In 2016, CW+ commissioned a report from Design Consultancy Arup, which provided a summary and analysis of the key components of good patient facing healthcare design. This report became the foundation for the CW+ Design Standards Guide. Building the guide, we have illustrated the principles with our current research, as well as the case studies which informed the original enquiry.
An evolving document, the aim of this guide is to provide a coherent summary of the CW+ design philosophy, honed over years of practice, and to provide a mechanism for capturing, recording, and sharing our extensive work in the field of patient environment. Our intention is to use the Design Guide to inform future work and bring a cohesive and informed approach to the delivery of new schemes.
The principles of good holistic design practice have been actively shared and adopted by Chelsea and Westminster Hospital NHS Foundation Trust and can be readily utilised by colleagues and external contractors working on built environment projects.
In developing the Design Guide and preparing it for publication, CW+ saw an opportunity for our research findings to be shared more widely with our sector colleagues. The current incarnation of the guide has been shared with the NHS National Performance Advisory Group (NPAG) on Arts and Design in Healthcare. NPAG is currently working on a best practice toolkit for the sector and it is our intention that the guide make a meaningful contribution to this increasing resource bank.
The Design Guide defines a set of key principles for creating the optimum ‘healing environment’:
“The term ‘healing environment’ in this context describes the factors that positively affect the community served by the healthcare facility. Health impacts can be both physical and psychological, and the opportunities for intervention span both physical setting as well as organisational culture. A healing environment is designed to stimulate, support and enhance the inherent healing capacity of patients, visitors and care providers, and facilitate interaction between all three, whilst not compromising the effective and successful delivery of healthcare services”. (Extract; Design Standards Guide, May 2020, Draft)
One factor is dominant in our design practice thinking – stress. Stress has a significant impact healthcare and can impede patient recovery. Stress is created largely through lack of control, which is significant in the hospital environment, where information and the treatments to support recovery or relieve pain can be overwhelming. Invasive procedures, pain and healthcare terminology can alienate patients. Noise, poor air quality, physical discomfort (exacerbated by unforgiving seating), lack of privacy, and an overtly clinical environment, all create the conditions of high stress response.
To alleviate stress, a restoration of patient control is required, and this has become an overarching theme of our design practice. The CW+ Patient Environment Team are guided by the question, “how we can reasonably restore a sense of control to patients, whilst operating clinically?”
We can achieve this by employing the following principles:
Wayfinding – the patient journey to their procedure or appointment is key to reducing stress. Through consistent, clear, and updated visual design we can create signage enhanced with passive wayfinding and colour, appropriate use of symbols and language options.
Control – optimising the opportunities for the patient to have control over their hospital experience. This could be as simple as offering noise cancelling headphones, access to music or choice of refreshment, if appropriate.
Comfort – comfort can fortify an individual against pain or stress and create conditions through which greater tolerance is achieved. In care provision and rehabilitation, patients whose comfort needs are met will achieve better rest and emotional stability which can expedite recovery.
Acoustics – noise is a major contributor to stress in hospitals, most notably in an ICU where equipment and air handling systems can reach 65 decibels. Acoustic tiles and mitigation measures should be carefully considered in relation to built environment schemes.
Lighting – can create stress by inhibiting a patient’s normal cycle of rest and activity. Hospitals are harsh environments where lighting is mainly focused on flooding spaces and supporting clinical examination and care.
Air quality – The benefits of good air quality include protecting patients and healthcare workers against hospital-acquired infections, preventing sick-hospital syndrome, which causes headaches, fatigue, eye, and skin irritation. Simple considerations such as access to opening windows can significantly improve patient and staff wellbeing.
Materials – Materials and aesthetic treatments can change the look and feel for a space, turning a sterile and stark environment into an inviting, calming space.
Colour – According to existing studies, colour influences people both psychologically and physiologically. Used wisely it can be beneficial in recovery and help to enhance moods. Differentiating spaces with colour, it can a play a crucial role in navigation and wayfinding.
Art – “When Chelsea and Westminster Hospital opened, our art and design programme kick-started a movement of arts in health across the globe. Our arts programme is about improving the environment for the patients we are working with, but also the psychological, physical and clinical outcomes across our hospitals. The design of a stimulating and responsive environment is pivotal to patient recovery. We are committed to bringing together design, art and technology to create optimum healing environments that are patient focused and support staff in delivering the best possible patient care.” Trystan Hawkins, CW+ Art Director
Music and soundscapes – Music, often used in soundscapes, has been shown to reduced anxiety and pain, slow breathing, and heart rates, and reduce stress hormones such as Cortisol.
Closeness to Nature, Biophilia – It is not only direct access to nature that can speed up healing, but also exposure to views and images of nature. A study showed that patient hallucinations and delusion were more than twice as high in rooms without windows.
Technology – offers great scope for innovation and improvement in design, from the evolution of materials, through to patient monitoring and tracking systems. A key strand of the work of CW+ is investing in the exploration and testing of patient focused technology.
Our findings, shared through case studies and research, support a holistic design approach. Whilst we appreciate the restrictive factors of hospital environments, where time and finance are pressured, we also encourage fresh solutions, pioneer new practice, and seize opportunities to embed good design for the benefit of our staff and patients. The Design Standards Guide will continue to evolve to reflect and define our work.