buildings

Review
Architectural Evaluation of Healthcare Facilities:
A Comprehensive Review and Implications for Building Design
Marko Jaušovec 1, * and Branko Gabrovec 2

1 Faculty of Civil Engineering, Transportation Engineering and Architecture, University of Maribor,

Smetanova 17, 2000 Maribor, Slovenia
2 Centre for Health Care, National Institute of Public Health Slovenia, Trubarjeva 2, 1000 Ljubljana, Slovenia;
[email protected]
* Correspondence: [email protected]; Tel.: +386-(41)-447-077

Abstract: The architectural design of healthcare institutions impacts patient experience and health
outcomes. Facing challenges like demographic aging and evolving treatments, this study reviewed
fourteen key publications on healthcare architecture. The insights gained have highlighted the
need for qualitative methods to understand these environments. An integrated healthcare archi-
tecture framework (IHAF) was developed, integrating architectural guidelines, user experience,
and sustainability. The IHAF emphasizes inclusive design, adaptability, patient-centricity, and staff
well-being, focusing on eco-friendly practices and green spaces in healthcare facilities. Advocating a
multidisciplinary design approach, the IHAF aims to create functional, sustainable, patient-focused
environments. This research identifies the need for qualitative methods unique to the Slovenian
healthcare context. It aims to inform architectural solutions for healthcare institutions, highlighting
the role of design in optimal patient care and well-being.

Keywords: architectural design; healthcare facilities; building evaluation; evidence-based architectural

solutions; user-centric design; sustainable healthcare buildings; design optimization

Citation: Jaušovec, M.; Gabrovec, B.

Architectural Evaluation of
1. Introduction
Healthcare Facilities: A
Comprehensive Review and The European Union recognizes architecture as a vital cultural and life component,
Implications for Building Design. particularly in healthcare, where it transcends mere aesthetics to foster environments
Buildings 2023, 13, 2926. conducive to healing and well-being [1]. In this realm, the role of architecture extends
https://doi.org/10.3390/ beyond visual appeal, playing a pivotal role in enhancing quality of life and contributing
buildings13122926 significantly to national wealth through thoughtful design and construction practices [2].
However, the challenge lies in ensuring these architectural principles are consistently
Academic Editor: Ángel Fermín
Ramos Ridao
applied across all healthcare settings, particularly in under-resourced areas.
In healthcare systems, architectural design is instrumental in creating environments
Received: 18 October 2023 that cater to the unique needs of patients. These environments, sensitive to the needs of
Revised: 16 November 2023 health-impaired individuals, prioritize comfort, safety, and therapeutic value, significantly
Accepted: 22 November 2023 impacting patient recovery and staff efficiency [3]. Critically, there is a need for more
Published: 23 November 2023
empirical research to quantify the impact of architectural design on patient outcomes and
staff productivity. Historically, the focus of healthcare architecture was predominantly on
functionality. However, recent advancements in architectural practices have shifted the
Copyright: © 2023 by the authors.
emphasis towards patient-centered design, sustainability, and adaptability. This modern ap-
Licensee MDPI, Basel, Switzerland. proach integrates natural lighting, efficient ventilation, noise control, and energy efficiency,
This article is an open access article all contributing to improved patient outcomes and enhancing the working conditions of
distributed under the terms and healthcare staff [4,5]. This shift represents a positive trend, but the challenge remains in
conditions of the Creative Commons balancing aesthetic appeal with practical functionality. Despite these advancements, the
Attribution (CC BY) license (https:// field of healthcare architecture faces ongoing challenges. The rapid evolution of medi-
creativecommons.org/licenses/by/ cal technologies, shifting patient demographics, and an increasing focus on sustainable
4.0/). practices present a complex landscape for architects. These challenges, however, also

Buildings 2023, 13, 2926. https://doi.org/10.3390/buildings13122926 https://www.mdpi.com/journal/buildings

Buildings 2023, 13, 2926 2 of 20

offer opportunities to innovate and integrate evidence-based design principles, creating

healthcare facilities that are more attuned to the needs of patients, staff, and the broader
environment [6]. The critical message here is the need for continuous adaptation and
innovation in architectural design to meet evolving healthcare demands.
In Slovenia, the architectural landscape is marked by challenges such as widespread
suburbanization, the erosion of cultural heritage, and environmental pollution. These issues
lead to architectural and urban solutions that often need a long-term, strategic vision [2].
Addressing these challenges through a strategic and integrated approach to urban planning
and architectural design is imperative. Addressing these challenges is crucial and requires
a commitment to inclusive architecture. This commitment involves planning diverse,
accessible housing and public spaces, ensuring equal access to services, and developing
new building typologies to accommodate the needs of an aging population. Inclusive
architecture is not just about building design; it is a tool for democratic development,
fostering active public life, social interactions, and cultural presentation and regulation [2].
The architectural design of healthcare institutions, while crucial in realizing care con-
cepts, has received limited attention in research. Studies like those by Steenwinkel et al.
have emphasized the importance of freedom, particularly freedom of movement, and
the balance between experiencing freedom and its connection with a social and physical
framework. These studies highlight architectural features such as the number of residents
per housing unit, spatial generosity, and physical accessibility, all of which play a significant
role in patient care and staff well-being [7]. This underscores the need for more focused
research on the specific architectural elements contributing to effective healthcare envi-
ronments. A comprehensive approach to planning high-quality living environments is
essential. This approach must consider various environmental, sociological, functional, and
cultural perspectives and view the environment as interconnected. The role of open space
and green areas in enhancing the quality of life is particularly noteworthy, as confirmed by
research findings [8]. Therefore, comprehensive and holistic planning is critical in creating
sustainable and livable healthcare environments.
The therapeutic benefits of nature in healthcare settings have been well-established.
Prof. Roger Ulrich’s seminal work in 1984 on hospital design, which emphasized the healing
power of natural views, has had a lasting impact on hospital architecture [9,10]. However,
the increasing complexity of healthcare treatments and the aging of current infrastructure
necessitates systematic investment in new, efficient infrastructures. This need is particularly
acute in Slovenia, where there is a lack of comprehensive research in the health and social
care infrastructure field and an absence of strategic planning documents [2]. This highlights
a critical gap in research and strategic planning in Slovenia’s healthcare infrastructure.
As Ulrich and others advocate, evidence-based design improves treatment outcomes and
hospital efficiency [9,11]. This approach requires a holistic, multidisciplinary perspective,
integrating various fields such as architecture, medicine, health sciences, and gerontology.
It emphasizes the importance of considering the entire ecosystem of healthcare facilities,
from the layout of individual rooms to the organization of whole buildings [11,12]. The
essential insight is the significance of evidence-based design in fostering healthcare settings
that are both productive and efficient.
Today, healthcare architecture places the patient at the center, focusing on individuality
and humanization. Health and social care infrastructure design is evolving to create spaces
that positively influence the patients’ mood and self-image, aiding in faster recovery [13].
The challenge for architects is to design hospitals that support modern healthcare needs
while minimizing patient harm [11]. The key conclusion imperative for patient-centered
architectural design in healthcare is that which enhances patient experiences and outcomes.
The University Medical Centre Ljubljana (UMCL) exemplifies the balance between preserv-
ing cultural heritage and adapting to technological advancements [3]. The goal is to create
healthcare environments that are not only efficient and accessible but also adaptable to fu-
ture needs, ensuring long-term sustainability and improved quality of life for patients and
Buildings 2023, 13, 2926 3 of 20

