Evidence Based vs Sensory vs Social Design

Evidence

Evidence-based design - like evidence-based medicine (which I'm intimately familiar with, being in mind my previous life as a medical writer and editor), it is research-informed. The results affect patient medical outcomes, staff satisfaction and facility operations.

Evidence-based design looks at building design - the physical space, but also the sensory environment of sight, sound, touch and smell.

Evidence-based design research is divided into 5 areas:

1. Access to nature. This research focuses on human responses to indoor plants and gardens, outdoor gardens, views of nature (both artificial and real) and natural light.

2. Control. This focuses on patient options and choice, access to privacy and navigating through a building. A sense of control is important to people's feelings of self-esteem and security. Lack of control can lead to results such as depression, passivity, elevated blood pressure and reduced immune function. The more a person has a sense of control over his or her environment, the more he or she might be able to manage the negative effects of a source of stress.

3. Positive distractions. For example nature, water, play areas, art, music, etc.These can provide a sense of engagement and well-being. Evidence shows that without this, patients can feel numb and depressed. Research in environmental psychology describes several sources of positive distraction: (1) happy, laughing faces, (2) the presence of pets or nonthreatening animals and (3) nature such as trees, plants and views of natural landscapes. In one study, researchers compared the pain levels of patients undergoing laceration repair surgery with or without headset music. Patients with headset music perceived noticeably less pain.

4. Social support. This includes provision of support for family members and cultural sensitivity, and social interactions. Environmental psychologists have found that individuals with a high level of social support experience less stress and greater wellness, with more favourable recovery indicators than people with lower levels. Social interaction in healthcare facilities can be influenced by furniture placement and floor/room layouts. Heavy or unmovable furniture inhibits social interaction, while comfortable, movable furniture that can be arranged in small, flexible groups can facilitate it.

5. Environmental stressors. This includes research on noise, glare/light levels and indoor air quality.
Environmental elements can increase stress if their disturbing presence is difficult to minimize.

Levin, Debra E. Design based on the evidence. Healthcare Design Magazine. August 31, 2002. pp6-7

See this link to a significant review of the literature by Robert Ulrich, plus an article in The Lancet (!) by the same author.

Social & Sensory

While scientific studies have confirmed that health can be positively affected by social support, very little research has been done on how the architecture of hospitals, the physical and sensory environments,  can facilitate social interactions.


The Vidar Clinic in Jarna, Sweden has gained a reputation for being a leading model in human-centred design. It's a 74-bed clinic for people with chronic diseases. It offers a wide variety of social settings within which the patient's experience is heightened by stimulation of their senses - the sculpted volumes of the spaces, layering of colour on the walls, day light, views to the surrounding landscape, textures comfortable to touch and the smell of fresh baking in the morning.

The non-hierarchical way the staff work together is mirrored in the layout of the building.

Day rooms that invite - the day rooms are roughly in the middle of each patient wing and the smell of fresh baking draws patients, doctors, nursers and therapists out of their rooms mid morning for morning tea and informal meetings. The day room interiors are visible from the corridors but each also offers areas to be more private (alcoves for reading or private conversations), and tables for group activities. They have a fireplace, a piano, large windows, skylights, plus a domestically sized kitchen for patients to prepare their own food if they want to. The day rooms also have outdoor verandas for small groups of people.

Corridors as streets - straight double-loaded corridors are life sapping spaces... This clinic has ones which have subtle changes in direction to break up the segments. They occasionally widen into alcove spaces to rest or socialise with skylights overhead.

The heart - most of the social spaces are at the core of the building clusters (dining room, cafe, assembly hall) around a central courtyard. So theses spaces are alive and busy while the patient room wings are quieter and more private. One of the courtyards includes a second level, open air arcade where patients, even those in wheelchairs, can be in the fresh air and also see down into the courtyard.

The cafe provides places where people can sit, be on view, and watch others. It's not a separate room as such, but an alcove-like widening of the main corridor with views into the courtyard. The cafe also serves members of the public, local community.

Communal dining - the walls in the dining hall are a subtle ochre, floors are broad planks of pine and the tables are clear coated hardwood. There is a row of openable windows with views out to the fields. The patients, doctors and staff members all dine here. The midday meal is served on the table, not buffet style, to encourage interactions.

Seipl-Coates, Susanne. "Social Spaces at the Vidar Clinic in Jarna, Sweden and their Role in the Healing Process." In The Architecture of Hospitals, edited by Cor Wagenaar, 406-412. Rotterdam, The Netherlands: NAi Publishers, 2006.

An article by Juhani Pallasma -