilitation
Environment to Optimize Sleep
A DESIGN LENS
PART 2: APPLYING A DESIGN-LENS TO SLEEP

14. Hybschmann et al. 2021. Sleep in
hospitalized children and
adolescents: A scoping review.
Sleep Medicine Reviews.
Sleep in Hospitals
–
Its Complicated!

15. Growing number of patient-centred education and empowerment interventions, eg I-SLEEP
brief patient-facing educational video (on ipad); 2. an educational brochure; 3. a sleep kit - eye mask, ear plugs,
and a notecard three questions patients can ask care teams to reduce night-time disruptions in the hospital
I-SLEEP intervention partners with patients to help them improve their own sleep by targeting barriers to in-
hospital sleep (i.e., noise, light, night-time disruptions): BUT HME RE-DESIGN ENVIRONMENT MORE ?
Mason et al. (2021). Piloting I-SLEEP: a
patient-centered education and
empowerment intervention to improve
patients’ in-hospital sleep. Pilot
Feasibility Stud 7.

16. if we intentionally adopt a design lens,
we can create an environment
that supports sleep… and care - for all
“Natural light and noise reduction technology would aid sleep, and communal areas would encourage socialising, rather than
eating in a chair next to the bed. We need separate areas where intimate examinations, treatments, and even difficult
conversations can happen. These should be large enough to house a hospital bed and a supportive family. We should replace
faded signs and use floor maps, with directions to toilets and exits, that are shown to nudge human behaviour.
Think too about staff. Central workspaces should encourage thoughtful work with additional areas close to patients, for
individualised care. Zoned areas could indicate different levels of need and safe “wander paths,” allowing movement even when
patients are unwell… Hospital needs to be a place that promotes healing, not one that simply delivers it”
Matt Morgan (2019). Fixing our broken wards. BMJ.

17. OUR CHALLENGE NOW:
TO ACTIVATE OUR CREATIVE
IMAGINATIONS
TO REIMAGINE & REDESIGN
THE HOSPITAL SLEEP
ENVIRONMENT & EXPERIENCE
grounded in therapeutic and healing architecture perspective
Lawson, B. (2010). Healing architecture. Arts & Health, 2(2).

18. Our Lens to this
Design Challenge:
Theory-Storming
Viewing a design problem through
multiple theoretical lenses. The
goal is to generate an evidence-
based design solution that is
creative and inspired, but also
effective and sustainable for
multiple stakeholders.
Inspired by Edward De Bono’s Six Thinking Hats

19. Fostering innovation, by
adopting a theory-
storming approach
to challenges
- ..
- A biophlic design lens
- A playable design lens
- An inclusive design lens
CHOOSE YOUR FRAME –
AND YOUR PERSPECTIVE
senses, patient, clinician, family etc –
voice of technology, the bed, the floor,
the window etc
FRESH IDEAS, VIA THEORY- STORMING INNOVATION
(also perspective storming)

20. Burton, L., Miller, E., Carthey, J. & Schofield, S. (2024). Designing hospital emergency departments for a post
pandemic world: The value of a BaSE Mindset – Biophilia (natural), Salutogenesis (healthy), Eudaimonia
(contentment) in architectural design. Forthcoming, in How designers are transforming healthcare. Springer.
THEORY-STORMING LENS: BIOPHILIC DESIGN
Let’s “Theory-Storm” Designing for Sleep in Hospital

21. Funan Singapore: shopping centre rooftop
features a biophilic green space,
community garden, and space for play
THEORY-STORMING LENS: BIOPHILIC DESIGN..
Therapeutic Outdoor Environments

22. Huntsman & Bulaj (2022). Healthy Dwelling: Design of
Biophilic Interior Environments Fostering Self-Care
Practices for People Living with Migraines, Chronic
Pain, and Depression. Int J Environ Res Public Health.
Creating Therapeutic Indoor Environments – Biophilic Design
Consider biophilic
elements, a smart
lighting system, and
soundscapes
delivering relaxing
music…

23. THEORY-STORMING LENS: PLAYABLE DESIGN
Making PARKING LOTS playable – rooftop, external stairs
In Copenhagen, Denmark, the recent rooftop refurbishment of an eight-story parking building into a ‘urban living space’ with
sports (running track, basketball) and play equipment: parking buildings become sites of play.
Credit: Rasmus Hjortshøj/Coast Studio for JAJA Architects.