residents [13]. This example highlights the importance of balancing heritage preservation
with modern healthcare needs in architectural design.
To provide a concise overview of the key themes discussed in this introduction, Table 1
summarizes the principal aspects of healthcare architecture.

Table 1. Critical aspects of healthcare architecture.

Research Themes Key Points References

- The EU recognizes architecture as a

cultural cornerstone, especially
The Role of Architecture in
in healthcare. [1,3]
European Healthcare
- Emphasis on healing, well-being, and
efficiency in architectural design.

- Shift from functionality to

Evolving Healthcare patient-centered design.
[4,5]
Architecture - Modern architecture focuses on natural
lighting, ventilation, and energy efficiency.

- Challenges include evolving medical

Challenges and Opportunities technologies and changing demographics.
[6]
in Healthcare Architecture - Opportunities in integrating
evidence-based design and sustainability.

- Issues with scattered construction,

suburbanization, and cultural
The Slovenian Context [2]
heritage erosion.
- Need for inclusive architecture in Slovenia.

- Emphasizes a multi-perspective approach

Importance of Comprehensive in planning living environments.
[8]
Approach - Role of open spaces and green areas in
enhancing quality of life.

- Nature’s role in healthcare settings for

Therapeutic Benefits of better recovery outcomes.
[9,10]
Nature in Healthcare - Importance of integrating natural elements
in design.

- Lack of comprehensive research in

Slovenia’s health and social
Need for Systematic Research
care infrastructure. [9,11]
and Innovation
- Importance of effective construction in
hospitals for treatment outcomes.

- Focus on patient-centric design for

Patient-Centric Design in improved patient experiences.
[13]
Healthcare - Role of architecture in mood and
recovery enhancement.

Case Study: University - UMCL is an example of balancing heritage

[3]
Medical Centre Ljubljana preservation with modernization.

Addressing Demographic Shifts and Healthcare Challenges through Architectural Innovation

Recent demographic shifts and technological advancements in Slovenia have brought
new challenges to healthcare architecture, underscoring the need for innovative design
solutions that are sustainable, patient-centric, and adaptable. The aging population is a
significant factor, with the proportion of those over 65 increasing from 9.9% in 1971 to
19.4% in 2018. This demographic change and extended life expectancies have profound
implications for healthcare infrastructure and architectural design [14,15].
Buildings 2023, 13, 2926 4 of 20

The objective of this study, originating from the “Targeted Research Program «CRP-
2019»”, is to critically analyze the architecture of healthcare institutions. This analysis
aims to develop and improve conditions for managing demographic changes and ensuring
quality care. The foundation of this research lies in addressing the gap between current
architectural practices and the evolving needs of healthcare systems, particularly in the
context of an aging society.
In addition to demographic challenges, the evolving nature of healthcare treatments
and the integration of new technologies have significantly influenced the design and func-
tionality of healthcare environments. The project seeks to review and analyze architectural
solutions in healthcare care institutions, examining how spatial and environmental factors
impact patient and staff safety and well-being. This comprehensive approach is essential
for proposing future architectural directions that are technically sound for and empathetic
to the users’ needs.
This study aims to bridge the gap between architectural design and healthcare delivery,
ensuring that the built environment effectively supports the evolving needs of the health-
care system. By focusing on sustainable, patient-centric, and adaptable design solutions,
the study aims to contribute to the broader discourse on healthcare architecture and its role
in enhancing the quality of life for patients and healthcare professionals alike.
Modern architectural practices prioritize the creation of environments that elevate the
quality of life for their inhabitants, as Allam et al. [16] clarify that integrating innovative
technologies, such as artificial intelligence, big data, and the internet of things (IoT), can
redefine urban planning and service provisioning, leading to enhanced urban efficiencies
and improved quality of life. The architectural design of healthcare facilities, influenced by
sustainable and evidence-based design principles, can redefine patient experiences, leading
to enhanced well-being and improved quality of care [5]. The historical context and cultural
significance of healthcare facilities, as seen in Ottoman healthcare structures, emphasize
the importance of preserving and adapting these spaces to contemporary needs [4]. By
enhancing the patient experience through thoughtful architectural design, we directly
align with the overarching goal of creating buildings prioritizing their users’ well-being
and holistic understanding [6,17,18]. Thus, the intersection of architecture and healthcare
becomes a pivotal domain, contributing significantly to the broader vision of sustainable,
efficient, and human-centric built environments.
Understanding the connection between architecture and healthcare is crucial for de-
signing effective and sustainable healthcare institutions, especially in the Slovenian health-
care system. Therefore, the review is structured to provide a comprehensive overview of
existing literature in the field of healthcare architecture, emphasizing the importance of
architectural design in enhancing healthcare delivery. The study’s methodology systemat-
ically analyzes architectural solutions in healthcare institutions, reflecting on how these
environments can adapt to the changing demographic landscape and emerging healthcare
challenges. Therefore, it is structured as follows: Section 2 describes the methodology and
reviews the relevant literature. This is followed by the presentation of results in Section 3.
Section 4 includes a discussion, implementation suggestions, and the proposal of the new
IHAF model. Section 5 presents the conclusions drawn from this study.

2. Materials and Methods

Knowledge generation in the field of architectural evaluation techniques for health-
care facilities is accelerating quickly while at the same time remaining fragmented and
interdisciplinary. Due to this rapid and multifaceted growth, it is difficult to stay updated
with the latest advancements, lead in research innovation, and comprehensively evaluate
the accumulated knowledge within this specialized field. Therefore, the literature review
as a research method is more relevant than ever. By integrating findings and perspectives
from multiple empirical studies, a literature review can address research questions with a
power that no single study can match [19]. Therefore, we used narrative review [20] for
the literature on the spatial location of health and social care facilities. This method allows
Buildings 2023, 13, 2926 5 of 20

data to be obtained from various sources, thus providing a comprehensive understanding

of the area under study.
In this investigation, we systematically analyzed scientific literature and expert com-
mentaries and conducted a cross-sectional review of articles evaluating architectural designs
within healthcare institutions. Given the demographic shifts and escalating healthcare
demands in Slovenia, architects, urban planners, and policymakers must thoroughly as-
sess the architectural frameworks of healthcare institutions, emphasizing their current
functionality and potential adaptability for future requirements. Our literature search
was methodically conducted across three primary databases: ScienceDirect, MDPI, and
Cobiss, adhering to the stringent guidelines delineated by the priority reports for systematic
reviews and meta-analysis (PRISMA-P) 2015 [21]. The inclusion and exclusion criteria for
our literature search are detailed in Table 2: Inclusion and exclusion criteria.

