The Role of the Physical Environment in the Hospital in the 21st Century: A Once-in-a-Lifetime Opportunity

Report to The Center for Health Design for the Designing the 21st Century Hospital Project (Robert Wood Johnson Foundation), September 2004, Roger Ulrich, Ph.D., Craig Zimring, Ph.D., et. al. Evaluation of over 600 studies showing that improved physical settings can be an important tool in making hospitals more healing, better places to work. Investigators consistently report that simply viewing nature has stress-reducing or restorative benefits, including positive emotional and physiological changes.

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Health Benefits of Gardens in Hospitals

Views of nature improve patient clinical outcomes. Health Benefits of Gardens in Hospitals, International Exhibition Floriade, Plants for People Conference, 2002. At Uppsala University Hospital in Sweden, the authors (1993) show that exposing heart surgery patients to simulated nature views improved recovery outcomes. Each of 160 patients in intensive care was assigned to one of six visual stimulation conditions: two nature pictures (a view of trees and water, or a forest scene); two abstract pictures; and two control conditions (a white panel, or no picture/panel). Results suggest that patients who viewed the trees/water scene were significantly less anxious during the postoperative period than patients assigned to the other pictures and control conditions. Patients exposed to the trees/water view suffered less severe pain, as evidenced by the fact they shifted faster than other groups from strong narcotic pain drugs to moderate strength analgesics.

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Investigation to Determine Whether The Built Environment Affects Patients Medical Outcomes

The designed environment has a significant effect on clinical outcomes. Investigation to Determine Whether The Built Environment Affects Patients Medical Outcomes, by Haya Rubin, MD, Adjunct Professor Johns Hopkins School of Medicine, et. al., in Integrating Complementary Medicine into Health Systems, by Nancy Faass, Aspen/Jones& Bartlett, 2001. There is suggestive evidence that aspects of the designed environment exert significant effects on clinical outcomes for patients receiving medical care.

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Healing by Design

Views of nature provide therapeutic benefits. Healing by Design, New England Journal of Medicine, Volume 333 (11). A retrospective study of patients who had undergone cholecystectomy showed that those assigned to rooms with a view of a natural setting had shorter postoperative stays and took fewer analgesic drugs than those whose rooms looked onto a brick wall. In a hospital study, views of nature were associated with reduced employee stress and fewer health-related complaints; students under the stress of examinations felt better after viewing nature scenes; prisoners with a view of nature were less likely to attend the sick call.

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The Role of Patient Amenities in Hospital Demand

Hospitals have various dimensions along which they can differentiate themselves in order to compete against other area hospitals. One is clinical quality, as measured by patient outcomes. Another is their ability to offer the latest technology and equipment. A third is the amenities they offer to patients and their families. Previous research has established that the first two factors affect patient demand for hospitals.

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Hospitals as Hotels

In Hospitals as Hotels: The Role of Patient Amenities in Hospital Demand (NBER Working Paper 14619), researchers Dana Goldman and John Romley provide the first systematic evidence on the role of amenities in hospital demand. Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient’s perspective, hospital quality, therefore, embodies amenities as well as clinical quality. They also found that a one-standard-deviation increase in amenities raises a hospital’s demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications for welfare.

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Art in hospitals: why is it there and what is it for?

Vibrant surroundings improve patient recovery. Art in hospitals: why is it there and what is it for? The Lancet, Volume 350(9077), August 1997, Pryle Behrman. Roger Ulrich, Ph.D., director and professor, Center of Health Systems and Design, College of Architecture, Texas A&M University, College Station, investigated the effects of visual stimulation on the rate of recuperation. He found that patients with vibrant surroundings (e.g., paintings, flowers, an outside view, etc.) recovered three-quarters of a day faster, and needed fewer painkillers than those with dull surroundings.

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