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By:THEODOROSZARKAS
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UNIVERSITY OF NICOSIA
DEPARTMENT OF ARCHITECTURE

Sustainable Design Unit

EXPLORING DIMENSIONS of ENVIRONMENTAL and

SOCIAL SUSTAINABILITY

Design for Healing…a place of birth

(maternity clinic)

theodoros zarkas october 2013

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EXPLORING DIMENSIONS OF ENVIRONMENTAL and

SOCIAL SUSTAINABILITY

DESIGN FOR HEALING

What sort of hospitals do we want in the twenty first century, how
might they differ from those of the recent past and why do we need
to change them?
What is the true purpose of hospitals? And how can we
reconceptualise our understanding of this purpose to give greater
meaning for better healing?

‘Architecture occupies a curious yet crucial

position in human history. In effect, it is the
‘..we are seeking to define most resonant manifestation of what it
architectural principles that really means to be human, embodying
are less about achievement how we conduct our relationship with each
of the individual and more other and the planet.
about man as part of Architecture crystallises the essence of
human civilization in ways of art, literature,
community..’
music and science do not. It gives us
physical structure and colour to our
existence.’

Until the end of the 19th century the average human life expectancy was
between 35 and 45 years. This number is increasing with the development
of health care. Health care since the moment we are born until the day we
die, and this care means Hospital!!!

Hospital design represents a big challenge. It addresses the human

dimension from BIRTH to DEATH. Birth and death are the two events at
the start and the end of a chain of events involving hospital use. The
architect must create a building exclusively for people, but one in such a
form that follows specialist medical function in variety of very particular
ways.

In general, hospitals as we know them from experience are buildings with

depressing environment, and negative atmosphere. These negative issues
alone with hospital phobia can influence someone’s recovery.

On the other hand, hospitals should not only provide medical treatment but
also healing environment. A healing environment for the mind, the body
and the Soul, a place where Respect and Dignity are waven into
everything.
A place where Life, Death, Illness and Healing define the moment.

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A key issue in designing Hospitals is to ensure that efficiency of services is
enhanced by the ‘building envelope’ and the technology that is necessary
for the function and the run of it.
The technology changes more frequently, and across a greater range of
areas, than it does in many other business environments, the task of
designing for anticipated change, but without knowing quite what that
change might be.

A pleasant environment, helps patients recover more quickly, using fewer

drugs and treatments.
The Physical environment of every patient has an effect on the way they
feel. These feelings have an effect on your state of both Mind and Health.
Another challenge, is the provision for extension to accommodate
increasing demands or new technologies in the future without interruption
to the existing facilities and minimum abortive work. As all very well said
that every patient should have their own room, with an exclusive nurse on
call, twenty-four hours a day. Life is not like that.
But how close would it be possible to come to such a civilized environment,
for patients, staff and visitor (as one of the important elements) without
increasing the cost disproportionate, to improvements for better ‘living’
environment, exploring the dimensions of environmental and the social
sustainability?

A series of elements which, in combination, would produced a building which is:

 safer, 
high level of staff  Air quality,
 patient-focused, amenity and comfort.  Thermal and noise
 family friendly,  single or double comfort,
 cost-sensitive, rooms with dedicates  Light,
 energy consuming (as space for in-room  privacy,
Hospital are if fact very procedures, and  Views of nature,
energy costly buildings) Maximized Day Light  Visual serenity,
exposure.  Access to nature,
 Friendly headwall,  Positive diversions,
eliminating the need to  Social and Welfare
move patients as their Support
conditions change.
are some of the important aspect for a hospital.

In respect of softer environmental issues, hospital must include peaceful

environments with artwork displays, space to listen music, and gardens
with fountains and benches. Noise - reduction measure with sound
absorbing floors, walls and ceilings, wireless communication, and patient
education center giving the opportunity to patients and relatives of a
greater understanding of illness.

Equally difficult is the creation of architecture that will provide the sort of
sustainable work place which help to attract and retain good medical staff.
This challenge does not end with the provision of a building that is fit for the
purpose merely from the point of view of the health service provided.

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On the other hand staff support facilities such as staff only cafeteria,
windowed break room with outside access and a health club, are some of
the non medical facilities that staff need for more pleasant working
environment.