24. THEORY-STORMING LENS:
PLAYABLE / SALUTOGENIC DESIGN
What about a climbing wall or a cycle lane,
inside or around a hospital?
Funan Singapore
shopping centre
features an indoor
climbing wall and red
biking track, which
means users can easily
run or cycle (7-8am)
through this mall!

25. We experience our built environment
though our senses, as architectural theorist,
Pallasmaa (2011) notes:
“Spaces, places, and buildings are undoubtedly
encountered as multisensory lived experiences.
Instead of registering architecture merely as visual
images, we scan our settings by the ears, skin,
nose, and tongue” (p. 595)
THEORY-STORMING LENS:
OUR SENSES,
MULTI-SENSORY DESIGN,
Let’s “Theory-Storm” Designing for Sleep in Hospital

26. UNDERSTANDING MULTI-SENSORY DESIGN
- activating touch, sound, smell, taste, and the wisdom of the body
“Designers consider interaction of bodies and things. What sound does a chair make when it scrapes
against the floor? How hard does a button need to be pressed to register a response? How much does
a surface flex when we push against it?...
Sensory design slows space down, making it feel thick – not thin.
Sensory design enhances health and wellbeing…
Sensory design is inclusive…
Sensory design enhances human diversity…
Sensory design considers not only the shape of things, but how things shape us – our behavior, our
emotions, our truth… when our body presses into the cushioned surface of a chair, both body and chair
give and react… We use our senses to change our world”.
Ellen Lupton & Andrea Lipps. 2018. The Senses: Design Beyond Vision. Princeton Architectural Press. (p. 11. & p14-15)

27. ENGAGE WITH OUR SENSES…
HOW MIGHT WE (HMW)
deploy a multi-sensory
design lens to reimagine the
hospital rehab environment
and support sleep
1. SENSE OF HEARING
The soundscape
SENSE OF SMELL
The olfactory senses
& odours by design
SENSE OF TOUCH
or Haptic Architecture
SENSE OF SIGHT
Light & Sight
Spence, C. (2020). Senses of place: architectural design for the multisensory mind. Cogn. Research 5, 46.

28. (1) what is the characteristic sound of hospital spaces?
.. (2) and how could it become a healing soundscape?
(1) relational
(2)) architectural-structural measures
Pallasmaa (1994) notes,
“every building or space has its
characteristic sound of intimacy or
monumentality, rejection or invitation,
hospitality or hostility” (p. 31)….
Sense 1 - SOUND

29. • PEOPLE
• SYSTEMS & PROCESSES
• EQUIPMENT (food trolleys,
automatic door openers, telephones,
beds, pagers; monitors, alarms)
Start by conduct a Sound-
Spatial Audit – where is the
excess noise coming from:
systems, processes or people?

30. change our
perspective
… THESE
SOUNDS
SAVE LIVES…
VISITING BNE IN NOV: A/Prof Victoria Bates (Modern Medical History),
from University of Bristol has a UK Research & Innovation Future Leaders
Fellowship: Sensing Spaces of Healthcare: Rethinking the NHS Hospital.
Her recent book is Making Noise in the Modern Hospital (2021)

31. ADDRESS SPATIAL NOISE – headphones, silence OR sounds of nature
Who here regularly listens to Insight Timer, Harmony Hypnosis or Harry Potter audio at night?
DO OLDER PATIENTS?
Research shows,
compared to ‘normal’
control, both sounds of
nature and silence (via
headphones) can
significantly improve
hospital sleep experience
- as measured by sleep
questionnaire
Nasari et al. (2018). Effects of nature sounds on sleep quality
among patients hospitalized in coronary care units: A
randomized controlled clinical trial. Nursing and Midwifery
Studies, 7(1), 18–23.

