Healthcare Systems Ergonomics and Patient Safety 2011 – Albolino et al. (eds)
© 2011 Taylor & Francis Group, London, ISBN 978-0-415-68413-2
Styles of healthcare design and their impact on patients’ well-being
Kieu Anh Vuong & Rebecca Cain
University of Warwick, Coventry, UK
Elizabeth Burton
University of Warwick, School of Health and Social Studies, Coventry, UK
Paul Jennings
University of Warwick, Coventry, UK
1
INTRODUCTION
The design of many hospitals is not in line with future end-user needs and requirements.
A growing body of research shows evidence for the impact of the design of a physical
environment on health and well-being. Patient safety cannot only be considered in terms
of avoidance of physical harm but should also be considered with regard to improving their
emotional well-being. While much effort is spent on improving the physical functionalities,
the visual aspect of design and its impact on patients should also be considered. The design of
waiting areas in particular communicate the initial impression of the overall healthcare setting
as well as face the challenge of accommodating the needs of multiple types of end-users. The
appearance of healthcare waiting areas often reflects the individual style of decision-makers,
designers and architects instead of end-users themselves. In order to assess and compare
different healthcare waiting areas, a formal classification of design styles and the way they are
perceived by the end-user needs to be explored. While the term institutional is most consistently
used to describe the clinical appearance, a broad number of classifications appear to have
ambiguous meanings. No formal classifications of different healthcare design styles have
been established and how they impact patients’ emotional response is not well-understood.
This study seeks to explore the rationale behind participants’ classification process as a first
step in order to understand how each style impacts upon end-user emotions.
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METHODOLOGY
This empirical study involved the general public in the classification process of healthcare design
styles as they are existing, former or potential end-users of these healthcare environments. Visual
material was used to stimulate participants’ emotional response, as it is an established method to
represent a real life environment [1]. Several selection criteria were applied e.g. absence of people
and animals, similar resolution and size were applied in order to normalise the images. After a
short briefing, sixty-five colour images displaying a range of possible designs in healthcare public
spaces and waiting areas were given to participants. They were asked to sort them into similar
groups based on their own concept of similarity, to explain their sorting decisions, and to label
them. The instruction for the sorting exercise is adapted from [2]. Duplications will be eliminated
and clusters will be formed in the analysis. A semi-structured interview was carried out during
the experiment to help the understanding and the content analysis. Participants were also asked
to eliminate the borderline images and choose the most characteristic one of each group. The
groups were then evaluated based on the three semantic pairs like-dislike, beautiful-ugly and calmstressful. The produced data once completed will be analysed using Multidimensional Scalogram
Analysis (MSA) [3, 4] that allows the comparison of similarity level amongst the pictures.
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3
PRELIMINARY RESULTS
This paper presents initial results of the study; a full analysis of the completed data set will
be displayed on the poster presentation at the conference. Fourteen individual sorts were
carried out, resulting in a raw data of 109 differently termed groups. After performing a
content analysis and eliminating duplications, 69 labels were extracted and re-coded. The
initial data suggested that the classification process is mainly determined by the association
of similar places, design features, physical attributes, modernity, activities and facilities and
purpose of the space. Most participants appear to prefer an environment that has been rated
as modern and does not have the typical healthcare look. This preference scale is based on the
scenario that they were in the environment waiting for a routine check-up. Some participants
indicated that the preference would shift towards the clinical style in case of a more severe
medical condition. The preference rating was related to how attractive participants judge the
environment shown on the images. Only a few participants based their likings on whether
they would feel relaxed or stressed in the waiting area. Overall, places with unclear purposes
and abstract design features were not well perceived.
4
DISCUSSION
Previous research suggested the modern, non-typical healthcare appearance has more positive
effect on end-users [5]. While this is in line with data on participants’ preference, the relationship between outcome and style appears to be more complex. When asked to rate groups
based on what they perceive as relaxing or stressful, often the modernity and non-traditional
style was not score as most calming but the conventional type of setting instead. Furthermore,
the context to their visit in the waiting area appears to have a major influence on which style
they perceived as most contributing to their well-being. The functional aspect of a healthcare
environment—providing health services—overrides the less preferred clinical look in case of
a more severe medical condition. However, the state of the environment appears to strongly
influence participants’ perception of the medical service quality, regardless of the style.
5
CONCLUSION
The data showed that the purpose of the environment needs to be clearly presented to all type
of end-users. Modern environment but with an unclear purpose were repeatedly perceived as
too abstract and even disturbing. This finding is in line with the finding in earlier research where
a modern hotel-like healthcare environment was not well-perceived by some end-users due to
the unclear purpose communicated by the building [6]. The research seeks to further explore the
main influencing factors of the classification system and their impact upon emotions.
REFERENCES
[1] Mehrabian, A. & Russell, J., An approach to environmental psychology. 1980.
[2] Scott, M. J. & Canter, D.V., Picture or Place? A multiple sorting study of landscape. Journal of
Environmental Psychology, 1997. 17(4): p. 263–281.
[3] Wilson, M., Structuring qualitative data: Multidimensional scalogram analysis. Research methods in
psychology, 1995: p. 259–273.
[4] Zvulun, E., Multidimensional scalogram analysis: The method and its application. Theory construction and data analysis in the behavioural sciences, 1978: p. 96–125.
[5] Leather, P., et al., Outcomes of environmental appraisal of different hospital waiting areas. Environment
and Behavior, 2003. 35(6): p. 842.
[6] Macnaughton, R., et al., Designing for health: architecture, art and design at the James Cook University
Hospital. 2007.
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