Table 2. Inclusion and exclusion criteria.

Inclusion Criteria Exclusion Criteria

Access to full text. Access only to abstract or bibliographic data.
Original scientific research articles, monograph, Discussion articles, academic articles, letters
review of a scientific paper. sent to the editorial office.
Studies that do not focus on healthcare
Studies focusing on the impact of architecture
architecture, its impact on patient care, or
on healthcare quality and patient care.
architectural design in healthcare settings.
Studies that do not address contemporary
Research addressing architectural design in
challenges in healthcare architecture, such as
healthcare settings, including hospitals and
demographic changes, technological
other healthcare facilities.
advancements, and sustainability concerns.
Studies that do not consider the multifaceted
Articles discussing the integration of
aspects of healthcare architecture, such as user
technology and sustainability in
experience, sustainability, and
healthcare architecture.
technological integration.
Papers exploring the role of architecture in
Studies that do not adopt a multidisciplinary
addressing modern healthcare challenges, such
perspective, combining architectural,
as demographic changes and technological
healthcare, and environmental considerations.
advancements.
Publications within the specified time range of Studies published outside the specified time
our literature review (2005–2020). range of our literature review (before 2005).
Works relevant to the Slovenian context or
Not published in Slovenian or English.
offering insights applicable to it.

When this research was conducted, concluding in March 2020, the world experienced
the unforeseen outbreak of the COVID-19 pandemic. This event significantly impacted
all facets of society, including the healthcare sector and the architecture of healthcare
institutions [22,23]. However, our research focused on the period before the pandemic
outbreak, as it was designed and executed before this event.
The COVID-19 outbreak introduced new challenges and needs in the design of health-
care and social care institutions, which previous research could not have anticipated [24].
Therefore, it was logical to limit the research period to 2020 to ensure consistency and
relevance of the collected data.
Furthermore, 2005 to 2020 encompassed significant changes and trends in healthcare
institution architecture, which were vital for our analysis [25]. Including the COVID-19
outbreak period would have necessitated additional research and analyses, potentially
altering the focus and scope of our study.
Future research will undoubtedly need to address the impact of the COVID-19 pan-
demic on the architecture of healthcare and social care institutions. However, this study
significantly contributes to understanding trends and practices in the pre-pandemic period.
Buildings 2023, 13, 2926 6 of 20

Articles published in professional, scientific journals and international documents,

standards, guidelines, and research studies were reviewed. The study did not include
information from editorials, letters, interviews, posters, and articles without full-text access.
Following the establishment of inclusion and exclusion criteria, our methodology
progressed to the next phase as outlined in the adapted PRISMA (preferred reporting
items for systematic reviews and meta-analyses) diagram. This phase involved a detailed
determination, review, suitability, and inclusion process, visually represented in Figure 1:
Adapted PRISMA diagram. This figure illustrates our systematic approach to selecting and
evaluating the literature, ensuring a comprehensive and systematic review.

Figure 1. Adapted PRISMA diagram: preferred reporting items for systematic reviews and meta-analyses.

Building upon this structured approach, we refined our methodology by employing

a systematic literature selection process, as comprehensively detailed in Table 3: The
literature selected. This table overviews our search strategy across the three primary
databases: ScienceDirect, MDPI, and Cobiss. It outlines the specific keywords used, the
number of results obtained, and the selection process that led to the final set of articles
included in our study.
Buildings 2023, 13, 2926 7 of 20

Table 3. The literature selected.

Keywords Number of Results Selected Results Final Selection

Architecture hospital 67,131 6 2
Design healthcare facilities 32,898 9 7
ScienceDirect Evidence-based design Healthcare 31,400 6 4
Evaluation healthcare facilities 35,861 8 5
Post-occupancy evaluation 968 4 1
Architecture hospital 36 2 0
Design healthcare facilities 28 3 0
MDPI Evidence-based design Healthcare 35 3 1
Evaluation healthcare facilities 41 0 0
Post-occupancy evaluation 35 2 1
Arhitektura bolnica 12 2 0
Oblikovanje zdravstvenih ustanov 16 0 0
Cobiss Na dokazih temeljeno oblikovanje zdravstva 0 0 0
Vrednotenje zdravstvenih ustanov 5 0 0
Post-uporabno vrednotenje zdravstvene ustanove 1 0 0
Total 168,467 45 21 1 (14 2 )
1 With duplicates. 2 Without duplicates.

For each database, we used specific keywords relevant to our research focus. In
ScienceDirect, we searched for five sets of keywords: “Architecture Hospital”, “Design
Healthcare Facilities”, “Evidence-based Design Healthcare”, “Evaluation Healthcare Facili-
ties”, and “Post-occupancy Evaluation”. These searches yielded a total of 168,467 results.
We initially selected 45 articles based on their relevance to our research. After a thor-
ough review and the removal of duplicates, we finalized a selection of 21 unique and
pertinent articles.
In MDPI, the same keyword sets resulted in a smaller pool of results, ranging from 28
to 41 per keyword. The initial selection here was ten articles, further narrowed to two after
careful consideration.
In the Cobiss database, the search was conducted with Slovenian equivalents of the
keywords. This search yielded significantly fewer results, with the highest being 16 for
“Oblikovanje Zdravstvenih Ustanov” (design of healthcare facilities). However, none of
these results met our inclusion criteria for the final selection.
The selection process involved two stages: an initial screening based on titles and
abstracts to assess relevance and a full-text review to ensure the articles met our specific
inclusion criteria. This systematic approach ensured that the final selection of literature
was highly relevant to our study’s focus on the impact of architecture in healthcare settings.
The final selection of 21 articles (14 unique articles after removing duplicates) provided a
comprehensive foundation for our analysis and discussion.

Analysis of Evaluation Methods for Healthcare Facilities’ Review

In this chapter, we will present the key findings of our literature review, illuminating
the connection between architecture and healthcare and highlighting specific methods
for evaluating healthcare facilities. To provide the reader with further information on the
studies included in this review, Table 4 outlines the author’s details, the year of publication,
the purpose of the research, and critical findings.
Buildings 2023, 13, 2926 8 of 20

Table 4. Summary of key studies in healthcare architecture included in the literature review.

