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Buildings that heal

Aditi Das discusses the healing power of hospital design

How medical buildings are designed and constructed directly influences health, and more than 700 scientific studies have explored the causal link between architecture and health outcomes.¹ A hospital should be a place of recuperation and healing but all too often this is hindered by the hospital’s environment. The term “sick building syndrome,” refers to the harmful effects that poor architecture can have on health.^{2 3} For example, poor ventilation and inappropriate regulation of temperature in hospitals can lead to cardiorespiratory illness, decreased psychosocial wellbeing, and ultimately more mortality and morbidity.⁴Several of these studies have shown the positive effects of aesthetically pleasing and appropriately constructed buildings in reducing anxiety, pain, and infection rates in patients.⁵⁶⁷⁸

Layout

Studies showing that hospitals with impractical layouts can distress patients have been known about for years, but still hospitals hospitals are being built with complicated plans.^{9 10} Signs are often missing, staircases are often hidden, and corridors are often poorly lit. Poor signposting wastes the valuable time of patients and staff: a study in Atlanta found that staff spent 4500 hours a year helping lost patients.¹¹ The Rikshospitalet University Hospital, Oslo, Norway, however, has won international esteem for its design, which facilitates access and orientation (fig 1¹).¹²

Fig 1 Rikshospitalet University Hospital, Oslo, Norway¹²

Inspired by the theme of a village, the hospital is laid out along a “main street,” studded by fountains, lampposts, and sculptures. These props not only visually stimulate patients but also act as reference points. At the end of the street is a pane of colourful stained glass, and a skylight spans the length of the main street, allowing soft light to bathe the corridors.

The Rikshospitalet has also been praised for its location, built on the edge of a magnificent fjord. All rooms, including operating theatres, have been built with scenic views for the benefit of patients and staff.

Natural symbolism

As early as 1984, Ulrich showed that after surgery, patients whose rooms had a view of nature were likely to consume fewer analgesics and have shorter inpatient stays than patients who had a view of a brick wall.¹³ Since then several studies have supported the cathartic effects of nature in improving health through stress reduction.^{14 15}

The Maggie’s Centre cancer institute, in Inverness, in the Highlands of Scotland, is a unique microcosm of charming originality. Its aim is to create an aesthetically pleasing environment that reduces the negative connotations of cancer and helps patients to learn about and cope with their illness.¹⁶

The centre draws on the theme of cells dividing during the mitotic cycle: the way cells communicate with each other to maintain the body’s normal balance is the inspiration for the building and landscape (figs 2² and 3³).

Fig 2 Landscaping the mitotic cycle¹⁶

In the gardens several areas allow for reflection. Specially designed seats overlook integrated visual illusions. For example, in the grass are flashes of white gravel that might represent endocrine, paracrine, and autocrine signalling in the body. These natural symbols are reminiscent of notions of balance and harmony that characterise the human body.

Fig 3 Maggie’s Centre, Inverness, Scotland¹⁶

The symbolism of this Maggie’s Centre might go undetected by the untrained eye, but its grounds emanate serenity, and the centre has received awards for its efforts to use design to revolutionise cancer care.

Ventilation

Until the early 20th century patients with tuberculosis were sent to recover in sanatoriums, hidden in picturesque mountainous locations. It was thought that fresh air was a natural antidote. The term “sanatorium,” comes from the Latin “sanare,” which means “to heal.”¹⁷ With medical development came their demise, and patients today are unlikely to be treated in the Alps or the Pyrenees.

But emerging evidence indicates that the traditional treatment might be better for patients. In the Hospital Nacional Dos de Mayo, Lima, Peru, patients with tuberculosis have been reported to have less infection from airborne contagions than patients in hospitals with mechanically ventilated negative pressure respiratory chambers (fig 4⁴).¹⁸¹⁹ Its large open windows and high ceilings are nostalgic of the old-style facilities in which natural ventilation was encouraged. The Hospital Nacional Dos de Mayo is testament that good hospital design need not be expensive or technologically savvy—after all, air is free.

Fig 4 Hospital Nacional Dos de Mayo, Lima, Peru¹⁸

Aesthetics

In North America, the San Diego Children’s Centre, capitalises on visual aesthetics (fig 5⁵).²⁰ The architectural historian Talbot Hamlin once said that hospitals should be places where you would choose to go on holiday.²¹ This hospital has taken heed of his advice. The building’s facade makes it look more like a Disneyland resort than a medical facility. And the building’s interior has few signs that it is a place of illness rather than wellness. Nursing stations are disguised as miniature houses, and ceiling lights are shaped like dominoes.

Fig 5 San Diego Children’s Centre, United States²⁰

Cultural awareness

In Australia, Aboriginal health care has generally been neglected. Many Western institutions have attempted to provide health services, but most have failed because the designs were deemed to be prescriptive and failed to understand Aboriginal culture and traditions. For more than 40 000 years, Wilcannia, on the banks of the Darling river, New South Wales, Australia, has been the home of the indigenous Barkinji river people.²² There, the Maari Ma Health Corporation run hospital is one of the few hospitals that have been built by indigenous people for indigenous people (fig 6⁶). This hospital is simply a small lodge built from mud, brick, and tin. But what is so striking about the structure is its unique cultural identity.

To encourage attendance the architects incorporated symbols of the river into the design of the hospital. The building has a raw, animal-like quality: the walls and roof evoke images of skin, gills, and fins. The hospital has few structural barriers such as walls and pillars, perhaps signifying the dissolution of hierarchy, which has perennially been associated with Western medicine.

Thanks to such innovative and culturally sensitive design, the hospital has won several architectural and health care awards. And around the globe it is held up as an example of how symbolism and cultural awareness can be incorporated into good design.

Fig 6 Far West Ward Aboriginal Health Service, Wilcannia, Australia²²

Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

See “Let there be light . . .” (BMJ Career Focus 2007 Jun 23, http://careers.bmj.com/careers/advice/view-article.html?id=2416).

Aditi Das fifth year medical student University of Manchester
aditi_d@yahoo.com
Student BMJ 2008;16:425468-ISSN 0966-6494 | December

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