Another important aspect, sometimes not taken into consideration is the

way that hospitals deal with death. Patients and relatives need more
calming environment (not only a good functional design).
The behavior of the staff and the training they receive, are crucial in this
area, but design has important part to play in giving comfort to the
individual patient, and to more general consideration of where facilities are
located, such as mortuary, viewing room, bereavement counseling spaces.

In hospital communities, specialisms rules as it must be. But in creation of

a new Healing Place (hospital), there is always the risk that one set of the
specialists conflict with another. This exclusion affect patients, visitors and
staff.

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Design for Healing must take in to account the spiritual and psychological EFFICIENCY

needs as much as their strictly medical needs, in what can make a life-
enhancing difference.

What patients want and need are well-tempered environment where they SUSTAINABLE
HEALTHCARE
can suffer and recover in peace and quiet, where sleep in regarded as INFRASTRUCTURE

important rather than an interference with meal delivery regimes and

accessible facilities for visitors on the other. GREEN QUALITY

Environmentally
sound

Economically Socially
Viable Responsible

The Healing Environment

Where policy meets sustainable design
Facility Care Magazine, Vol. 5 Sep. 2010

‘The physical environment is vital to healing and well-being’ – Planetree

Research will be based on Green Hospital, and especially on a place of

birth (maternity clinic). ‘The Green Hospital is defined as a hospital that has
taken the initiative to do the one or more of the following: choose an
environmentally friendly site, utilizes sustainable and efficient designs, uses green
building materials and products, thinks green during construction and keeps the
greening process going. A Green Hospital is constructed around a facility that
i
recycles, reuses materials, reduces waste, and produces cleaner air.

i
Hospital 2020 is a mission to promote and advocate for the transformation of hospitals worldwide. Established in 2009 as a compassionate mission
of visionary physicians, administrators and hospital staff that saw the immediate need for change in hospitals worldwide. They researched successful
programs and best practices and produced four needed initiatives for the hospital of the future.

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HEALING ENVIRONMENT

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WHAT IS A HEALING ENVIRONMENT?

When you think of a healing environment, what comes to mind?

A spa, a Japanese garden, perhaps a corner of our house?

Few of us would immediately think of their local health clinic or a hospital.

But that is beginning to change as healthcare organizations pay attention to
a growing body of research that clearly demonstrates the benefits of a
healing environment.

WHAT IS HEALING?
The word healing comes from the Anglo-Saxon word haelen, which means
to make whole. One way to look at it is as harmony of mind, body, and
spirit.
Healing is not the same as curing (which is more about fixing problems,
eradicating disease, and decreasing symptoms). People can be healed
even if they are not cured. For example, those with a chronic disease can
learn to live in peace with their condition. Conversely, people may be cured
but not healed.

What factors create our environment?

It begins with our interior living spaces and their elements:
 Light
 Space
 Color
 Shape
 Texture
 Artwork
Our experience of our living spaces also includes sounds (music), aromas,
and sensations (walking on soft carpet or smooth hardwood).
In addition, our experience is also affected by the:

 Larger physical environment:

 Building design: the buildings that surround us in our day-to-day
encounters-our homes, the bank, the hospital, and so on.
 Urban design: (if you live in a town or city): the layout and elements of
streets and neighborhoods.
 Social environment: the people with whom we share the interior space
and all the factors associated with them-mood, behavior, and
relationship. This also extends out to the various communities of people
we belong to.
 Natural environment: the natural surroundings, air, water, earth.
And perhaps most importantly, our experience is influenced by our own
interior environment-our memories, as well as our attitudes, beliefs,
values, and intentions.

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HOW DOES THIS APPLY TO HEALTHCARE

ENVIRONMENTS?
What factors contribute to a healing environment in healthcare?

One answer comes from the Samueli Institute, a non-profit organization

dedicated to researching the science of healing. In partnership with experts
from around the world, the Samueli Institute developed a model that
includes all the factors that surround the patient, family, healthcare
practitioner, and community.

This model includes the places, people, processes, and principles involved
in patient care.