Authors and Research

Research Purpose Key Findings Conclusions
Year Methodology
Use of architectural Roles in the planning Advocates patient/staff
Hignett and Lu, Quantitative
guidelines in UK process and spatial involvement and
2008 [26] descriptive method
healthcare requirements standardization in design.
Emphasizes user-friendly
Haron et al., Quantitative Patient complexity in Usability: reachability,
and intuitive healthcare
2011 [27] descriptive method healthcare facility use accessibility, orientation
design.
Suggests more healthcare
Huisman et al., Healthcare facility Scarce evidence from
Descriptive method staff involvement in
2012 [28] design research healthcare professionals
planning.
Highlights design’s impact
Samah et al., Importance of quality care
Descriptive method Hospital design aspects on patient experience in
2013 [29] in space design
healthcare.
Nineteen environmental Stresses evidence-based
Bengtsson and Quantitative Quality assessment tool
properties for comfort and design in outdoor
Grahn, 2014 [30] descriptive method for healthcare exteriors
nature access healthcare settings.
Combines creativity and
Verderbera Role of competition in Two-phase model for
Descriptive method knowledge in healthcare
et al., 2014 [31] healthcare design design competitions
planning.
Use of “3P” The “3P” method informs Highlights inclusive
Hicks et al., Quantitative
participatory planning medical institution planning in healthcare
2015 [32] descriptive method
in healthcare planning design.
Links sustainability with
Hamed et al., Quantitative Sustainability and Patient well-being linked to
patient preferences in
2016 [33] descriptive method planning in healthcare plants, safety, single rooms
design.
Advocates for socially
Djukic and Quantitative Social sustainability in Key problems and new
sustainable,
Marić, 2017 [34] descriptive method Serbian hospitals social sustainability model
human-centered design.
Sustainability Differences in BREEAM Emphasizes the life-cycle
Stevanovic Quantitative
evaluation tools in and “Duurzaamheidsmeter approach in sustainability
et al., 2017 [35] descriptive method
Flemish hospitals zorg” evaluation.
Challenges larger hospitals’
Pantzartzis Sustainability in Context-specific
Descriptive method cost-effectiveness, broader
et al., 2017 [36] healthcare facilities sustainability factors
sustainability.
Quality of internal Low correlation between Importance of quality
Liu et al., Quantitative
environment in physical environment and indoor environments for
2018 [37] descriptive method
Chinese hospitals satisfaction well-being.
Brambilla and Growing importance of
Quantitative Evaluation tools for Health as a key criterion in
Capolongo, health impact in healthcare
descriptive method hospital settings modern evaluation tools
2019 [38] design.
Architectural Limited interaction Advocates for stronger
Marsh et al.,
Descriptive method contribution to health between architecture and architecture–public health
2020 [39]
and well-being public health connections.

The review was conducted using five key search terms for the review process. Figure 2
outlines these key criteria in percentage terms for the studies that underwent full-text
examination and denotes the strength of individual measures.
Buildings 2023, 13, 2926 9 of 20

8
33.33%
7
6
23.81% 23.81%
5
4
3
9.52% 9.52%
2
1
2 7 5 5 2
0
Architecture Design Evidence-based Evaluation Post-occupancy
Hospital Healthcare Design Healthcare Evaluation
Facilities Healthcare Facilities

Number of studies and the precentage of key search criteria included in the review

Figure 2. Percentage of key search criteria for the studies that underwent full-text review.

3. Results
The main goal of this research review was to present an overview of the studies
evaluating healthcare institutions with a focus on architecture. Given the area’s specificity
and analysis, we limited ourselves to reviewing the methods and tools for assessing
buildings to select the most appropriate method for evaluating the architectural solutions
of healthcare institutions. In the modern healthcare sector, architecture is becoming a key
factor influencing the quality of care, sustainability, and the entire planning process of
healthcare institutions.
In this review, the reasons mentioned in the different studies included in our results
have been classified into key categories that reflect the critical aspects of evaluating health-
care institutions: architectural and design guidelines, user experience and satisfaction, and
sustainability and environmental impact.
1. Architectural and design guidelines for healthcare institutions: This evaluation cate-
gory focuses on specific architectural and design approaches that have been used in
the planning and construction of healthcare institutions. The evaluation is based on
considering particular guidelines and standards used and how they influenced the
final design and functionality of the healthcare institution.
2. User experience and satisfaction in healthcare institutions: This evaluation category
focuses on the experiences and satisfaction of healthcare institution users—patients,
their families, healthcare staff, and other visitors. The evaluation is based on under-
standing how people feel in the space of a healthcare institution, how easy it is to
navigate the facility, the accessibility and availability of rooms and general comfort
and safety within the institution.
3. Sustainability and environmental impact of healthcare institutions: This evaluation
category focuses on sustainable practices and the impact of the healthcare institution
on the environment. The evaluation is based on considering energy efficiency, the use
of sustainable materials, waste management, water efficiency, and other sustainable
approaches used in the planning and construction of the healthcare institution.
Table 5 provides an insight into their alignment with individual study findings.
In the following, we will examine each of these categories in more detail to better
understand their significance and impact on the design of healthcare institutions.
Buildings 2023, 13, 2926 10 of 20

Table 5. Key themes involved in the siting of healthcare care facilities.

Architectural and User Experience and Sustainability and

Author and Year
Design Guidelines Satisfaction Environmental Impact
Hignett and Lu, 2008 [26] X
Haron, Hamid, Talib and Rahim, 2011 [27] X
Huisman, Morales, Hoof and Kort, 2012 [28] X
Samah, Ibrahim and Amir, 2013 [29] X
Bengtsson and Grahn, 2014 [30] X
Verderbera, Jiang, Hughes and Xiao, 2014 [31] X
Hicks, McGovern, Prior and Smith, 2015 [32] X
Hamed, El-Bassiouny and Ternes, 2016 [33] X
Djukic and Marić, 2017 [34] X
Stevanovic, Allackera and Vermeulen, 2017 [35] X
Pantzartzis, Edum-Fotwe and Price, 2017 [36] X
Liu, Wang, Zhang, Honga and Lina, 2018 [37] X
Brambilla and Capolongo, 2019 [38] X
Marsh, Pilkington and Rice, 2020 [39] X

