Reflections on Healing Environments and Evidence-Based Design

Being a patient is about the least amount of fun a consumer can buy. What is more stressful, frightening, and emotionally draining than being a patient? That comment, by Leonard Berry, a scholar in the field of services marketing, really sums it up. Hospital experiences are seared into our memories. The life-and-death stakes of these encounters elevate them to a sacred status, yet the stage on which these dramas unfold is often unworthy of their holiness. Corridors cluttered with equipment and housekeeping carts and patient units suffering from visual blandness do little to reduce patients' stress.Yet we know that the built environment has a substantial impact on patients' and family members' hospital experiences, their ability to function, their comfort, and their overall well-being. In fact, evidence-based research has demonstrated that the built environment can affect patient clinical outcomes. This is truly the holy grail of healthcare design. Research, long the province of academicians, is now the subject of daily conversations among design professionals who seek to bring maximum value to hospital decision makers. The escalation of construction costs has made it imperative to understand the return on investment associated with alternative design features.Access to research is not easy, however, if one is not affiliated with a university. Not all journals can be accessed through the Internet on the most commonly used websites. Nevertheless, the Internet does provide instant access to countless e-newsletters, reports by regulatory agencies, and online healthcare publications. It is frustrating to see an excellent reference list at the end of a journal article and then be unable to locate all of the studies necessary to delve more deeply into a topic. This will no doubt become easier as organizations such as the Center for Health Design build knowledge management tools that create a bridge for design professionals to acquire the data they need.Enter the Health Environments Research & Design Journal, and just in time. A peer-reviewed journal dedicated to health environments research is a welcome resource. The need to inform design decisions with the best available evidence creates an insatiable demand for journals and databases such as the report, published in 2004 by Roger Ulrich, Craig Zimring, and colleagues, in which 650 studies demonstrating an effect of the built environment on patient clinical outcomes were identified (the current compilation exceeds 1,000 studies). The situation was much different in 1990 when I was doing research for my book, Hospital Interior Architecture, published in 1992. The Internet did not exist. I had to contract with a university library to research journal articles that were then mailed to me. This was a very cumbersome process.The Transition from Healing Environments to Evidence-Based DesignTo further illustrate how much things have changed, the subtitle of my book had the term "healing environments" in it, and I wondered if anyone would know what that meant. As ubiquitous as the term has become, at that time the concept was unfamiliar. I defined it as research-based design, the research coming from the fields of neuroscience, psychoneuroimmunology, evolutionary biology, and environmental design. The common denominator among these studies is the reduction of stress. That book bundled together research focused on specific patient populations such as rehabilitation, birthing, cancer, psychiatric, and so on.Equally difficult at that time was exposure to innovative projects, because magazines like Healthcare Design did not exist. The hundreds of photos in my book enabled readers to see the application of research principles. Thankfully, the situation today is much different. There are many excellent books and resources available that present exemplary projects.In lectures I sometimes find myself saying that the concept of healing environments has evolved into evidence-based design (EBD). …