Impact of Healthcare Facility Architecture and Arts on Healing and Health

Impact of Healthcare Facility Architecture and Arts on Healing and Health

Introduction

The effectiveness of any healthcare facility is subject to the identification and measurement of both patient and staff satisfaction. Patient satisfaction has become a major component of healthcare services and it is a critical determinant of how well patients do since there is a clear connection between patient satisfaction scores and patient outcomes. The combination of expectations, experiences, and needs perceived by an individual accounts for patients satisfaction. The patients’ expectations of care as well as attitudes greatly impact satisfaction. In addition, other psychological factors such as pain and depression also have contributory effect to the patient satisfaction scores.  It is pertinent to note that making observations of a patient satisfaction subject to the physical environment of a health care facility is one of the fundamental methods of improving patients’ outcome.  
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The designing of the healthcare setting is a complex and multifaceted endeavor.  While the essential component of healthcare environment is patient and staff satisfaction, enhancing healing process, and abating nosocomial infections spread, the concept of architecture as well as artwork in the facility is complicated and influenced by various factors. While there are many aspects that impact the patient’s satisfaction with the services received from a healthcare facility  department that are beyond the scope and mandate of the healthcare providers, there are numerous variables that are under the mandate of the physical planning department that has significant impact on patients’ satisfaction (Hozak & Watson, 2012). This review of literature seeks to develop an empirical assessment in a bid to determine the implications of improving healthcare environments architectural options and flexibility to the satisfaction of patients and staff. Patients are primary sources of data as pertains to service function. In majority of healthcare facilities, patient satisfaction surveys have been administered, as well as quality-control programs implemented. Nonetheless, most of conventional patient satisfaction surveys dwell only on a few generic as regards to architectural design and artwork (Theurer, 2011).
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A Recapitulate of Cleveland Clinic, Abu Dhabi, Architectural Design, Artwork and Healing Environment

Extending the U.S based Cleveland Clinic concept of care, Cleveland Clinic Abu Dhabi, offers a wide spectrum of tertiary and quaternary medical services that encapsulates a world-class healthcare to the region. The 364-bed, although expandable to 490-bed, facility is located in Al Maryah Island and is organized into five institutes namely; Eye, Heart and Vascular; Digestive Disease; Respiratory; Neurological; and Critical Care. Jointly owned by Mubadala Development Company and the government of Abu Dhabi, Cleveland Clinic facility blends evidence-based design, cutting-edge design, Arabic culture, and world class care with elegant architecture and artwork designs.  The facility is specially designed to offer outstanding patient and staff experience with exceptional quality and it is projected to attract patients from around the region. The facility is expected to enhance the healing process, boost patient and staff satisfaction besides spurring medical tourism Market in the UAE (IBM, 2013).

With elaborate and elegant architecture, Cleveland Clinic, Abi Dhabi provides safer and faster care to patients through the creation of process efficiencies and more capacity while remaining cost friendly. The major benefits provided by Cleveland Clinic, Abu Dhabi, include improved patient outcomes, weighed through reduced hospital stays and readmission rates. The heath facility offers safer, green environments, healthier medical workplace that aid in attracting world-class medical talents and subsequently satisfied and motivated staff. There is improved customer service as well as patient satisfaction (Jordana, 2012). There are improved operational efficiencies as well as decreased capital expenditure besides major improvements in the access of quality, safer and sustainable care. Designed with luxuriant gardens, modern interiors and colorful artwork, the Cleveland Clinic facility in Abu Dhabi, represents a suite of cultural references that are architecturally superior. The color palette of the building highlights the natural elements including the turquoise of the Gulf waters (Jordana, 2012) as well as the spectrum of neutrals of the desert. In addition, the interior artworks, motifs and patterns accentuate the local vernacular.
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To ease accessibility and way finding, the Cleveland Clinic facility has each component represented in a unique individual architecture form, and laid out to highlight the continuum of healthcare (IBM, 2012).  The grouping of various bocks brings about efficiencies for staff as well as enhanced way-finding for patients and visitors. The interior design of the facility serves to create harmony between hospital and hospitality (Jordana, 2012).  Using glistening onyx, rich wood tones, and the facility depicts warmth and softness which when coupled with indoor water elements serve to calm patients and offer a sense of tranquility. Additionally, the greener ambiences on the outside enhance mental alertness as well as providing comfortable gathering areas that accentuate the clinic’s sense of community. The patient rooms are designed intentionally large to offer enough space for families and amenities to have the relatives get involved in the healing process. There are numerous windows that provide views of the lush greenery of the gardens as well as the soothing atmosphere offered by the Arabian Sea, all serving to enhance patients’ wellness and healing (Jordana, 2012).