3.1. Architectural and Design Guidelines for Healthcare Institutions

With their work, skills, and potential influence, architects can significantly improve
health. The architectural profession can contribute to improving the health and well-being
of the population with healthier buildings and spaces. However, there needs to be more
connection between architecture and public health [39]. Hignett and Lu [26] conducted
a study focusing on the use of architectural guidelines by architects and designers of
healthcare institutions. They identified two key roles: involving patients and healthcare
workers in the planning process and the importance of supporting standardization in
obtaining new research evidence. This approach is crucial to ensure healthcare institutions
are designed to serve their users best.
Samah, Ibrahim and Amir [29] focused on the design aspects of hospitals. Their
research revealed 105 design aspects, including quality patient care, crucial in building new
and renovating existing facilities. This extensive analysis emphasizes the importance of
design in a healthcare environment and how it can influence the patient experience.
Verderbera et al. [31] analyzed the role of the competition format in the design and
construction of healthcare institutions. The competition is a widely accepted method that
accelerates and improves innovation, creativity, theoretical discourse, and the profession.
The authors introduced a two-phase model that combines creativity and knowledge. This
model emphasizes the importance of combining these two aspects to achieve optimal
results in healthcare planning.
Hicks et al. [32] introduced a participatory planning method known as the “3P” model.
The building design determines the layout of spaces and the mutual interactions of patients,
doctors, visitors, medicines, supplies, equipment, and information, i.e., the seven flows
of medicine. This approach emphasizes the importance of involving all stakeholders in
planning to ensure everyone’s needs are considered. Liu et al. [37] focused on assessing
the quality of the indoor environment of hospitals. The study is based on a measurement
survey conducted in two healthcare institutions in China. This study emphasizes the
importance of providing a quality indoor environment for the well-being of patients.

3.2. User Experience and Satisfaction in Healthcare Institutions

Haron et al. [27] explored the understanding of patients’ complexities when using
healthcare institutions. The research survey results showed that the following usability
criteria are essential for most patients: accessibility, availability, and spatial orientation. This
finding emphasizes the importance of designing healthcare institutions that are intuitive
and user-friendly.
Huisman et al. [28] structured scientific research on the design of healthcare institutions
based on evidence from patients, their families, and healthcare staff. The study results
Buildings 2023, 13, 2926 11 of 20

showed that the orientation towards the outcomes of employees in healthcare institutions is
rare and insufficiently substantiated and needs to be considered in the planning stage. This
finding indicates the need for greater involvement of employees in the planning process.
Bengtsson and Grahn [30] introduced a quality evaluation tool (QET) tailored for de-
signing outdoor environments in healthcare settings, such as healthcare gardens. This tool,
developed through theory triangulation, integrates evidence from research on health/well-
being and the outdoor environment. The QET identified 19 environmental qualities essen-
tial for the design of healthcare gardens. These qualities are divided into two categories: six
based on the need for comfort in the outdoor environment and thirteen based on the need
for access to nature and surrounding life. The tool also offers insights into user involvement
in the design process and provides general design guidelines to cater to users’ diverse
needs and preferences. Their work emphasizes the significance of evidence-based design
and its connection to salutogenesis and pathogenesis, ensuring that outdoor healthcare
environments are therapeutic and user-centric.
Djukic and Marić [34] highlighted the pressing need for socially sustainable healthcare
facilities, especially in regions like Serbia, where public hospitals are declining. Their
research, centered on the most significant healthcare facility in Serbia, the Medical Military
Academy (MMA), utilized qualitative and quantitative methods to assess the current design
problems. Engaging with diverse stakeholders, including patients and medical staff, they
identified critical issues in the existing design, particularly concerning comfort, distribution,
safety, and humanization.

3.3. Sustainability and Health in Healthcare Institutions

Healthcare facilities across Europe are undergoing significant transformations to
deliver efficient services amidst dwindling resources. A prevailing trend has been the shift
towards more extensive, specialized hospitals, driven by the notion of achieving economies
of scale. However, the article by Pantzartzis et al. [36] challenges this prevailing notion,
suggesting that the evidence supporting the cost-effectiveness of more extensive healthcare
facilities is both limited and contradictory. Their comprehensive literature review delves
into the factors that can lead to sustainable small healthcare facilities, emphasizing the need
to consider broader sustainability issues beyond economic metrics.
The global trend towards sustainability has led the healthcare sector to adopt the
“greening movement”. This has resulted in the creation of sustainability certification tools
like BREEAM, LEED, and the Green Guide for Healthcare; however, Stevanovic et al. [35]
raise concerns about these tools’ subjectivity. Their research in the Flemish healthcare
sector revealed limitations in the “Duurzaamheidsmeter zorg”, a local qualitative tool.
Feedback indicated a need for a more quantitative sustainability assessment method. Based
on professionals’ experiences, their SWOT analysis suggested the importance of a life cycle
thinking perspective in developing new evaluation methods.
Hamed et al. [33] tried to bridge the gap between sustainability and evidence-based
planning research areas. The results of their research indicate that, according to patients,
the most important aspects contributing to their well-being are plants and greenery, safety,
and single-bed rooms. This study points to the connection between sustainability and
health in architectural planning.
Brambilla and Capolongo [38] introduced the latest tools for evaluating the hospital
environment and measuring health and sustainability. Thirteen tools created between 1990
and 2017 were analyzed. This research emphasizes the importance of using tools to ensure
that healthcare institutions are designed to best serve their users and the environment.
In light of these insights, it is evident that architecture plays a pivotal role in the health-
care sector, influencing care quality, user experience, and sustainability. The subsequent
chapters will delve deeper into how these findings can shape the design of future healthcare
institutions, ensuring they are both practical and sustainable.
Buildings 2023, 13, 2926 12 of 20

4. Discussion
The literature review revealed the importance of the connection between architecture
and healthcare. Quality architecture ensures high-quality living and care in healthcare
institutions [1,2]. Healthcare institutions face numerous challenges in the modern world,
from demographic changes to technological innovations [26]. Architecture plays a crucial
role in shaping the response to these challenges, as it can influence the quality of care,
sustainability, and the entire planning process of healthcare institutions [29].
When discussing the architectural and design guidelines for healthcare institutions, it
is important to emphasize that these approaches are crucial for ensuring the functionality
and efficiency of healthcare facilities. The policies and standards used in the planning
process directly influence how a healthcare institution integrates into its environment and
serves its users [33].
Regarding user experience and satisfaction in healthcare institutions, understanding
the interactions between patients, healthcare staff, and space is paramount. The design
and layout of a healthcare institution can significantly influence how people feel and how
effectively they can perform their tasks [28].
In the context of sustainability and the environmental impact of healthcare institutions,
it is important to note that they are at the forefront of efforts to reduce the ecological
footprint. By using sustainable approaches, such as energy efficiency and environmentally
friendly materials, healthcare institutions contribute to a greener and more sustainable
future [38].
These findings lay the foundation for further analysis and interpretation, as they
allow us to better understand the connections between architecture, user experience, and
sustainability in the context of healthcare institutions.

