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Therapeutic Environments
Bharti Sharma M.des, NIFT Mumbai
Mentor : Ms. Sushama Saitwal
Devising space designs that provide measurable
positive effect on patients clinical outcomes
C 2014 Bharti Sharma.All rights reserved
Part 1
Therapeutic environmentsTherapeutic + environments
Supports clinical excellence in the treatment of the physical body
Supports the psycho-social and spiritual needs of the patient, family, and staff
Produces measurable positive effects on patients' clinical outcomes and staff effectiveness
Having a good effect on the body or mind; contributing to a sense of well-being
source:oxford dictionaries The setting or conditions in which a particular activity is carried on }{
Structure
Present scenario
The landscapehealthcare
Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.
Human Health
WHO defination
Health industrycare
Comprises of providers of diagnostic, preventive, remedial, and
therapeutic services such as doctors, nurses, hospitals and other
private, public, and voluntary organizations within the economic
system.businessdictionary.com
Health industry: INDIAcarepresent scenario
This industry is currently worth Rs 73,000 crore which is roughly 4% of
the GDP. The industry is expected to grow at the rate of 15 percent
which amounts to an addition of Rs 9,000 crores each year.
2017E $158.2 Bn
2012 $78.6 Bn
2011 $68.4 Bn
2010 $59.5 Bn
2009 $45.0 Bn
2008 $51.7 Bn
expected growth of healthcare sector in India
http://healthcare.financialexpress.com/
Medical Tourism
India has emerged as the fastest growing segment of tourism industry and
seems to be the most promising medical tourism destination in the
world. The report further said that by the end of 2015, its global medical
tourism industry share would be around 3 per cent. UK-based TransWorldNews
The population to bed ratio in India is 1 bed per 1000, in relation to the
WHO norm of 1 bed per 300. In India, there exists space for 75000 to
100000 hospital beds.
Over the last five years, there has been an attitudinal change amongst
section of Indians who are spending more on healthcare.
Rise in retail clinics, single speciality, secondary and tertiary care centres
www.who.int/
Segmentation
3%
Segmentation of the healthcare industry
Medical software and Diagnostics
Segmentation
http://healthcare.financialexpress.com/
3% 4%
Segmentation of the healthcare industry
Health maintenance organizations
(Medical insurance)
Medical software and Diagnostics
Segmentation
http://healthcare.financialexpress.com/
3% 4%9%
Segmentation of the healthcare industry
Health maintenance organizations
(Medical insurance)
Medical software and Diagnostics
Health equipments and supplies
Segmentation
http://healthcare.financialexpress.com/
3% 4%9%
13%
Segmentation of the healthcare industry
Health maintenance organizations
(Medical insurance)
Medical software and Diagnostics
Health equipments and supplies
Pharmaceutical
Segmentation
http://healthcare.financialexpress.com/
Hospital management firms
71%
3% 4%9%
13%
Segmentation of the healthcare industry
Health maintenance organizations
(Medical insurance)
Medical software and Diagnostics
Health equipments and supplies
Pharmaceutical
Segmentation
http://healthcare.financialexpress.com/
3% 4%
A facility with specialised staff and equipment
whose primary function is to provide inpatient
and outpatient services, diagnostic and
therapeutic, for a variety of medical
conditions, both surgical and non surgical.
Hospital management firms
3% 4%
A facility with specialised staff and equipment
whose primary function is to provide inpatient
and outpatient services, diagnostic and
therapeutic, for a variety of medical
conditions, both surgical and non surgical.
Hospital management firms
Objective
Teaching cum- research
General
Speciality
Classi�cation of Hospitals
3% 4%
A facility with specialised staff and equipment
whose primary function is to provide inpatient
and outpatient services, diagnostic and
therapeutic, for a variety of medical
conditions, both surgical and non surgical.