Impact of Architectural Design and Artwork on Patient’s Healing and Staff Job Satisfaction

Ham et al. (2012) postulates that the concept of healing environments holds that the physical environment of any healthcare setting makes the difference as pertains to how quickly the patient recovers from or adapts to specific acute as well as chronic conditions. Formerly, the emphasis on the designing of healthcare locations was on the functional provision of healthcare (Ulrich, 1999). However, according to Hozak et al. (2016), the importance has gradually shifted towards an outlook of designing healthcare settings that are psychosomatically supportive and reassuring. Comprehending the physical environmental incentives in healthcare facilities will ensure we are well versed in creating settings that positively aid the healing process as well as the well-being of patients and staff. Ulrich (2000a) highlights that the healing environments have beneficial effects on a number of health indicators, such as blood pressure, anxiety, postoperative recovery, the length of stay, and the use of analgesic medication.

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 In 2012, Huisman et al. distinguished three relevant dimensions of the physical healing environment which are architectural features, interior design features, and ambient features. Huisman et al. (2012) considered the architectural features of a healthcare facility as being the relatively permanent characteristics that include room sizes, spatial layout of the facility, and window placement. The interior design features are taken as the less permanent attributes such as colors, furnishings, and artwork. Lighting, odors, noise, and temperature make up the ambient features.  Hozak & Brennan (2012) relies on a classification that subdivided the physical environment features in either purely stimulus objects, or interactional components. For purposes of illustration, a potted plant, used as an interior design feature, can be considered as a stimulus object in the event that the patients are passively exposed to them, while they serve as interactional objects once the patients are actively involved in taking care of them (Delliteri & Belvedere, 2010).

It is imperative to appreciate the background of how individuals perceive their surroundings in determining how the surroundings can influence behavioral change. (Kopec 2002) suggests that the environment we reside in dramatically influences how we perceive the world around us, how the environment affects our social behavior, and how we view ourselves with respect to the greater social hierarchy. This concept is vital in the area of environmental psychology, especially when it comes to cognitive mapping, and the underpinning beliefs of environmental graphic design. The primary beliefs are subject to the holistic notion that social, biological and environmental aspects influences behavior (Kopec, 2002). It is vital to note that the color, shape, symmetry, density, and shape of an object contribute greatly to our perception of the object as well as place limits upon its use (Ham et al, 2012). There is need to make considerations from various levels, from macroscopic architecture to the interior aspects through to microscopic signage, and the inherent properties of each in a healthcare facility lobby. These aspects and components as well as their properties make up the general environmental influences which in turn determine the general navigation and increase the privacy of the patient (Nelson & Watson, 2012).

According to Delliteri & Belvedere (2010), the components of a healthcare facilities’ architecture play a significant role in the patient’s and staff’s wayfinding process of cognitive mapping making it easy to identify locations as well as pathways in navigating through the interior environment.  The building’s walls, corners, doors, windows, and other architectural elements are always in a consistent arrangement that do not change; while the interior and artwork can be manipulated easily. Every site has varying architectural delineation that influences the arrangement and placement of interior elements, artwork, paths, and signage. Finding out the circulation patterns is vital in identifying locations and areas as motility directive points, fundamental decision points at which a patient would choose to move forward or halt, in a bid to exercise patient privacy ((Delliteri & Belvedere, 2010).