4.1. Contextualization and Interpretation

In the preliminary part of this article, we highlighted how quality architecture affects
the quality of living and care in healthcare institutions, as defined in the Council Resolution
of Europe [1] and the Architectural Policy of Slovenia [2]. This emphasis on the quality of
architecture as a critical factor in ensuring high-quality living aligns with current trends in
the architectural design of healthcare institutions.
Healthcare institutions face numerous challenges today, from demographic changes
to technological innovations [26]. In this context, architecture has become a critical factor
influencing the quality of care, sustainability, and the entire planning process of healthcare
institutions [29]. However, it is crucial to note that while architecture plays a significant
role, it must be integrated with other aspects, such as healthcare policies and technological
advancements, to create a holistic healthcare environment.
Compared to newer scientific articles, such as those by Giudici et al. [22] and Howarth
et al. [23], which focused on the impact of the COVID-19 pandemic on the architectural
design of healthcare institutions, our research emphasizes the importance of a sustainable
and user-centered approach to architectural planning. While the pandemic brought new
challenges and needs in healthcare and social care institutions, our findings indicate that the
guidelines and principles we discussed remain relevant and crucial for designing quality
healthcare institutions. This highlights the enduring nature of these principles, even in the
face of unprecedented challenges such as a global pandemic.
Why do specific patterns appear in the architectural design of healthcare institutions?
One of the fundamental mechanisms is the response to changes in the healthcare environ-
ment. Changes in demographics, technological advancements, and increased awareness
of sustainable practices have influenced how healthcare institutions are designed and
managed [28]. For example, the aging population in Slovenia and elsewhere has increased
the need for healthcare institutions tailored to older patients [26]. This demographic shift
necessitates a re-evaluation of existing architectural designs to better cater to the specific
needs of this growing patient demographic.
Buildings 2023, 13, 2926 13 of 20

Additionally, with the rise in technological innovations, there has been an increased
need for healthcare institutions that can support advanced medical equipment and tech-
nology. This has led to design guidelines that emphasize the flexibility and adaptability of
spaces [29]. Integrating technology in healthcare architecture is not just a trend but a neces-
sity, underscoring the need for designs to accommodate future technological advancements.
The influence of architecture on user experience is another crucial aspect. The design
of a healthcare institution can affect how patients, their families, and healthcare staff feel
and how effectively they can operate within that institution. For instance, well-designed
hospitals can reduce stress in patients and enhance their overall treatment experience [33].
This underscores the importance of a patient-centric approach in architectural design,
where the well-being of patients and staff is a primary consideration.
Lastly, with the growing awareness of the impact of human activities on the environ-
ment, sustainable practices have also become of paramount importance in the architecture
of healthcare institutions. Designing a healthcare institution that considers energy efficiency,
uses sustainable materials, and other sustainable approaches reduces its environmental
impact. It can decrease operational costs and improve the quality of care [38]. Sustainability
in healthcare architecture is not just an environmental concern but also a practical one,
influencing long-term operational efficiency and patient well-being.

4.2. Comparison with Previous Research

Our initial discussion highlighted the role of architecture in healthcare and its impact
on the quality of living and care in healthcare institutions [1,2]. In this light, Hignett
and Lu [26] emphasized the value of involving patients and healthcare staff in the plan-
ning process, echoing our initial findings on the importance of user participation in the
design process.
Furthermore, in the introductory segment, we also mentioned various design guide-
lines, user experience, sustainability, and environmental impact as critical factors in design-
ing healthcare institutions [2,8,10,11]. This aligns with the findings of Samah, Ibrahim and
Amir [29], who identified 105 design aspects crucial for the construction and renovation
of healthcare facilities, and with the results of Hignett and Lu, who emphasized the im-
portance of supporting standardization in obtaining new research evidence in planning
processes [26].
The initial chapter also discussed the importance of innovation, fresh, and especially
holistic approaches in architectural planning [2,12,13]. This aligns with the analysis of
Verderber and colleagues [31], who researched the role of the competition format in plan-
ning healthcare institutions. Furthermore, this is confirmed by Brambilla and Capolongo,
who argue that in modern evaluation tools, health is now three times more important as a
criterion than in those tools developed in the nineties [38].
Lastly, in the context of the Slovenian healthcare system, we found in the initial section
that there needs to be more research focusing on evaluating the architecture of healthcare
institutions [2]. This emphasizes the need for further research in this area and aligns with
our findings in this review article.

4.3. Implications—Integrated Healthcare Architecture Framework (IHAF)

The synthesis of our findings highlights the profound interplay between healthcare
architecture and the broader objectives of building design and urban development, which
is at a critical juncture, facing multilayered challenges that stem from evolving healthcare
needs, technological advancements, and a growing emphasis on sustainability and user
experience. A visual representation of the interconnected elements influencing healthcare
architecture in urban development is presented in Figure 3. The central part emphasizes
the core focus on healthcare architecture, while the radiating branches highlight the mul-
tifaceted implications discussed in the study. Traditional architectural approaches often
need to be more holistically addressing these contemporary demands, by considering users’
emotional and psychological well-being and the environmental sustainability of healthcare
Buildings 2023, 13, 2926 14 of 20

facilities. This gap emphasizes the need for a new, integrative framework to navigate
modern healthcare architecture’s complexities.

Figure 3. Interconnected elements influencing healthcare architecture in urban developments.

The integrated healthcare architecture framework (IHAF) responds to this need. It is a

comprehensive model designed to encapsulate the diverse aspects of healthcare architecture,
including the critical categories defined in our review: architectural and design guidelines,
user experience and satisfaction, and sustainability and environmental impact. These
ensure that facilities are functionally efficientffibut also patient-centric, sustainable, and
adaptable to future needs. The IHAF is a novel, multidimensional, holistic approach
developed from our comprehensive review of healthcare architecture. The IHAF model is
presented in Table 6 below, providing insight into the framework.

Table 6. Integrated healthcare architecture framework (IHAF) components and their application in
healthcare architecture.

Key Category IHAF Component Application in

Alignment Component Description Healthcare Architecture
Facilitates the creation of
Involves all stakeholders in the
Inclusive spaces that are universally
design process, ensuring facilities
design process accessible and meet the
meet diverse user needs.
Architectural and specific needs of all users.
ffi
Design Guidelines Ensures healthcare facilities
Advocates for adaptable designs to
remain functional and efficient
Adaptive and flexible spaces accommodate changing
in evolving medical practices
technologies and patient needs.
and patient demographics.
Prioritizes patient comfort and Enhances patient experience
ffi
ff ffi well-being, focusing on ff a healing
by creating
Patient-centric design ff
straightforward navigation and environment that is intuitive
User Experience and stress reduction. and comforting.
Satisfaction Focuses on creating efficient
ffi It aims to improve staff
workspaces for healthcare staff,
Staff efficiency and well-being productivity and morale,
promoting a positive work
enhancing patient care quality.
environment.
tt
Buildings 2023, 13, 2926 15 of 20

Table 6. Cont.

