Chapter 1. Introduction

The broad foundation for the problem that leads to the study is that current state hospitals are not producing the health care optimally possible. One of the factors for this is that there are a lack of beds for patients in need and also contributing to this is the lack of doctors needed as they spend their much needed time and attention on the patients just staying in the hospital to await a later scheduled scan or test such as MRI and CT . The reason for the reduced number of open patient space is not that the planning therefore was inadequate but because too many patients stay in hospitals unnecessarily and do not need medical treatment, but are mostly waiting for medical tests done with technologically equipment that are only due in a weeks time or more while already obtained for healthcare in the hospital. They then stay in the hospital for that period of waiting time, mainly because of the expense of transport to their homes and back and are nurtured in hospital. Another foundation problem is the waiting quee for state hospital patients and that current method applied to reduce this is not working well. A system should be incorporated consisting of more medical staff and nurses at entrance, so that there will be a staff member assigned to the task of attending and moderating the incoming patients with immediate effect on the level of the specific health situation importance, so that the patients with the most needed healthcare could be assisted first, which is in the patients best interest and also the hospitals, as they all have the same goal which is to look after a person best sense of well being.

This all contributed to a larger study into the aesthetics of general hospitals. The aim of the study is to throw light on the influence of aesthetics on the health and well-being of patients and the professional personnel, and to examine how aesthetic considerations are dealt with.The aesthetic area should not be a neglected field in the directions for the daily management of hospitals as it is of main importance to the patients’ well being and psychological healing process.

There are not many documentations for this specific studied field, but has been addressed as a major issue numerous times. However, it has been proven that the effect one’s environment has on the state of health and mental soundness is of utmost importance to developing a better psychological state, which leads to utmost physical well being if achieved. Contributing factors are design elements of surrounding spaces (natural and artificial light, room space layout, personal space, creating a sense of control, colour, all object in the space etc) influences a persons mood and also his/her physical condition highly and should not be included in a certain space created as an after thought, but as a core contribution in the process of designing a building for a specific purpose.

I have chosen hospitals and the health field as a main approach as I think this specific topic stated could have the most profound impact on as it is dealing with human lives, which should never be taken up lightly. A broad study will be done on the effect and impact our invironments on us physically and psychologically, but will focus on healing areas as they are much needed to be understood correctly and implemented as optimal as possible.

Chapter 2. Literature review

Most people with some kind of mental deterioration of organic or functional origin spend a majority of time in nursing homes and hospitals; therefore it’s of high importance to be accurate of what contribution the design of these environments makes to their lives. (Keen, J. 1989).

There are many facts on what people feel when they are in hospitals or any needed healing space and what the impact is of how the building looks, specifically considering theoretical facts are there for the purpose of the objects. (Keen, J. 1989).

Frameworks of why things are the way they are, are much generalized and have to be questioned especially considering the rapid growth of the population, a practical concern is also highlighted is the connotation people experience between privacy and home. (Keen, J. 1989). Links are also questioned between policy research and design by Keen.

The atmosphere aesthetic enhancements of an environment largely effects the person in the space, and as we’re dealing with healing spaces it is definitely a key factor as it reduces stress and anxiety, being inherently healing, increase patient satisfaction and promote health and healing which is of main concern. (Frampton et al. 2004).

Opportunities exist to make meaningful contributions in the healing environment that are likely to make a significant impact on health outcomes of human beings. (Frampton et al. 2004).

The role of the environment in the healing process is a growing concern

among health care providers, environmental psychologists, consultants, and

architects. (Arneill, A. & Devlin, A. 2003).

There is a lot of potential for thorough research to improve patient well-being and the current health care system through design, and we have the tools to do the kind of research that will lead to evidence-based design. (Arneill, A. & Devlin, A. 2003). Providers are also becoming more willing to support such efforts, therefore there should be no reason not to investigate these matters and should be included in the planning and building process as a must. (Arneill, A. & Devlin, A. 2003).