Good interior design is considered as responsible design. Such design takes into consideration the needs as well as the realities of the situation and the groups of people who are intended to use the space. In a healthcare facility, the basic need is primarily visual and auditory privacy. Making use of elements that have various textures and surfaces gives the visual organization of the setting by way of patterning. There is creation of contrast subject to the color pattern, lighting, and material used. These attributes are components of the environment that patients and staff organize in a bid to form recognizable patterns.  They can be referred to as cognitive affordances, or instantly recognizable functions (Ulrich, 200b). The prime purpose of interior rudiments is way showing, forming explicit directions of movement within the setting for a patient to follow, and blended with signage can simplify way stopping and the eventual goal of improved patient privacy.

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Healthcare facilities in the Abu Dhabi, especially Dubai have appreciated the fact that patient healing process and satisfaction are fundamental strategic variables that impact patient attraction and consequently the survival of healthcare facilities in the long term (Dayasiri & Lekamge, 2010). Drahota (2012) maintains that there are three important aspects to consider when designing health facilities or renovating as well as redesigning the existing architecture. These aspects are; design priorities, sustainability, and elements influencing the design. Good use of these aspects in the architectural and artwork designing of healthcare facilities of Cleveland Clinics in Abu Dhabi, has promoted the impact of the facilities on recuperation of patients. Effective design of the healing environment results in a holistic and coordinated view of life, which subsequently leads to better outcomes as well as positive feedback from patients, relatives, and clinical staff (Elysayed et al., 2013).

Impact of Architecture and Built Environment Designs on Control of nosocomial Infections

Design guidelines for healthcare facilities suggest the building of walls and floors to be constructed with smooth surfaces that do not have free spaces and crevices that may offer harboring to dirt, dust, moisture, or bacteria. In addition, the wall coverings have been observed to have the potential of trapping moisture-enhancing fungal growth on substrate material. The strategies for Scheming and construction of Hospitals and Healthcare Facilities provide commendations for choosing furniture materials, parquet surfaces, and wall finishes (Lankford et al., 2007). According to Hozak et al. (2016), fire-resistant qualities and materials that limit the production of noxious gases are advised. Optimum hard flooring faces are recommended to support easiness of scrubbing and vacuuming, water and wear-resistance, and resilience against the eroding chattels of germicides or food acids (Lankford et al., 2007). It should be noted that carpeted surfaces are latent reservoirs for microorganisms. Subsequently, it is suggested “they not be utilized in high traffic areas, areas prone to spills, or in protective isolation rooms” Lankford et al., 2007).
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Ham et al. (2012) maintains that acquisition of infections from nosocomial pathogens may cause as many as 90,000 deaths annually. The lengthy survival pathogen cross-contamination and transmission from the hands of healthcare staff to the environmental surfaces and lifeless objects have the potential to impact patients, mainly those at high risk for contaminations secondary to compromised immune systems (Delliteri & Belvedero, 2010). Suitable decontamination of healthcare staff and clinical workers’ hands, uniforms, medical equipment, and adulterated healthcare in built surfaces continues to be imperative in the abatement of prevention of the transmission of microorganisms and subsequently the nosocomial infections (Lankford et al., 2007).

A research study by Drahota (2012) highlights that environmental factors in hospitals such as images, odors, sounds, lighting, and air quality are attributable to better patient recuperation.   There is need therefore for designers to consider the fundamental aspects in the provision of healthcare facility designs that are more suitable for the patients, their relatives and staff (Hozak & Brennan, 2012).  Individuals might need different facilities at their disposal a factor that is subject to age, physical problems, and abilities. Consequently, there is need for designers to come up with flexible designs in a bid to ensure the healing environment is more comfortable and offers more accessibility for a wide spectrum of individuals with different abilities and needs.  Having an apposite design and artwork, putting into account basic elements which include light, access, circulation, and privacy, as well as, the proper application of the relevant secondary components which include nature, tradition, timelessness, security, elegance, and way-finding, enhances the patient and medical staff satisfaction, subsequently improving the approach of handling interpersonal relationships between clinical staff and patients. Nonetheless, the manner and level of benefits acquired from such elements relies on various factors such as the regional and urban context, perceptions of architects and designers, and the local culture (Hozak & Brennan, 2012). 
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References

Dayasiri, M. B. K. C., & Lekamge, E. L. S. (2010), Predictors of Patient Satisfaction With Quality Of Health Care In Asian Hospitals. Australasian Medical Journal AMJ, 3(11), 739-744.