Key Category IHAF Component Application in

Alignment Component Description Healthcare Architecture
Promotes environmentally
Integrates sustainable practices like
responsible practices,
Eco-friendly practices energy efficiency, sustainable
contributing to a sustainable
materials, and waste management.
Sustainability and healthcare sector.
Environmental Impact Enhances healthcare facilities’
Encourages the inclusion of green aesthetic and therapeutic
Green spaces
spaces within healthcare settings. qualities while reducing their
environmental footprint.

The IHAF addresses the needs by encapsulating the key categories’ diverse aspects of
healthcare architecture.
1. Architectural and Design Guidelines
• Inclusive design process: IHAF’s inclusive design process ensures that the voices
of all stakeholders are heard and integrated. This approach leads to creating
spaces that are not just architecturally sound but also empathetic to the needs
of patients, healthcare workers, and visitors. It fosters a collaborative design
environment, resulting in more effective and user-friendly healthcare facilities.
• Adaptive and flexible spaces: The emphasis on adaptive and flexible spaces
allows healthcare facilities to remain relevant and functional in the face of rapid
technological advancements and changing healthcare demands. This component
ensures that healthcare architecture is not static but evolves, accommodating new
treatments, technologies, and patient care models.
2. User Experience and Satisfaction
• Patient-centric design: By prioritizing patient-centric design, IHAF ensures that
healthcare facilities are not just places for treatment but also spaces that promote
healing and well-being. This aspect of the framework focuses on creating a
supportive and comforting environment for patients, which is crucial for their
recovery and overall experience.
• Staff efficiency and well-being: Recognizing the critical role of healthcare staff,
IHAF places equal importance on designing spaces that enhance staff efficiency
and well-being. Efficiently designed workspaces can significantly reduce stress
and burnout among healthcare professionals, leading to improved patient care
and staff satisfaction.
3. Sustainability and Environmental Impact
• Eco-friendly practices: IHAF’s commitment to eco-friendly practices ensures
that healthcare facilities contribute positively to the environment. This approach
aligns with global sustainability goals and can lead to cost savings in the long
run through the efficient use of resources.
• Green spaces: Integrating green spaces within healthcare settings under IHAF
enhances the aesthetic appeal and provides therapeutic benefits to patients and
staff. These spaces serve as areas for relaxation and respite, contributing to the
overall healing environment.
Implementing the IHAF has the potential of extensive implications for future health-
care architecture projects, policymaking, and research. It could set a new standard for
designing healthcare facilities that are resilient, patient-focused, and environmentally re-
sponsible. In policymaking, the IHAF could serve as a guideline for developing regulations
and standards that could ensure holistic designs for healthcare facilities. From the research
point of view, the IHAF opens new avenues to explore the impact of architectural design
on patient outcomes, staff efficiency, and environmental sustainability.
Buildings 2023, 13, 2926 16 of 20

4.4. Assessing IHAF against Existing Approaches

The proposed IHAF is a step forward in the expanding environment of healthcare
architecture. This subsection compares the IHAF to the existing architectural methods
assessed in this review. It places the IHAF in the context of current methodologies and
clarifies its possible contributions, innovations, benefits, and applications within the three
key categories defined in our review.
1. Architectural and Design Guidelines
• Existing approaches: Traditionally, healthcare architecture has focused on func-
tional and operational efficiency, adhering to standard architectural guidelines
and regulations. These approaches often prioritize technical and operational
aspects, sometimes overlooking the diverse needs of end-users [26].
• IHAF: The IHAF introduces an inclusive design process, actively involving
patients, healthcare workers, and architects. This approach ensures that fa-
cilities are operationally efficient and cater to all stakeholders’ diverse needs.
The IHAF’s emphasis on adaptability accommodates evolving technologies and
patient needs, marking a significant shift from traditional, more rigid design
methodologies [29,37].
2. User Experience and Satisfaction
• Existing approaches: Conventional designs often prioritize operational efficiency
and cost-effectiveness, compromising patient comfort and staff well-being. The
focus is typically on the physical layout and technical aspects, with less consider-
ation for the experiential aspects of the users [28].
• IHAF: Places a strong emphasis on patient-centric design, ensuring facilities are
functional, comforting, and stress-reducing. The IHAF equally values the well-
being of healthcare staff, advocating for efficient and positive work environments.
This holistic approach to design under the IHAF contrasts sharply with the more
practical focus of traditional methods [27,30].
3. Sustainability and Environmental Impact
• Existing approaches: Sustainability in traditional healthcare architecture often
comes as an afterthought, focusing primarily on energy efficiency and operational
cost reduction. While these are important aspects, they only encompass part of
the spectrum of sustainability [35,36].
• IHAF: Integrates eco-friendly practices and green spaces as fundamental com-
ponents of the design process. This comprehensive approach to sustainability
extends beyond mere energy efficiency, encompassing a broader environmental
perspective that includes patient and staff well-being, offering a more holistic
approach to sustainable healthcare architecture [33,38].
This comparative analysis underscores the innovative aspects of IHAF, highlighting
its comprehensive, user-centric, and sustainable approach. IHAF addresses the functional
requirements of healthcare facilities and prioritizes the well-being of users and the environ-
ment, setting a new standard in healthcare architecture.

4.5. Empirical Insights from Evidence-Based Hospital Room Design

This review underscores the intrinsic relationship between architectural design and
healthcare quality; therefore, to strengthen the conclusions, we incorporated real data
gathered from comprehensive questionnaires focused on healthcare-facility design in the
study by Quan et al. [40]. They offer empirical insights that resonate with our findings,
particularly emphasizing the role of evidence-based design in enhancing patient care and
staff efficiency in healthcare environments.
Quan et al. developed and validated tools like design checklists and post-occupancy
evaluation (POE) tools tailored explicitly for hospital inpatient rooms [38]. These tools
focus on optimizing room layouts to improve patient mobility and reduce falls, aligning
Buildings 2023, 13, 2926 17 of 20