As we can see, this model lists factors that impact the inner environment
on the left and moves to the right with factors that have a progressively
greater impact on the outer environment. Thus healing intention, personal
wholeness, and healing relationships are found on the left, healthy lifestyle
is in the middle, and collaborative medicine, healing organizations, and
healing spaces are on the right.

This inclusive view of what is needed to heal is not new. Thousands of

years ago, Greek temples were designed to surround patients with nature,
music, and art to restore harmony and promote healing.

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COMPONENTS OF A HEALING ENVIRONMENT

Lighting components transform clinical facilities that appear rather functional and uninviting into
environments that help the patient to relax and to recover. Light elements on the wall or in the ceiling
can significantly contribute to easing fear and reducing nervousness. In general, a healing
environment can be created by paying attention to three findings:

 Light has a major impact on human well-being and the body´s healing processes.
 Color is a powerful medium to stimulate positive emotional reactions and thereby promote the
conditions for recovery.
 Interesting views of the outside world help to create pleasant associations and deflect from fear
– an effect that is particularly valuable for the treatment of children.

Addressing patient fears

In a clinical environment where patients often feel confronted with unknown or anxiety-provoking
situations, it is beneficial that healthcare designs convey a feeling of security and safety. Generally,
this is better achieved with softer color tones versus loud tones. At the same time, visuals that evoke
a light, warm and positive feeling are much more suitable than images with ambiguous, uncertain,
provocative or surreal characteristics.

Benefits of a healing environment

Stimulating positive emotions can not only foster the patient’s well-being and improve his or her
overall hospital experience, but may also shorten the therapeutic process. A healing environment
may lead to:

 Less need for strong sedatives

 Faster and better examination results
 Better healing conditions
 Higher patient satisfaction

Another benefit is that a healing environment improves the working conditions for healthcare
professionals by reducing stress levels, which in turn may improve productivity

HEALING ENVIRONMENT IN HOSPITAL DESIGN

In hospital buildings, where patients seek medical treatment and staff provides continuous support,
creating a healing environment with appropriate physical aspects is an imperative to sustainable
design. The term ‘Healing Architecture’ is adopted to invoke a sense of a continuous process; in
creating an environment physically healthy and psychologically appropriate. A healing environment
with appropriate physical aspects would indirectly contribute to patients’ outcome such as shorter
length of stay, reduced stress, increased patients satisfaction. One may agree to the idea that
sustainable hospital design in the form of healing environment is achieved if these measurable
outcomes could be quantified through appropriate design of physical aspects.
Most healthcare designers accept the fact that designing a hospital is a complex task: both
functional and psychological. Apart from building services, healthcare designers are expected to
conform to various requirements provided by the Ministry of Health which includes medical specialist
requirements and equipment both for diagnostics and for treatment. In the effort to comply with the
explicit requirements, it seems that most healthcare designers pay less attention to the ultimate aim

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of creating a healing environment. This has been well documented in most scientific literature that
modern hospitals designed and equipped with technology for diagnostics, curing and treating have
contributed to stress, depression and anxiety which have a harmful effect on health to patients and
staff.
As a response to this, most literature in the healing environment have outlined that noise control,
air quality, thermal comfort, lighting, communication, colour, texture, privacy and
view to nature are among the physical factors which have to be thoroughly considered in hospital
design. These factors have a more pronounced influence in hospitals than in other buildings
especially for patients who are bedridden or have limited freedom of movement.

DAYIGHT AND HEALTH

Creating a healing environment is not like building up a garage workshop, where cars are sent for
repairs before continuing their journey. It is an imperative for a hospital environment however, where
‘repair’ of the body (i.e. healing) is the concern, to have the optimum level of comfort and care
physically, socially and symbolically. For this the luminous environment plays an important role and
an integral part of the hospital’s healing environment. As a matter of the fact, natural daylight is often
regarded as part of the healthy environment. Therefore, daylight is required in most areas in hospital
buildings and is one of the crucial physical aspects to be considered in the healing environment. In
the hospital wards indoor environment, appropriate window design would allow the potential benefit
of daylight to be experienced by patients and staff. Their physical attributes are intertwined in the
healing environment of hospital wards.
Numerous studies have indicated that daylight has significant effects on the well-being of humans
both physically and psychologically. In fact, it has been recognised for many years that light has a
significant effect on our circadian rhythm (i.e. biological cycles that repeat 24 hours). Light is the
most important environmental input in controlling bodily function after food. Similarly clearly indicate
that access to natural light is one of the crucial factors affecting patients’ recovery. The presence of
visible light in an indoor environment does influence the physiological responses, mood as well as

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visual needs.

