Therapeutic Environments - Devising space designs that provide measurable positive effect on patients clinical outcomes (part1)
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Threads of time and space weave human life, the pattern so weaved dictates its every aspect. If the effect of space on human mind and spirit is so intense then why not mould it to heal people. This presentation was the foundation of the graduation project of my MDes at NIFT Mumbai. It deals with the nuances of health care design unravelling the ways in which environment can act as a catalyst in the healing process. PART 1 For the purpose of a more lucid account of my research, it has been divided into two parts. The first part i.e this presentation is the foundation of the research and deals with the objectives of the research and identification of the contemporary healthcare design pattern.
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Therapeutic Environments - Devising space designs that provide measurable positive effect on patients clinical outcomes (part1)
- 1. Therapeutic Environments Bharti Sharma M.des, NIFT Mumbai Mentor : Ms. Sushama Saitwal Devising space designs that provide measurable positive effect on patients clinical outcomes C 2014 Bharti Sharma.All rights reserved Part 1
- 3. Therapeutic environments Therapeutic + environments Supports clinical excellence in the treatment of the physical body Supports the psycho-social and spiritual needs of the patient, family, and staff Produces measurable positive effects on patients' clinical outcomes and staff effectiveness Having a good effect on the body or mind; contributing to a sense of well-being source:oxford dictionaries The setting or conditions in which a particular activity is carried on }{
- 5. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Human Health WHO defination
- 6. Health industrycare Comprises of providers of diagnostic, preventive, remedial, and therapeutic services such as doctors, nurses, hospitals and other private, public, and voluntary organizations within the economic system. businessdictionary.com
- 7. Health industry: INDIAcare present scenario This industry is currently worth Rs 73,000 crore which is roughly 4% of the GDP. The industry is expected to grow at the rate of 15 percent which amounts to an addition of Rs 9,000 crores each year. 2017E $158.2 Bn 2012 $78.6 Bn 2011 $68.4 Bn 2010 $59.5 Bn 2009 $45.0 Bn 2008 $51.7 Bn expected growth of healthcare sector in India http://healthcare.financialexpress.com/
- 8. Medical Tourism India has emerged as the fastest growing segment of tourism industry and seems to be the most promising medical tourism destination in the world. The report further said that by the end of 2015, its global medical tourism industry share would be around 3 per cent. UK-based TransWorldNews The population to bed ratio in India is 1 bed per 1000, in relation to the WHO norm of 1 bed per 300. In India, there exists space for 75000 to 100000 hospital beds. Over the last five years, there has been an attitudinal change amongst section of Indians who are spending more on healthcare. Rise in retail clinics, single speciality, secondary and tertiary care centres www.who.int/
- 9. Segmentation
- 10. 3% Segmentation of the healthcare industry Medical software and Diagnostics Segmentation http://healthcare.financialexpress.com/
- 11. 3% 4% Segmentation of the healthcare industry Health maintenance organizations (Medical insurance) Medical software and Diagnostics Segmentation http://healthcare.financialexpress.com/
- 12. 3% 4% 9% Segmentation of the healthcare industry Health maintenance organizations (Medical insurance) Medical software and Diagnostics Health equipments and supplies Segmentation http://healthcare.financialexpress.com/
- 13. 3% 4% 9% 13% Segmentation of the healthcare industry Health maintenance organizations (Medical insurance) Medical software and Diagnostics Health equipments and supplies Pharmaceutical Segmentation http://healthcare.financialexpress.com/
- 14. Hospital management firms 71% 3% 4% 9% 13% Segmentation of the healthcare industry Health maintenance organizations (Medical insurance) Medical software and Diagnostics Health equipments and supplies Pharmaceutical Segmentation http://healthcare.financialexpress.com/
- 15. 3% 4% A facility with specialised staff and equipment whose primary function is to provide inpatient and outpatient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and non surgical. Hospital management firms
- 16. 3% 4% A facility with specialised staff and equipment whose primary function is to provide inpatient and outpatient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and non surgical. Hospital management firms Objective Teaching cum- research General Speciality Classi cation of Hospitals
- 17. 3% 4% A facility with specialised staff and equipment whose primary function is to provide inpatient and outpatient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and non surgical. Hospital management firms Objective OwnershipTeaching cum- research General Speciality Government Private Charitable Corporate Classi cation of Hospitals
- 18. A facility with specialised staff and equipment whose primary function is to provide inpatient and outpatient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and non surgical. Hospital management firms Objective Ownership Service Teaching cum- research General Speciality Government Private Charitable General Specialty (patients belonging to a particular group, patients suffering from diseases of a particular organ or groups of organs) (Clinical Services, Surgery, emergency, Outpatient, support service) Corporate Classi cation of Hospitals