Hospital management firms
Objective
OwnershipTeaching cum- research
General
Speciality
Government
Private
Charitable
Corporate
Classi�cation of Hospitals
A facility with specialised staff and equipment
whose primary function is to provide inpatient
and outpatient services, diagnostic and
therapeutic, for a variety of medical
conditions, both surgical and non surgical.
Hospital management firms
Objective
Ownership
Service
Teaching cum- research
General
Speciality
Government
Private
CharitableGeneral
Specialty
(patients belonging to a particular group,patients suffering from diseases of a particular organ or groups of organs)
(Clinical Services, Surgery, emergency,Outpatient, support service)
Corporate
Classi�cation of Hospitals
A facility with specialised staff and equipment
whose primary function is to provide inpatient
and outpatient services, diagnostic and
therapeutic, for a variety of medical
conditions, both surgical and non surgical.
Hospital management firms
Objective
Ownership
Service
Classi�cation of Hospitals
Teaching cum- research
General
Speciality
Government
Private
CharitableGeneral
Specialty
(patients belonging to a particular group,patients suffering from diseases of a particular organ or groups of organs)
(Clinical Services, Surgery, emergency,Outpatient, support service)
Area of intervention
Corporate
Curing model of Hospitals
Medicine
Medical organization
Infrastructure
DoctorsNurses
management staff
TechnologyServiceCultureEmpathy
based on analysis of secondary data
Curing model of Hospitals
DoctorsNurses
management staff
TechnologyServiceCultureEmpathy
Infrastructure
Medicine
Medical organization
Medical Equipments
Environment (space design)
Ancillary and Support Services
Curing model of Hospitals
DoctorsNurses
management staff
TechnologyServiceCultureEmpathy
Infrastructure
Medicine
Medical organization
Supports clinical outcomes
Produces measurable positive effects on patients' clinical outcomes and staff effectiveness
Study focuses on these two elements,
And using Architecture in a way that it:
Medical Equipments
Ancillary and Support Services
Environment (space design)
Treatment
The gap so
discovered is
between the
present use of
the hospital space
as a medicinal
infrastructure
element and its
potential use as a
supplementary
treatment for
holistic health.
Gap identified(Context: India)
Physical Clinical facilities
Experiential attributes of the hospital(eg color, light)
Effect of treatment on mind
Effect of treatment on body
Psychological Hospital
Patient
Psychological Physical
Through Medicine
Treatment
The gap so
discovered is
between the
present use of
the hospital space
as a medicinal
infrastructure
element and its
potential use as a
supplementary
treatment for
holistic health.
Gap identified(Context: India)
Physical Clinical facilities
Experiential attributes of the hospital(eg color, light)
Effect of treatment on mind
Effect of treatment on body
Psychological Hospital
Patient
Psychological Physical
Through Medicine
Through Healing
Treatment
The gap so
discovered is
between the
present use of
the hospital space
as a medicinal
infrastructure
element and its
potential use as a
supplementary
treatment for
holistic health.
Gap identified(Context: India)
Physical Clinical facilities
Experiential attributes of the hospital(eg color, light)
Effect of treatment on mind
Effect of treatment on body
Psychological Hospital
Patient
Psychological Physical
Physical Clinical facilities
Experiential attributes of the hospital(eg color, light)
Effect of treatment on mind
Effect of treatment on body
Psychological Hospital
Patient
Psychological Active
Passive
Through Medicine
Through Healing
Treatment
Therapiesused as a medium
Positive effect onmental health (well- being)
Physical
The gap so
discovered is
between the
present use of
the hospital space
as a medicinal
infrastructure
element and its
potential use as a
supplementary
treatment for
holistic health.
Gap identified(Context: India)
Objectives of research
To study the environmental psychology and understand the relationship between behavioural health
and the physical environment.
To identify and analyze the latest developments in the interior design of health care centers and hospitals.
To investigate the various therapies allied to the sphere of space along with other environmental
characteristics and their positive effects on human psyche.