Daylight in hospital design should rigorously be pursued as one of the physical aspects in creating a
healing environment.

However, it is believed that experimental studies of daylighting in hospital design are very few and
far in between. Many studies on the subject of daylight focus on schools, offices and commercial
buildings but few on hospitals. Therefore, the present study calls for a comprehensive consideration
on the physical aspects (i.e. daylighting design) in a healing environment as a strategy for
implementation on a sustainable hospital design. Daylight should be incorporated into lighting
design in hospital buildings, not only because it is beneficial to patients and staff, but also because it
is light delivered at no cost. Adopting and implementing good daylighting will obviate the need for
artificial lighting, subsequently lead for energy conservation, contributing to sustainability.

BUILDING ORIENTATION
In hospital building, orientation plays a major part in the early process of
the design. In fact, it can be argued that is the highest priority in the design
decision for achieving sustainable hospital environment. Regrettably, a
preliminary finding seems to indicate that most healthcare designers regard
physical planning issues as the topmost priority to be sorted out at the early
stage of hospital design. This is due to the fact that designing a hospital
building is generally accepted a complex task both: functionally and
psychologically.
In theory, the decision on building orientation will subsequently influence
the design of the physical aspects (i.e. shading devices, window opening,
placement and profile). Similarly in hospital design, where creating a

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healing environment is the primary concern, orientation of the building does
influence the design of the windows directly affecting the quality of
daylighting (i.e. glare effect and daylight distribution) and access to outside
view (i.e. optimise the surrounding scenery). Hence, it would have a
significant impact on the end users’ (i.e. patients, medical staff and visitors)
experience and well-being. Providing access to outside view through a
window would provide patients in the ward environments with a sense of
orientation and connection to the external environment.

WINDOW DESIGN
In the research fraternity of healing environment, there is a growing consensus recognising the
window as one of the most significant physical aspects for patients and medical staff physically,
psychologically and mentally.

There are two benefits of windows: one is daylight and the other is view.
In an empirical research conducted by keep and others as quoted by Jana et al. (2005); of two
groups of individuals in the intensive ward therapy unit: one was unit without windows, and the other
with translucent windows; indicates that patients with translucent windows were more oriented
during their stay and gain better health outcomes such as avoiding sleep disorders, hallucinations
and delusions. Even with translucent windows in this aspect do provide the vital link to the outside
world for patients and the feeling of orientation helped to maintain their normalcy.

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ACCESS TO VIEW
There is growing research evidence that access to view in the ward
environment would provide a positive impact on patients physically,
psychologically and mentally. Evidently, research by Ulrich (1984) of
surgical patients with a view through a window may provide shorter length
of stay. This evidence and findings by others send a clear message to the
professionals involved in the healthcare services that coordinated effort
must be taken beyond the requirements of the project briefs. Initial
investigation on the hospital project briefs proves that there is no
requirement explicitly stated emphasising this aspect. On the same tone,
the quality of outside view has to be positively promoted in a ward
environment for patients and staff psychological well-being: view of a
children playground instead of a view of a blank wall. However, in reality
of the building design, the availability of view for the users is not always
positive quality. In healthcare design, to achieve quality view depends
highly on the site selection, building orientation, wards layout, bed
positions and windows design.

References
1. Evidence-Based Healthcare Design, By Rosalyn Cam
2. The role of physical environment in Hospital of the 21st century : once-in-a-life opportunity,
By Roger Ulrich et al, report to the Center for Health Design, Sep. 2004.
3. Improving the patients experience – A place to die with dignity: creating a supporting environment, report for
NHS Estates, by Richard Burton.
4. The architecture of hospital, by Markus Schaefer
5. Facility Care Magazine, Vol. 5 Sep. 2010

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TYOFNI
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A-DEPARTMENT OF ARCHI
TECTURE

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