- 19. A facility with specialised staff and equipment whose primary function is to provide inpatient and outpatient services, diagnostic and therapeutic, for a variety of medical conditions, both surgical and non surgical. Hospital management firms Objective Ownership Service Classi cation of Hospitals Teaching cum- research General Speciality Government Private Charitable General Specialty (patients belonging to a particular group, patients suffering from diseases of a particular organ or groups of organs) (Clinical Services, Surgery, emergency, Outpatient, support service) Area of intervention Corporate
- 20. Curing model of Hospitals Medicine Medical organization Infrastructure Doctors Nurses management staff Technology Service Culture Empathy based on analysis of secondary data
- 21. Curing model of Hospitals Doctors Nurses management staff Technology Service Culture Empathy Infrastructure Medicine Medical organization Medical Equipments Environment (space design) Ancillary and Support Services
- 22. Curing model of Hospitals Doctors Nurses management staff Technology Service Culture Empathy Infrastructure Medicine Medical organization Supports clinical outcomes Produces measurable positive effects on patients' clinical outcomes and staff effectiveness Study focuses on these two elements, And using Architecture in a way that it: Medical Equipments Ancillary and Support Services Environment (space design)
- 23. Treatment The gap so discovered is between the present use of the hospital space as a medicinal infrastructure element and its potential use as a supplementary treatment for holistic health. Gap identified (Context: India) Physical Clinical facilities Experiential attributes of the hospital (eg color, light) Effect of treatment on mind Effect of treatment on body Psychological Hospital Patient PsychologicalPhysical
- 24. Through Medicine Treatment The gap so discovered is between the present use of the hospital space as a medicinal infrastructure element and its potential use as a supplementary treatment for holistic health. Gap identified (Context: India) Physical Clinical facilities Experiential attributes of the hospital (eg color, light) Effect of treatment on mind Effect of treatment on body Psychological Hospital Patient PsychologicalPhysical
- 25. Through Medicine Through Healing Treatment The gap so discovered is between the present use of the hospital space as a medicinal infrastructure element and its potential use as a supplementary treatment for holistic health. Gap identified (Context: India) Physical Clinical facilities Experiential attributes of the hospital (eg color, light) Effect of treatment on mind Effect of treatment on body Psychological Hospital Patient PsychologicalPhysical
- 26. Physical Clinical facilities Experiential attributes of the hospital (eg color, light) Effect of treatment on mind Effect of treatment on body Psychological Hospital Patient PsychologicalActive Passive Through Medicine Through Healing Treatment Therapies used as a medium Positive effect on mental health (well- being) Physical The gap so discovered is between the present use of the hospital space as a medicinal infrastructure element and its potential use as a supplementary treatment for holistic health. Gap identified (Context: India)
- 27. Objectives of research To study the environmental psychology and understand the relationship between behavioural health and the physical environment. To identify and analyze the latest developments in the interior design of health care centers and hospitals. To investigate the various therapies allied to the sphere of space along with other environmental characteristics and their positive effects on human psyche. To substantiate the research by the way of design solutions of the interiors of a healthcare center.
- 28. Expected result The research model aims at achieving the following : Enabling the health care centers to become not merely an ensemble of concrete and contraptions or a warehouses for sick but a comfortable haven for both the care givers and care receiver . Incorporating such therapies in space design which have a direct and ongoing effect on the patient’s psyche as well as measurable positive effects on his/her clinical outcomes . To evolve space designs that lend the interiors , an environment that enhances staff efficiency, staff satisfaction and organizational outcomes.
- 29. Secondary Research Primary Research Critical Theory Analysis (Tertiary & Secondary data) Observation Care Giver Care Reciever Designer Field Study Patient And Doctor Activity Mapping Interview Gap Identi cation Development of Key Design Considerations study analysis identification Design Development Hospital feedback Hospital Design, Interactive spaces, Children Spaces Behaviourial Health Therapies and other environmental characteristics found to influence Health outcomes Environmental Psychology Child Psychology Space Psychology Design Medical Science methodology
- 30. Secondary Theory Secondary Visual Research Secondary Analysis Tertiary research Secondary Research Concepts Theories Present researches Present researches Critical review to understand the various theories and concepts related to the field of environment and healthcare. Critical Theory Analysis Comprehension and Analysis of present healthcare scenario Tertiary Data Secondary Data Phase 1
- 31. The liberal use of colors , vivid illustrations and animated characters make the interiors come alive Use of cool colors and nautical paintings effectively pull off a serene oceanfront feel , granting the ambiance a sense of calm and peace . The continuity of the narration is unhindered , maintained by the continuation of illustrations on glass . Scale and perspective provides quick visual stimulation and acts as a positive distraction. Secondary Visual Research
- 32. Melbourne’s Royal Children’s Hospital Melbourne, Australia The waiting areas are not conventional sitting arrangements but evolved into activity spaces to engage the child during the waiting hours . Reflecting the sense of warmth and care , the soft edges impart tenderness that sharp edging essentially forgoes. softer and round edges The illustrations complement the interiors in every respect thus leaving no room for visual tension or distraction.