32. Applying a multi-sensory
design lens to reimagine the
hospital rehab environment
and support sleep
SENSE OF HEARING
The soundscape
SENSE OF SMELL
The olfactory senses
& odours by design
SENSE OF TOUCH
or Haptic Architecture
2.SENSE OF SIGHT
Light & Sight
Throughout time, from our
hunter-gather days, light
has been the most
important time-giver for
the human circadian
system, from daylight to
night-time darkness

33. Exposure to artificial light during
normal dark periods has a negative
impact: delays the circadian phase,
suppresses melatonin production,
delays sleep onset, changing sleep
architecture, and increasing alertness
SENSE 2 - LIGHT

34. • before new hospital opened
• first evaluation of residing in blue-depleted LE
(LED lighting system ; blue-blocking window
filters in evening; televisions had permanent
blue-blocking filters
• randomized cross-over trial including objective
markers of circadian rhythms, sleep, and arousal:
Vethe et al. 2021., The evening light environment in hospitals can be designed to produce
less disruptive effects on the circadian system and improve sleep, Sleep, 44,(3)
blue-depleted light environment bedroom
“when healthy adults reside for 5
consecutive days in an evening blue-
depleted LE, they exhibit substantially
reduced suppression of melatonin
production and phase-advancement
of endogenous circadian rhythms
compared with when residing for a
similar period in standard LE
conditions”

35. PROTOTYPES
immersive sound & light -
potential as a
therapeutic tool
QUT’s The Aerie
(a bespoke portable &
collapsible structure
Prof Marianella Chamorro-Koc

36. What about VR?
Hands Up.. who has:
- tried VR
- used more than 5 x
- own a headset?
Improved sleep quality:
48 cardiac intensive care unit
patients in Korea. Experimental
group, 30 minutes meditation using
a head-mounted VR (FitBit & Self-
reported Sleep scale)

37. Applying a multi-sensory
design lens to reimagine the
hospital rehab environment
and support sleep
SENSE OF HEARING
The soundscape
3. SENSE OF SMELL
The olfactory senses
& odours by design
SENSE OF TOUCH
or Haptic Architecture
SENSE OF SIGHT
Light & Sight

38. • Double rows of lilac planted on 4
busy streets in Harbin, China.
• Fragrance positively affected
perception of traffic noise
- increased overall comfort of street
- decreased annoyance of traffic noise:
- improvement auditory & olfactory
satisfaction.
How might we deploy ‘scent stimuli’ in hospital settings?
Ba, M. & Kang, J. (2019). Effect of a fragrant tree on the perception of
traffic noise. Building and Environment, 156, 147-155,
SENSE 3 – SMELL

39. WEARABLE SCENT DELIVERY SYSTEMS – TESTING PROTOPYPES
Ezzence – the first smartphone-controlled olfactometer, integrated with a
wearable EEG and real-time sleep staging algorithm (to release scent during
specific sleep stages) - was trialed in a home-based sleep environment
Compared to control participants with water, N = 40 participants: satisfied with
the device, found it easy to use & reported a significant improvement in sleep
quality, better mood the following morning and and shorter time to sleep onset
Amores et al. (2022).. Development and Study of Ezzence: A Modular Scent Wearable to Improve Wellbeing in Home Sleep Environments. Front Psychol.

40. Applying a multi-sensory
design lens to reimagine the
hospital rehab environment
and support sleep
SENSE OF HEARING
The soundscape
SENSE OF SMELL
The olfactory senses
& odours by design
4. SENSE OF TOUCH
or Haptic Architecture
SENSE OF SIGHT
Light & Sight
“Spaces, places, and buildings are undoubtedly encountered as
multisensory lived experiences. Instead of registering architecture
merely as visual images, we scan our settings by the ears, skin,
nose, and tongue” (Pallasmaa, 2011, p. 595)

41. WHAT ABOUT WEIGHTED BLANKETS? HELPS PEOPLE W ADD FALL ASLEEP &
EMERGING RESEARCH CALMING IN DEMENTIA (AMANDA FOX, QUT)
How could a better awareness
of ‘materiality ’ be safely
deployed in hospital settings?
- absorptive materials often
overlooked in healthcare as
difficulties in cleaning
- sound could be dissapated via
quiet flooring or fabric wall
panels
Bolic Baric et al. (2021) The effectiveness of weighted blankets on sleep and everyday activities - A retrospective follow-up study o
children and adults with attention deficit hyperactivity disorder and/or autism spectrum disorder. Scand J Occup Ther.
SENSE 4 – TOUCH