To substantiate the research by the way of design solutions of the interiors of a healthcare center.
Expected result
The research model aims at achieving the following :
Enabling the health care centers to become not merely an ensemble of concrete and contraptions
or a warehouses for sick but a comfortable haven for both the care givers and care receiver .
Incorporating such therapies in space design which have a direct and ongoing effect on
the patient’s psyche as well as measurable positive effects on his/her clinical outcomes .
To evolve space designs that lend the interiors , an environment that enhances staff efficiency,
staff satisfaction and organizational outcomes.
Secondary Research Primary Research Critical Theory Analysis
(Tertiary & Secondary data)Observation
Care Giver Care Reciever Designer
Field Study
Patient And Doctor
Activity Mapping
Interview
Gap Identi�cation
Developmentof Key DesignConsiderations
study analysis identification
Design Development
Hospital feedback
Hospital Design, Interactive spaces, Children Spaces
Behaviourial Health
Therapies and other environmental characteristics found to influence Health outcomes
Environmental Psychology
Child Psychology
Space
Psychology
Design
Medical Science
methodology
Secondary TheorySecondary Visual ResearchSecondary AnalysisTertiary research
Secondary Research
Concepts Theories Present researches
Present researches
Critical review to understand the various theories and concepts related to the field ofenvironment and healthcare.
Critical Theory Analysis
Comprehension and Analysis of present healthcare scenario
Tertiary Data Secondary Data
Phase 1
The liberal use of colors , vivid illustrations and animated characters make the interiors come alive
Use of cool colors and nautical paintings effectively pull off a sereneoceanfront feel , granting the ambiance a sense of calm and peace .
The continuity of the narration is unhindered , maintained by the continuation of illustrations on glass .
Scale and perspective provides quick visual stimulation and acts as a positive distraction.
Secondary Visual Research
Melbourne’s Royal Children’s Hospital Melbourne, Australia
The waiting areas are not conventional sitting arrangements but evolved into activity spaces to engage the child during the waiting hours . Reflecting the sense of warmth and care ,
the soft edges impart tenderness that sharp edging essentially forgoes.
softer and round edges
The illustrations complement the interiors in every respect thus leaving no room for visual tension or distraction.
Randall Children’s Hospital
The corridors make clever use of creative installations , colour blocking and asymmetric designing to not only create a happy sitting space but also break free from the institutional typecast inherent to hospitals .
The children’s rooms are designed to provide a homely environment made complete with warm and comfortable design setting .
The small lounging spaces at regular intervals provide personal space to patients and their accompanists
Texas Children's Hospital Page Southerland Page,Houston, Texas
The bright and contrasting combination of yellow and violet add a dash of playfulness to the interiors making them appear less institutional.
interactive spaces
Ceiling designs and sky installations generate awe and interest among young and old alike .
Sky installations add more interest
Randall Children’s Hospital
Ingenious and Interactive learning areas in corridors seek toengage the attention of the onlookers
The traditional black and white signage is given a new life through interesting , colourful icons that speak for themselves .
The accessories of the rooms play upon nature therapy through prints in refreshing greens . To ease the tension of patients the
ECG room is given a serene dreamlike background almost meditative in nature .