- 33. Randall Children’s Hospital The corridors make clever use of creative installations , colour blocking and asymmetric designing to not only create a happy sitting space but also break free from the institutional typecast inherent to hospitals . The children’s rooms are designed to provide a homely environment made complete with warm and comfortable design setting . The small lounging spaces at regular intervals provide personal space to patients and their accompanists
- 34. Texas Children's Hospital Page Southerland Page,Houston, Texas The bright and contrasting combination of yellow and violet add a dash of playfulness to the interiors making them appear less institutional. interactive spaces Ceiling designs and sky installations generate awe and interest among young and old alike . Sky installations add more interest
- 35. Randall Children’s Hospital Ingenious and Interactive learning areas in corridors seek to engage the attention of the onlookers The traditional black and white signage is given a new life through interesting , colourful icons that speak for themselves . The accessories of the rooms play upon nature therapy through prints in refreshing greens .To ease the tension of patients the ECG room is given a serene dreamlike background almost meditative in nature .
- 36. Designing for Healthcare analysis of various models suggested by medical researches and centers to create and healthcare envirnoment
- 37. Disease Physical Environment Medicine Technology (Disease centric) Cure Designing for Healthcare analysis of various models suggested by medical researches and centers to create and healthcare envirnoment
- 38. Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Designing for Healthcare analysis of various models suggested by medical researches and centers to create and healthcare envirnoment
- 39. Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Hope Music etc engagement of senses architecture Empathy Art Nature Aroma Entertainment Interaction communication comfort way finding lighting color communication equipments medical facilities Designing for Healthcare analysis of various models suggested by medical researches and centers to create and healthcare envirnoment
- 40. Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Hope Music etc engagement of senses architecture Empathy Art Nature Aroma Entertainment Interaction communication comfort way finding lighting color communication equipments medical facilities Environmental psychology Parallels between Behaviourial health and Physical Environmental Psychoneuroimmunology
- 41. Designing for Healthcare Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Hope Music etc engagement of senses architecture Empathy Art Nature Aroma Entertainment Interaction communication comfort way finding lighting color communication equipments medical facilities Disease Patient (Disease centric) Cure Care (patient centric)
- 42. Designing for Healthcare Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Hope Music etc engagement of senses architecture Empathy Art Nature Aroma Entertainment Interaction communication comfort way finding lighting color communication equipments medical facilities Disease Patient Balance (Disease centric) Cure Care (patient centric)
- 43. Designing for Healthcare Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Hope Music etc engagement of senses architecture Empathy Art Nature Aroma Entertainment Interaction communication comfort way finding lighting color communication equipments medical facilities Disease Patient Balance Patient experience Effectiveness of treatment Florence Nightingale Body-and-mind connection. Consumer- and user-focused culture are growing, patients will be making demands on the quality, context and accessibility both of services and of the environmental components that encourage good health. (Disease centric) Cure Care (patient centric)
- 44. Designing for Healthcare Disease Physical Environment Medicine Technology (Disease centric) Cure Patient Social Environment Therapy Spirituality Care (patient centric) Hope Music etc engagement of senses architecture Empathy Art Nature Aroma Entertainment Interaction communication comfort way finding lighting color communication equipments medical facilities Patient experience Effectiveness of treatment
- 45. Social Environment Art Effectiveness of treatmentPatient experience Reduce pain, fear, anxiety & other psychological conditions, need for sedative drugs, length of stay Improve physical functioning, mental /psychological functioning, patient / care giver communication, care giver empathy Increase adherence to medical regiments, satisfaction with overall quality of careArtEnvironment some factors from each category physical psychological
- 46. Social Environment Art Effectiveness of treatmentPatient experience Nature Art A study at the University of British Columbia demonstrated that using wood, in the design of a room lowered sympathetic nervous system activation and patient stress. Provides a sense of fascination, Acts as a positive distraction, Reduces negative emotions and blocks stressful thoughts Researches have also found that nursing homes with physical or visual access have greater caloric intake and exercise than those without. A revolutionary study by Ulrich (1984) found that postsurgical patients recovered more quickly when exposed to a window view . Environment some factors from each category physical psychological