42. Experiencing Physical Warmth
Promotes Interpersonal
Warmth!
COFFFE vs ICED COFFEE
Williams, L, & Bargh J. (2008) Experiencing physical warmth promotes interpersonal warmth. Science, 24. .
NEVER TRUST PSYCHOLOGY RESEARCHERS CARRYING COFFEE … J
• Participants encounter a person ( researcher) in the hallway , who is carrying papers etc – and asks
them to briefly held a cup of hot (versus iced) coffee . They then evaluated a job candidate; those who
TOUHCED the warm coffee judged them as having a a “warmer” personality (generous, caring)
• The warm-cold assessment is the social perceiver's immediate “first-pass” as to whether the target
individual is a friend or foe – SO MATTERS

43. many ways to activate the design of the built environment to
promote an atmosphere of rest, healing,
and SLEEP in hospitals …. but, doing that requires:

44. What we can learn from
an Indian fable –
“6 Blind Men
& the Elephant”
FIRSTLY – IT HAS TO BE VIA A TRUE TRANS/CROSS DISCIPLINARY PARTNERSHIP

45. SECONDLY - CO-DESIGNED

46. THIRDLY - ADOPT A DESIGN LENS. HOW DOES THE ARCHITECTURE & DESIGN
‘SUPPORT THE MOOD THE ACTIVITY NEEDS’?
p.20. Christopher Day (2014). Places of the soul: Architecture and environmental design as healing art. Routledge. 3rd Ed.

47. • Radical: Are the practices
foregrounded by the experiment
fundamentally different from dominant
practices?
• Challenge driven: Is the experiment a
step toward a potentially long-term
change pathway to address a societal
challenge?
• Feasible: Is it possible to realise the
experiment in the short term and with
readily available resources?
• Strategic: Can the experiment generate
lessons about how to reach the
envisioned fundamental changes? Can
the agents needed for such changes
access these lessons?
• Communicative/mobilising: Can news
about the experiment reach and
possibly mobilise the broader public?
CONTEXT OF URBAN MOBILITY & ACTIVATING STREETS Drawing on Roorda et al.’s
(2014) five defining characteristics of transition experiments, Bertolini (2020)
argues that street experiments must be:
FOURTH, TO ADOPT A MINDSET
FOR CHANGE, WE NEED TO THINK:

48. WHY CARE ABOUT DESIGN & ARCHITECTURE IN HEALTHCARE?
“Architecture: does it matter? Architects tend to think architecture matters. Not everyone does. To many
people, buildings are expensive, but not very interesting. Its what goes on inside them that matters.
The argument continues that it’s better to have a good teacher (or craftsperson, parent, designer, manager
etc ) [CLINCIAN] in an ugly shed, barrack, pre-fab, tower-block, flat etc., than a poor one in a beautiful
room. But few of us are exceptionally good or exceptionally bad; we’re middling, so we need support”
We need to think of the architecture - the design, experience and interactions within
the built environment - as a PARTNER in the care [sleep] experience
Christopher Day (2014). Places of the soul: architecture and
environmental design as healing art. Routledge (p.1).
FINALLY: take-home message…. design to enable/support (not restrict) the care experience
FINALLY – CONTINUE TO ADVOCATE FOR DESIGN AS A PARTNER IN CARE

49. Adapting the Rehabilitation
Environment to Optimize
Sleep - a design lens
Prof Evonne Miller
@evonnephd
Director, QUT Design Lab
Co-Director, HEAL – CEQ
Queensland University of Technology
HEAL: the transformative power of design & designers, in collaboration with clinicians & consumers
https://research.qut.edu.au/heal/

50. “The ultimate aim of the practice of
both medicine and architecture seems to
be to improve the human condition, one in
the intimate bodily end of the scale of
existence, the other in the experiential,
mental and environmental end of the
human-world [man] world continuum. Both
are also essentially practices of the hand.
Although recent developments in
technology, and especially in digitalisation
and computerisation, have distanced
both practices from the direct use of
the hand, the hand still has its role in
the pre-reflective processes of embodied
thinking and feeling. Both practices also call
for a holistic and comprehensive
understanding of the human situation”
Juhani Pallasmaa (2017). Empathy, Design and Care – Intention,
Knowledge and Intuition: The Example of Alvar Aalto. In Care and Design:
Bodies, Buildings, Cities. Eds. Charlotte Bates, Rob Imrie & Kim Kullman.
The Similarities between Medicine, Care, Architecture, & Design