Today’s healthcare leaders face multiple challenges in the delivery of care. Unpredictable reimbursements, shortages of virtually every type of provider, expanding disclosure requirements, increasingly demanding consumers and employees, unprecedented quality and safety requirements, aging facilities, and skyrocketing expenses are just some of the forces influencing the provision of care. While these forces present complex challenges to leaders, they also present opportunities, especially in the area of healthcare design. Specifically, when healthcare facilities are designed and built or renovated, opportunities arise to improve patient care and provide supportive, therapeutic working conditions for employees. Evidence-based design (EBD) of architecture, as well as exterior and interior design, can profoundly impact patient outcomes, employee health, and organizational productivity (Sadler, DuBose, Malone, & Zimring, 2008).
According to many experts, the design of a healing environment should seek to minimize the impact of the building’s location on those who live and work in it as well as the surrounding community and the entire world. This fundamental aspect of design, especially in healthcare buildings, is consistent with the Hippocratic Oath of “First, do no harm.” Laux (2008a) states, “There are two major questions: What does the building say about you and your concern for patients, your workers, and the environment, and how are these values reflected in every aspect of the design?” (p. 7).
Leibrock & Harris (2011) asserts that client outcomes suffer from overbuilt U.S. healthcare institutions and staff-intensive protocols for client care. Leibrock & Harris call for “healthcare models that improve patient outcomes, lower liability, and reduce costs” and adds that “empowering design details can reduce costs as patients take responsibilities for their health care and decrease their reliance on staff... Without these details, healthcare facilities are places where patients are overexposed to strangers and separated from family, where independence is lost to providers or to disabling design” (pp. xv–xvi).
Multiple studies on the effects of healthcare design suggest that all hospital clients (and visitors) have the following design-related needs (Brown, 2013; Miller & Swensson, 2012):
- Physical comfort, which includes appropriate room temperature, pleasant lighting, comfortable furniture, and freedom from unpleasant odors and harsh, annoying noise
- Social contact, which includes personal privacy (limiting what others see and hear of you) and controlling what you see and hear of others
- Symbolic meaning, which includes the array of nonverbal messages embodied in design (for example, cramped, uncomfortable waiting rooms suggest that hospital administrators don’t respect their clients very much)
- Wayfinding, which includes the ability to find the way easily through the maze of equipment and hallways and to avoid inadvertently wandering into a restricted, embarrassing, or even frightening space