Issues which would be brought up would regard patients involvement with health care by focussing on patients need to be control as a human being in situations and circumstances which is personally uncontrollable. (Arneill, A. & Devlin, A. 2003).

The impact of the ambient environment (e.g., sound, light, art) and specialized building types currently emerging for patients with specific needs will be discussed. (Arneill, A. & Devlin, A. 2003).

The aesthetics of a space and created healing environment in regards with physical elements such as accessories, colour, furniture and room design, lighting, smell, sound, texture and thermal conditions have a significant tentative impact when counselling patients. (Heesacker, M. & Pressly, P. 2001).

By being more aware of these stated design factors counsellors can create better environments promoting healing, by using these elements as possible application to counselling settings. (Heesacker, M. & Pressly, P. 2001). This can also enhance the relationship between counsellor and patient and also contribute these factors to the studied field of observational, critical incident and experimental approaches regarding the physical context of counselling. (Heesacker, M. & Pressly, P. 2001).

“The underlying assumption is that the aesthetics of the hospital surroundings are often neglected”. (Caspari et al. 2006).

When considering aesthetic influence healing environments have on patients and medical personnel and why they are implemented the way they are, one has to look at the strategic plans when designing a health care centre. (Caspari et al. 2006).

The problem is that this major psychological influence is merely touched on in these plans and therefore not always well thought through and therefore do not exceed its purposes. This is of high importance as many studies gained have shown the importance of this sphere to patients and medical staff, therefore it is confirmed that designers need to cohere to the patients’ comfort, how they evaluate hospital environment aesthetics, what they think about their influence of their wellbeing, health and recovery. (Caspari et al. 2006). Therefore it is of main importance to have a clear, though through and well researched explanatory guidelines recorded in the strategic plans for the psychological impact of aesthetics in health care centres. (Caspari et al. 2006).

To enhance the well being of patients and evoke social interaction it’s important to consider design elements smartly (configuration, furniture, privacy etc) and the number of people per room (residential crowding) and exterior noise could cause psychological distress. (Evans, G. 2003).

When patients are not exposed to enough daylight they may also develop depressive symptoms and indirectly, the physical environment influences mental health. Supportive relationships, personal control and the healing process are all affected by the built environment. (Evans, G. 2003).

“Studies have demonstrated that exposure to multiple adverse physical and social conditions can combine to yield more negative mental health outcomes compared to exposure to individual environmental stressors.” (Evans, G. 2003).

In a society that questions everything and have resources available for almost every topic thinkable, it’s no surprise that we see hospitals changing in form and function. (Bell et al. 2004).

Research have gone further that just simply enhancing a disease-free body, but also mind. These shifting goals are, however, being encouraged through a diverse range of design features, encompassing modifications to the social, symbolic and physical spaces of hospitals. (Bell et al. 2004).

A lot of problems we’re dealing with regarding the impact health-care facilities have on individuals and the community, can be dealt with when implementing the patient-centred design process. (Ryan, K. & LaBat, K. 2009). This is broadly based on health care professionals (all staff at hospitals or any health care facility) and design professionals need to understands each other’s fields and worlds better, and of most importance the needs of the patients. (Ryan, K. & LaBat, K. 2009). These professionals all have the exact end goal, which is to better the health of the patient, so therefore will progress the best when working together in harmony with clear regular communication among all parties when targeting complex problems and finding the best solution for them. (Ryan, K. & LaBat, K. 2009).

Waiting spaces should also be researched thoroughly, as patients and their families/friends spend a majority of time in and form an opinion of the whole centre. (Hsieh, M., Lee, W. 2010).

A study have shown that most people prefer a shaded place to sit down which is visible to friends, but a sense of security is their main priority when regarding their pshycological need when concerning the waiting space. (Hsieh, M., Lee, W. 2010).

Fig.1. The Preference of Waiting Space (Gender). (Hsieh, M., Lee, W. 2010).

