Styles of healthcare design and their impact on patients’ well-being
Kieu Anh Vuong, Dr. Rebecca Cain, Prof. Elizabeth Burton, Prof. Paul Jennings
WMG, International Digital Laboratory, University of Warwick, Coventry CV4 7AL, UK
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 [1,2]. 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 is often neglected. The appearance and functionalities of healthcare waiting areas
often reflect the individual style of decision-makers, designers and architects. Understanding the
potential impact that design styles of public healthcare environments have on end-users will contribute
to design implications.
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. In
order to assess and compare different healthcare waiting areas, a formal classification of design styles
and the way they are perceived by end-users need to be explored.
RESEARCH
OBJECTIVES
Identify
healthcare
design styles
and their
characteristics
Establish
classification
criteria for
each styles
METHODOLOGY
This
empirical
study
involved
twenty-four
participants, twelve female and twelve male, from
the University of Warwick over a four months period
from Feb - May 2011. On average, each experiment
took 45 minutes. Sixty-five colour images from
diverse waiting areas were used to stimulate
participants’ emotional response, an established
method to represent a real life environment [3].
Several selection criteria, for example, minimal
presence of people and animals, similar resolution
and size were applied to normalise the images.
Participants were asked to perform a sorting
exercise of the images, followed by an exploratory
interview explaining their decision-making and
related emotions. Sorting instructions were adapted
from Vuong et al., [4]. Content and Multidimensional
Scaling Analysis [5] were used to analyse the
collected data.
Explore enduser emotions
related to each
classified style
RESULTS
Illustrative examples of data collection and analysis
Examples of collected data
Sorting process
Label Groups
Rating groups
Classification of Design Styles
- Overall Level -
Sort images
into groups
Groups
with
labels
A
Emotions
B
C
Rate Groups based on
 Preference
 Physical
Attractiveness
 Level of Relaxation
/ Stress
Design
Elements
Design
element
Emotion & design
Emotion
Twenty-four individual sorts were carried out by twelve female and twelve male
participants, resulting in a raw data of 173 differently termed groups. After
performing a content analysis and eliminating duplications, 118 labels were
extracted and re-coded. The classification process appears to be mainly
determined by 3 dimensions place, design and evaluation. The place dimension
refers to the association of different environments like home, hotel, a bar etc.
while design mainly refers to the interior within the environment, most
dominantly chairs and counter in the waiting area. Evaluation refers to
participants’ affective terms and the rating of the overall value and quality of the
environment. All interviews were transcribed and the content was used to help
putting results into context.
Place
Design
Count
78
82
Forming Clusters
Examples of data analysis
Group 1: This set of pictures they were impressive, quite modern and nice and some of them don’t
look like hospital exactly, they just look like...don’t know how to call it but they make you feel
comfortable, like a hotel. Especially number (61) it doesn’t look like a hospital, more like a hotel or a
large company’s area. Gives me good impression. All of them (from that group) are impressive.
Exploratory
Questions
Select the most
characteristic one/s of
each group
Label groups
Dimensions
What went through your mind when I first gave you the pictures? What was your impression?
Exploration of characteristics & emotions
- Detail Level -
Evaluation
They are bright, colour creamy/neutral. Comfortable feeling. I mean this one (49) looks like typical
hospital but the colours are soft, neutral.
47
Main Constructs
Examples of Labels
Healthcare
Clinical, typical healthcare,
Hospital, Standard
Non - Healthcare
Hotel, lounge, corporate, home
Non – Waiting room
Corridor, thoroughfare
Interior
Seats, reception, counter, carpet
Physical attributes
Light, spacious, rigid structure
Modernity
Old-fashioned, modern
Facility
Open space for communication
Value / Quality
Top Level, much effort
Emotion
Happy, scary, nice place
What makes the look so typical hospital? The counter, very typical of a HC counter.
(60) very modern, is that a needle or an infusion device in the room? (points out in the modern
picture). Does it bother you? Not at all, just that it shows that it’s healthcare.
Modern, cosy, comfortable, beautiful.
3 groups that are similar:
Group 2: This group is quite similar; they give impression that they are waiting room. This one (24) is
very typical like healthcare waiting room to me. It’s actually quite good decorated but it’s quite
empty, the space makes me feel nervous.
What do those pictures have in common? They are all typical waiting rooms.
Multidimensional Analysis
Content Analysis
CONCLUSION
 Participants prefer modern healthcare appearance compared to ones with the
traditionally known or expected appearance.
 Modern and other non-typical healthcare appearances were not consistently
rated most calming, suggesting a more complex relationship between style and
end-user emotional responses.
 The context of the visit to the healthcare environment needs to be clear to the
participant in order for the environment to be perceived as contributing to overall
well-being.
 The general design quality of the environment appears to strongly influence
participants’ perception of cleanliness and the quality of medical service,
regardless of the style.
 Some results suggest that depending on the severity of medical conditions, the
perception and evaluation of a healthcare environment can change.
Most participants prefer an environment that has been rated as modern and
does not have the typical healthcare look. Some participants indicated that the
preference may shift towards the clinical style in the occurrence of a severe
medical condition. The preference rating was related to how attractive
participants judge the environment shown on the images. Some participants do
not relate a physically more pleasing healthcare environment with a higher level
of relaxation. Overall, places with unclear purposes and abstract design
features increasing the sense of unfamiliarity or leading to confusion were least
well perceived. Perceived level of hygiene and being well-informed are found to
be important criteria for user of healthcare waiting environment.
REFERENCES
[1] Devlin, A. S. and A. B. Arneill (2003). "Health Care Environments and Patient Outcomes: A
Review of the Literature." Environment and Behavior 35(5): 665-694.
[2] Ulrich, R. (2008). "A Review of Research Literature on Evidence-based Healthcare Design."
Health Environments Research and Design Journal (HERD) 1(3).
[3] Mehrabian, A. and J. Russell, An approach to environmental psychology. 1980.
[4] Scott, M.J. and D.V. Canter, Picture or Place? A multiple sorting study of landscape. Journal
of Environmental Psychology, 1997. 17(4): p. 263-281.
[5] Wilson, M., Structuring qualitative data: Multidimensional scalogram analysis. Research
methods in psychology, 1995: p. 259-273.
Acknowledgement: This research is funded under the EPSRC Challenging Engineering programme: Participation in Healthcare Environment Engineering.