Designing for Healthcareanalysis of various models suggested by medical researches and centers to create and healthcare envirnoment
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Designing for Healthcareanalysis of various models suggested by medical researches and centers to create and healthcare envirnoment
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Designing for Healthcareanalysis of various models suggested by medical researches and centers to create and healthcare envirnoment
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Hope
Music etc
engagement of senses
architecture
Empathy
ArtNature
Aroma
Entertainment
Interaction
communication
comfortway finding
lighting
color
communication
equipments
medical facilities
Designing for Healthcareanalysis of various models suggested by medical researches and centers to create and healthcare envirnoment
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Hope
Music etc
engagement of senses
architecture
Empathy
ArtNature
Aroma
Entertainment
Interaction
communication
comfortway finding
lighting
color
communication
equipments
medical facilities
Environmental psychology
Parallels between Behaviourial health and Physical Environmental
Psychoneuroimmunology
Designing for Healthcare
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Hope
Music etc
engagement of senses
architecture
Empathy
ArtNature
Aroma
Entertainment
Interaction
communication
comfortway finding
lighting
color
communication
equipments
medical facilities
Disease Patient(Disease centric) Cure Care (patient centric)
Designing for Healthcare
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Hope
Music etc
engagement of senses
architecture
Empathy
ArtNature
Aroma
Entertainment
Interaction
communication
comfortway finding
lighting
color
communication
equipments
medical facilities
Disease Patient
Balance
(Disease centric) Cure Care (patient centric)
Designing for Healthcare
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Hope
Music etc
engagement of senses
architecture
Empathy
ArtNature
Aroma
Entertainment
Interaction
communication
comfortway finding
lighting
color
communication
equipments
medical facilities
Disease Patient
Balance
Patient experience Effectiveness of treatment
Florence Nightingale
Body-and-mind connection.
Consumer- and user-focused culture are growing, patients will
be making demands on the quality, context and accessibility
both of services and of the environmental components that
encourage good health.
(Disease centric) Cure Care (patient centric)
Designing for Healthcare
Disease
Physical Environment
Medicine
Technology
(Disease centric) Cure
Patient
Social Environment
Therapy
Spirituality
Care (patient centric)
Hope
Music etc
engagement of senses
architecture
Empathy
ArtNature
Aroma
Entertainment
Interaction
communication
comfortway finding
lighting
color
communication
equipments
medical facilities
Patient experience Effectiveness of treatment
Social Environment
Art
Effectiveness of treatmentPatient experience
Reduce pain, fear, anxiety & other psychological conditions,
need for sedative drugs, length of stay
Improve physical functioning, mental /psychological
functioning, patient / care giver communication,
care giver empathy
Increase adherence to medical regiments,
satisfaction with overall quality of careArtEnvironment some factors from each category
physical
psychological
Social Environment
Art
Effectiveness of treatmentPatient experience
NatureArt
A study at the University of British Columbia demonstrated that using wood, in the design of a room lowered sympathetic nervous system activation and patient stress.
Provides a sense of fascination, Acts as a positive distraction,Reduces negative emotions and blocks stressful thoughts
Researches have also found that nursing homes with physical or visual access have greater caloric intake and exercise than those without.
A revolutionary study by Ulrich (1984) found that postsurgical patients recovered more quickly when exposed to a window view .
Environment some factors from each category
physical
psychological
Social EnvironmentEffectiveness of treatmentPatient experience
Nature
Color & Light
Art
In Indian culture, each color is assigned to various energy centers of the body. Color has electromagnetic energy that can influence healing in similar ways to sunlight.
Egyptians used colour for cures and ailments. Built temples for healing and used gems (crystals) through which the sunlight shone.
Affects mood and perception
Improves sleep, adjustment to night-shift work among staff
Environment some factors from each category
physical
psychological
Art
Social Environment
Art
Effectiveness of treatmentPatient experience
Social Envirnoment
Comfort
Communication
Care giver
Interaction
promotes confidentiality and privacy
hygiene personal attention
with staff
with treatment (sense of control, information etc)
with environment
empathy
Way finding , zoning & Signage
other hospital communication
Staff effectiveness, teamwork, Qualification
physical
psychological Nature
Comfort
Color & Light
CommunicationCare giverInteraction
Art
Social Envirnoment
Environment some factors from each category
Social Environment
Art
Effectiveness of treatmentPatient experience
Medicine
Social Envirnoment
Environment Nature
Comfort
Color & Light
CommunicationCare giverInteraction
Medical environment
Medical environment
Medical Staff
Medical Staff
Artsome factors from each category
Art
Medicine
both stimulate a patient’s trust over the medication given
physical
psychological
Primary ResearchObservation Interview Activity mapping
Observation
Three Hospitals-2 private & 1government
Patient and Staff (Doctor, nurses etc)
Activity Mapping
Interview
Care Giver Care Reciever Designer
Doctor Therapist Nurse (2 out patient & 1 admitted) (1 architect & 2 interior designer)(1 each)
Phase 2
areas identi�ed
Expert Views
Userexperience
Examinationroom, wards
Rooms (Children
& Maternity)
Administrativedepartments
Reception
Waiting lounge
ICU, OT Gardenspaces
interviews
& analysis Secondary Data
interviews,
observation & activity mapping
feel numb, afraid, having no control
Hope
Mental well-being(staff)
Unoccupied time (feels longer than occupied time)
Uncertain waits
Feel Anxiety
Clean & hygienic.