- 47. Social Environment Effectiveness of treatmentPatient experience Nature Color & Light Art In Indian culture, each color is assigned to various energy centers of the body. Color has electromagnetic energy that can influence healing in similar ways to sunlight. Egyptians used colour for cures and ailments. Built temples for healing and used gems (crystals) through which the sunlight shone. Affects mood and perception Improves sleep, adjustment to night-shift work among staff Environment some factors from each category physical psychological Art
- 48. Social Environment Art Effectiveness of treatmentPatient experience Social Envirnoment Comfort Communication Care giver Interaction promotes confidentiality and privacy hygiene personal attention with staff with treatment (sense of control, information etc) with environment empathy Way finding , zoning & Signage other hospital communication Staff effectiveness, teamwork, Qualification physical psychological Nature Comfort Color & Light Communication Care giver Interaction Art Social Envirnoment Environment some factors from each category
- 49. Social Environment Art Effectiveness of treatmentPatient experience Medicine Social Envirnoment Environment Nature Comfort Color & Light Communication Care giver Interaction Medical environment Medical environment Medical Staff Medical Staff Art some factors from each category Art Medicine both stimulate a patient’s trust over the medication given physical psychological
- 50. Primary Research Observation Interview Activity mapping Observation Three Hospitals-2 private & 1government Patient and Staff (Doctor, nurses etc) Activity Mapping Interview Care Giver Care Reciever Designer Doctor Therapist Nurse (2 out patient & 1 admitted) (1 architect & 2 interior designer)(1 each) Phase 2
- 51. areas identi ed Expert Views User experience Examination room, wards Rooms (Children & Maternity) Administrative departments Reception Waiting lounge ICU, OT Garden spaces interviews & analysis Secondary Data interviews, observation & activity mapping feel numb, afraid, having no control Hope Mental well-being (staff) Unoccupied time (feels longer than occupied time) Uncertain waits Feel Anxiety Clean & hygienic. feels homesick Areas of healing Aesthetic appeal Positive distraction Anxiety (makes waits seem longer) Expect information, assurance, support, and comfort Feel their injury is more urgent than others. (leads to distrust ) Should relax and get a sense of control. Distraction Manage nurse walking time & exhaustion (negative effect on productivity.)Should have positive energy Need empathy rather sympathy Sense of control Feel extreme anxiety Fearful & worrying experience Clinical Facilities Medically controlled Patient Sleep & restoration Trust depends on the staff Feel home sick. Socially disconnected Alone and depressed Unoccupied time Risk of injury from medical equipment no user - interaction Synopsis Interview & observation
- 52. areas identi ed Design Solutions Examination room, wards Rooms (Children & Maternity) Administrative departments Reception Waiting lounge More therapeutic Design not barrier in medical treatment Healthy Work environment Reduce exhaustion and Walking time. Home away from home ICU, OT Garden spaces based on interviews, Secondary analysis & Secondary Visual Analysis Creating an interaction map (patient, other patient, staff) eg making them busy with loads of paperwork Inviting & calming Feel a sense of control limit noise & stress Programs for staff well-being. Connects patient’s experience and treatment plan control over light, temperature Ceiling Design Liberalized visiting policy Integrates complementary therapy Healing Garden Both Physical & Visual Interaction More Interactive Medicative in nature Dieses centric design Care Cure Experience
- 53. areas identi ed Examination room, wards Rooms (Children & Maternity) Administrative departments Reception Waiting lounge ICU, OT Garden spaces Interaction SocialSpacial Elimination of Psychological stressors Spirituality Therapies Aroma Therapy Art Application of design elements
- 54. areas identi ed Examination room, wards Rooms (Children & Maternity) Administrative departments Reception Waiting lounge ICU, OT Garden spaces Positive Distractions Access to Nature Elimination of Environment stressors Entertainment Stimulation & engagement of ve senses
- 55. areas identi ed Reception Waiting lounge (examination ward & ICU, OT) Visual Research No interaction with artworks No two way interaction Seating arrangement highlights the waiting time (unoccupied time) No spaces for kids interaction no positive distraction Poor communication design, way finding
- 56. areas identi ed Patient rooms Visual Research The Ceiling design lacks innovation and shows no experimentation of space . The upholstery design does little to lift the mood . The ambiance design is simplistic and bland reinforcing the institutional feel in the environment .
- 57. areas identi ed Miscellaneous Visual Research Outdoor space unutilized Lack of designing elements in corridors, staircase, walls and glasses. No positive distractions in these areas. No usage of areas for complimentary activites. No usage of therapeutic elements in such spaces.