seamlessly with our integrated healthcare architecture framework (IHAF), which empha-
sizes patient-centric and staff-friendly designs. The study’s approach to room layout,
ensuring clear, barrier-free access to amenities like bathrooms and accommodating patient
needs, is a testament to the importance of thoughtful design in healthcare settings. The
usability tests involving healthcare professionals and designers further validate these tools,
demonstrating their practical applicability in real-world settings. This aspect of practical
implementation is particularly relevant to our discussion on the IHAF model, highlighting
the need for theoretical and practical designs.
Moreover, the study’s emphasis on continuous optimization and adaptation in re-
sponse to evolving research and design practices resonates with our call for innovative and
adaptable solutions in healthcare architecture. Quan et al. highlighted that developing
evidence-based design (EBD) tools are critical to integrating research evidence in design
practices to achieve optimal outcomes [40]. This reflects our encouragement for a multidis-
ciplinary approach in designing healthcare facilities, which is crucial for addressing the
multifaceted challenges healthcare institutions face today.
In conclusion, the findings from Quan et al.’s study provide robust empirical support
to our manuscript’s conclusions. They emphasize the significance of adopting evidence-
based, user-centric, and adaptable design approaches in healthcare architecture. This
approach is not just a theoretical ideal but a practical necessity, as demonstrated by the
effective implementation of EBD tools in enhancing healthcare facilities. As we look to the
future, fostering collaborative interactions between architects, healthcare professionals, and
other vital stakeholders remains instrumental in designing healthcare infrastructures that
holistically cater to patient and staff needs, thereby contributing to the vision of sustainable
and inclusive architectural practices.

4.6. Limitations and Recommendations for Future Research

Despite extensive research in architecture and health, there are still gaps in the litera-
ture. One of the fundamental limitations is the need for more research on the impact of
architecture on healthcare in Slovenia, as identified in the Architectural Policy of Slove-
nia [2]. Moreover, as stated by Kristl [3], building a hospital is one of the most challenging
tasks for an architect, yet there needs to be more research focused on this specific topic.
Some studies have primarily focused on design aspects, while others have emphasized
the importance of sustainability and environmental impact, which can lead to inconsisten-
cies in the literature [33,38]. For further research, it would be beneficial to examine how
architectural practices can adapt to the specific needs of the Slovenian healthcare system.
Additionally, it would be valuable to explore how architecture can address challenges faced
by the Slovenian healthcare sector, such as an aging population, the need for sustainable
solutions, and the demand for better quality of care.
Integrating advanced technological systems, such as those highlighted by Kumari et al. [41]
and Tanwar et al. [42] necessitates the re-evaluation of architectural design in healthcare
settings. These technologies, including fog computing, cloud computing, and EMRs,
are not just peripheral additions but central components that can significantly influence
healthcare facilities’ physical architecture and spatial planning. For instance, enhanced
digital infrastructure may require redesigning spaces to accommodate advanced computing
systems. Similarly, ensuring data privacy through spatial design becomes crucial when
integrating EMRs, requiring architects to consider secure, private areas for data handling.
Incorporating smart technologies into healthcare environments also demands innovative
architectural solutions that seamlessly blend technology with human-centric design [41,42].
In light of the COVID-19 pandemic, future research should also explore how this
global health crisis has influenced the architecture of healthcare facilities. A post-COVID-
19 analysis could provide valuable insights into the necessary architectural adaptations
for handling such pandemics, including designing more flexible, adaptable spaces and
enhanced infection control measures. Comparing pre- and post-COVID-19 architectural
Buildings 2023, 13, 2926 18 of 20

strategies would offer a comprehensive understanding of the changes and adaptations

required in healthcare facilities, informed by the lessons learned during the pandemic.
Another critical area for future research involves empirically validating the proposed
IHAF model in the Slovenian context. Conducting a comprehensive questionnaire or
survey among healthcare professionals, architects, and patients could provide real data
to support the conclusions drawn in this study. Such research would assess the practical
applicability, effectiveness, and user satisfaction of the IHAF model, offering a grounded
perspective on its relevance and impact in actual healthcare settings.
These recommendations aim to bridge the gap between theoretical architectural con-
cepts and practical, real-world applications, ensuring that future healthcare architecture
research is comprehensive and contextually relevant.

5. Conclusions
The extensive literature review conducted in this study illuminates the intrinsic re-
lationship between architecture and healthcare, particularly underscoring architecture’s
pivotal role in enhancing the quality of care and overall patient experience within healthcare
institutions. This relationship is especially relevant within the Slovenian context, where a
noticeable gap exists and it highlights an urgent need for more comprehensive and nuanced
research in this domain.
Our review has distinctly emphasized three central facets crucial for evaluating health-
care institutions. Firstly, the significance of specific architectural and design approaches
was highlighted, noting the profound impact of adhering to established guidelines on
healthcare facilities’ final design and functionality. This aspect was further enriched by
introducing the integrated healthcare architecture framework (IHAF) which offers a novel
and comprehensive approach to healthcare architecture, encompassing user experience,
sustainability, and adaptability to technological advancements.
Secondly, the evaluation prioritized the experience and satisfaction of healthcare
institution users, including patients, their families, staff, and visitors. The focus was on
creating an ambiance that facilitates navigational ease, accessibility, and overall comfort
and safety of the spaces. The IHAF model particularly emphasizes patient-centric and
staff-friendly designs, ensuring that healthcare facilities are functional but also supportive
and comforting environments.
Lastly, the review underscored the importance of sustainable practices in healthcare
architecture. These encompass energy efficiency, sustainable material utilization, waste
management, and water conservation in the planning and construction phases. The IHAF
model integrates these sustainable practices as fundamental components, advocating for
environmentally responsible healthcare facilities.
As the architectural landscape evolves, healthcare institutions face multifaceted chal-
lenges, ranging from demographic shifts to rapid technological advancements. Addressing
these challenges necessitates innovative architectural solutions that cater to immediate
healthcare needs while aligning with broader objectives of creating sustainable, efficient,
and user-centric built environments. This review highlights the significance of adopting
a multidisciplinary approach in designing, planning, and evaluating healthcare facilities.
Collaboration between architects, healthcare professionals, and other key stakeholders
will be instrumental in creating healthcare infrastructures that holistically cater to the
needs of patients and healthcare personnel. This approach contributes to the overarch-
ing vision of sustainable and inclusive architectural practices, setting a new standard in
healthcare architecture.

Author Contributions: Conceptualization, M.J. and B.G.; methodology, B.G.; formal analysis, M.J.
and B.G.; writing—original draft preparation, M.J. and B.G. All authors have read and agreed to the
published version of the manuscript.
Funding: This research was funded by “ARRS-CRP-2019”, which analyzes Slovenian health care and
social care architectural solutions (Slovenian Research Agency, grant number V5-1905).
Buildings 2023, 13, 2926 19 of 20

Data Availability Statement: Not applicable.

Conflicts of Interest: The authors declare no conflict of interest.

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