Fig.2. The Preference of Waiting Space (Age). (Hsieh, M., Lee, W. 2010).

Fig.3. The Preference of Waiting Space (Waiting Time). (Hsieh, M., Lee, W. 2010).

Fig.4. Psychological Effects of Six Open Spaces. (Hsieh, M., Lee, W. 2010).

Healthcare facilities are functionally built well (doors big enough for beds, spaces well thought through for equipment etc) but are psychologically lacking. (Ulrich, R. 2001).

Standpoint of marketing (facilities to patients) is the aim for any business model and should provide the best environment possible to patients, visitors and staff. (Ulrich, R. 2001).

Patients may suffer physical defects if they’re not happy with mental circumstances such as high blood pressure, anxiety, delirium, increase intake of pain drugs – research linked poor design works against well being of patients. (Ulrich, R. 2001).

Design should be ‘psychologically supportive’ and facilitate and foster the healing process, not just concern functional values, this should include a social support system, provide patients with a sense of control and focus on positive not negative distractions, evidence have shown that nature’s elements are a major contribution in these factors. (Ulrich, R. 2001).

Although this sounds very easy, every person’s views and experiences differ, therefore designers are responsible to solve these personal issues and predict certain conflict which leads to stressors. (Ulrich, R. 2001). Ulrich suggested that this study should include the staff and visitors views as well as the obvious patients’ preferences.

The designer should understand personal needs, and also leave the patient with some of the decision making possible in their own environment, suggested Ulrich.

Scientific research on these healing environments shouldn’t be considered lightly as it has the same goal as the designer which is to achieve a successful solution and promote wellness, but should be questioned regarding every patients’ situation is different from the next. (Ulrich, R. 2001).

Hospital noise pollution is an environmental and ambiant stress model affecting patients’ health and in order to reduce them influences sustaining against and towards it, is different socio political views and values, technological advances and motivation for controlling these noise hazards and barriers. (Topf, M. 2000).

Chapter 3. Methodology

My research approach was to go to the library first and take out books regarding psychological affects of design, specifically in a healing environment. Books found however was mainly on hospital design and architecture in general, and how the spaces relate to each other which was very interesting, but not really focusing on the problem stated.

I then went to a state hospital, Tygerberg hospital, as I want to mainly target state hospitals of my main approach of aiming and stating current issues concluding how it could be achieved by focusing on the psychological effect design elements have on the well being of patients and therefore better the healing process.

I got a few articles from journals from my lecturer, which was very significant and helpful as it involved all the different fields of study I am mainly approaching as stated. I would go on by studying other articles regarding the transport system between hospitals and patients’ homes as this is also very relevant as one of the problems why the state of state hospitals are faulting is because of a lack of beds for patients as there are unnecessary beds taken up because of the expensive of transport.

I will mainly focus on the impact of psychological aesthetic environment, but will research the given statements thoroughly, aiming certain problems in state hospitals and also find solutions for hospital design as a whole by inhancing patient-centred design, therefore all elements should be understood thoroughly contributing to the design of a state hospital.

Chapter 4. Conclusion

Current issues regarding the psychological effect the environment has on a patient is important because human health is very important to any country, individual, family or society. If it is possible to enhance the healing process through considering the environments interior design elements wisely and coherently, we should definitely do so to better wellness and human life.

The implications of designing for physiological need is that there should be more focus on the strategic plans when implementing a hospital design and focus on the emotional and physiological effects on patients and not only on the functionality of the design.

Theoretical framework by reviewing the relevant literature I have read so far all contribute to the stated problem. The direction I will take first from among the possible theoretical directions is studying the relationships of patient-centred design to universal design, user-centred design and the newer human-centred design.

Also as a conceptual framework, I will also explore why interdisciplinary approaches are needed for patient-centred design and how interdisciplinary collaboration between all professions involved and patients works to address the challenges of patient centred design.