Drahota, A. (2012). Hospital Environments Could Influence Patient Recovery, Retrieved 19 June, 2016, from http://www.news-medical.net/news/20120315/Hospital-environments-could-influence-patient-recovery.aspx

Elsayed M.A. M. (2015). Hospital or Hotel? A New Way of Thinking in Healthcare Facility Design, Hamad Medical Corporation, Doha, Qatar. Retrieved March, 2015, from http://hospitalbuildandinfrastructure.com/?portfolio=hospital-or-hotel-a-new-way-of-thinking-in-healthcarefacility-design

Ham, C., Dixon, A., & Brooke, B. (2012), Transforming the Delivery of Health and Social Care, The King’s Fund publication, London.

Hozak, M. A., & Brennan, M. (2012), Caring At the Core: Maximizing the Likelihood That a Caring Moment Will Occur. In J. W. Nelson & J. Watson (Eds.), Measuring Caring: A compilation of international research on Caritas as Healing intervention. New York: Springer.

Hozak, M. A; Nelson, J. & Gregory, D (2016), Relationship of Hospital Architecture to Nursing Staff Caring for Self, Caring for Patients, and Job Satisfaction, Interdisciplinary Journal of Partnership Studies, Vol. 3: Iss. 1, Article 5. Available at: http://pubs.lib.umn.edu/ijps/vol3/iss1/5

Huisman, E. R. C. M., Morales, E., van Hoof, J., & Kort, H. S. M. (2012), Healing Environment: A Review Of The Impact Of Physical Environmental Factors On Users. Building and Environment, 58, 70-80. doi: http://dx.doi.org/10.1016/j.buildenv.2012.06.016

IBM (2013), The Digital Hospital Evolution, Creating a Framework for the Healthcare System of the Future, IBM Global Business Services, White Paper, Retrieved from <https://www.ibm.com/smarterplanet/global/files/whitepaper_-_the_digital_hospital_evolution.pdf, Accessed on 19 June 2016

Jordana, S. “In Progress: Cleveland Clinic Abu Dhabi / HDR Architecture” 12 Nov 2012, ArchDaily, Retrieved from www.archdaily.com/292167, Accessed 19 June 2016

Nelson, J. W., & Watson, J. (Eds.) (2012), Measuring Caring: A Compilation of International Research on Caritas as Healing Intervention. New York: Springer.

Pellitteri, G., & Belvedere, F. (2010), Characteristics of the Hospital Buildings: Changes, Processes and Quality, Retrieved March, 2015, from http://www.aia.org/aiaucmp/groups/aia/documents/pdf/aiab087217.pdf Perneger

Theurer, V. A. (2011) Improving Patient Satisfaction in a Hospital Foodservice System Using Low-Cost Interventions: Determining Whether a Room Service System is the Next Step. All Graduate Plan B and other Reports, Paper 32, Utah State University. 

Ulrich, R. S. (1999). Effects of Gardens on Health Outcomes: Theory and Research. Chapter in C. C. Marcus and M. Barnes (Eds.), Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley, 27-86.

 Ulrich, R. S. (2000a). Environmental Research and Critical Care, in D. K. Hamilton (Ed.), ICU 2010: Design for the Future. Houston: Center for Innovation in Health Facilities, 195-207.

Ulrich, R. S. (2000b). Evidence Based Environmental Design For Improving Medical Outcomes. Proceedings of the conference, Healing by Design: Building for Health Care in the 21st Century. Montreal: McGill University Health Centre, 3.1-3.10

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