feelshomesick
Areas ofhealing
Aesthetic appeal
Positivedistraction
Anxiety (makes waits seem longer)
Expect information, assurance, support, and comfort
Feel their injury is more urgent than others. (leads to distrust )
Should relax and get a sense of control.
Distraction
Managenurse walking time& exhaustion(negative effect on productivity.)Should have
positive energy
Need empathyrather sympathy
Sense of control
Feel extreme anxiety
Fearful &worrying experience
Clinical Facilities
Medicallycontrolled
Patient Sleep& restoration
Trust dependson the staff
Feel homesick.
Socially disconnected
Alone and depressed
Unoccupiedtime
Risk of injury frommedical equipment
no user -interaction
Synopsis Interview
& observation
areas identi�ed
Design Solutions
Examinationroom, wards
Rooms (Children
& Maternity)
Administrativedepartments
Reception
Waiting lounge
More therapeutic
Design not barrier in medical treatment
Healthy Work environment
Reduce exhaustionand Walking time.
Home awayfrom home
ICU, OT Gardenspaces
based on interviews,
Secondary analysis & Secondary
Visual Analysis
Creating an interaction map (patient, other patient, staff)eg making them busy with loads of paperwork
Inviting & calming
Feel a sense of control
limit noise & stress
Programs forstaff well-being.
Connects patient’s experience and treatment plan
control over light, temperature
Ceiling Design
Liberalized visiting policy
Integratescomplementary
therapy
Healing Garden
BothPhysical & VisualInteraction
More Interactive
Medicativein nature
Dieses centricdesign
Care
Cure
Experience
areas identi�ed
Examinationroom, wards
Rooms (Children
& Maternity)
Administrativedepartments
Reception
Waiting lounge
ICU, OT Gardenspaces
InteractionSocialSpacial
Elimination of Psychological
stressors
Spirituality
Therapies
Aroma Therapy
Art
Applicationof designelements
areas identi�ed
Examinationroom, wards
Rooms (Children
& Maternity)
Administrativedepartments
Reception
Waiting lounge
ICU, OT Gardenspaces
PositiveDistractions
Access to Nature
Elimination of Environment
stressors
Entertainment
Stimulation &engagement of
�ve senses
areas identi�ed
Reception
Waiting lounge (examination ward & ICU, OT)
VisualResearch
No interaction with artworks
No two way interaction
Seating arrangement highlights the waiting time (unoccupied time)
No spaces for kids interaction
no positive distraction
Poor communication design,way finding
areas identi�ed Patient rooms
VisualResearch
The Ceiling design lacks innovation and shows no experimentation of space .
The upholstery design does little to lift the mood .
The ambiance design is simplistic and bland reinforcing the institutional feel in the environment .
areas identi�ed Miscellaneous
VisualResearch
Outdoor space unutilized
Lack of designing elements in corridors,staircase, walls and glasses.
No positive distractions in these areas.
No usage of areas for complimentaryactivites.
No usage of therapeutic elements insuch spaces.