dunlop architects inc. surveys on hospital design

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Dunlop Architects Inc.Surveys on Hospital Design

Michael Moxam

Michael Moxam, OAA,MRAIC, Assoc. AIA

Mr. Moxam is Design Principal ofDunlop Architects Inc., an innovati-ve Toronto-based design firm speciali-zing in the design of acute care facili-

ties. With over 19 years experience in the design andplanning of complex project types, Mr. Moxam main-tains a strong commitment to design excellence and toredefining the ”type” in acute care design. His recentdesign work in acute care has focused on the creation offully integrated community facilities and the creation ofstaff and patient-centred environments. Mr. Moxam isthe Design Principal for the new 529 bed PeterboroughRegional Health Centre in Peterborough, Ontario, theredevelopment of the University Health Network’sToronto Western Hospital and the redevelopment of theChatham-Kent Health Alliance in Chatham, Ontario.

BackgroundArchitecture, in its most fundamental defini-tion, is about engaging the mind, accommoda-ting the body and lifting the spirit. It is about

the human experience.Design for healthcare is an incredibly chal-lenging task, balancing many complex and oftencontradictory issues:

• integration of medical technology• healthcare planning issues• long term flexibility• community integration• systems integration• cost

Often, it seems the goal of enhancing and rein-forcing human experience weakens as theseissues fight for priority – sometimes resulting infacilities that are more about equipment andplanning than matters of human experience.

The ideas that enhance human experience mustbe embedded in the very first diagrams thatdefine the conceptual direction of a facility, toprotect them from being lost.

As architects, we are very intuitive about whatdraws out people’s emotional responses – space,proportion, clear circulation, natural light,views, materials, connections. In 2002, wedetermined to push ourselves beyond this, totest and challenge our natural intuition.

We decided ask patients and staff about theiremotional response to the built environment.Other available studies were not specificenough to provide the information we wereseeking. Also, we wanted to build a database ofour own experience that would feed back intothe design process and contribute to the conti-nuous evolution of our work. This was notintended as a strictly controlled scientific expe-riment, but a sampling of people’s ideas andsatisfaction. It remains a “work in progress”.Architecture + Health

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2) Approximately 40% feel the physical envi-ronment improves effectiveness of treatment

When we asked what impact they felt the phy-sical environment had on the effectiveness oftreatment, the numbers increased – approxima-tely 40% said the physical environment madetreatment “somewhat” or “a lot” more effective.

3) The majority of patients report the physicalenvironment lowers their stress. Staff havemixed views.

Patients were even more positive about the impacton their stress levels – more than half reportedthat the physical surroundings made them feel“somewhat” or “a lot” less stressed. Figures forstaff were quite different – we believe this reflectsthe combination of new and old construction inthe same facility, but intend to explore this further.

DUNLOP ARCHITECTS INC. SURVEYS ON HOSPITAL DESIGN

International Academy for Design and Health

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We chose ambulatory care departments as thefocus of the pilot study. These facilities aregrowing in importance for the healthcare sec-tor. With the wide variety of patients who visitambulatory care facilities, they also offer abroad sample of differing levels of acuity. Ourinitial approach was to three clients:Headwaters Health Care Centre inOrangeville, University Health Network’sToronto Western Hospital, and PeterboroughRegional Health Centre. We examined varioustools, including surveys, focus groups and siteobservations. Survey questions were refinedwith input from the clients and from an outsideresearch agency.

The study focussed on two key areas: generalimpact of the physical environment on patientsand staff, and opinions about specific designelements.

Key Findings – General Impact1) About one quarter of patients and staff feelthe physical environment speeds up recovery

While the majority of people said the physicalenvironment had no impact on recoverytimes, almost one quarter reported that itmade recovery “somewhat” faster, and a smallpercentage felt it made recovery “a lot” faster.(Patients were asked about their own experi-ence; staff were asked their opinions about theimpact on patients.)

Key Results to Date – Speed of Recovery

Key Results to Date – Effectiveness of Treatment

Key Results to Date – Stress Levels


4) Half of patients and almost as many staffsay the physical environment improves thesense of “wellness”

More than half of the patients, and close to half ofthe staff, felt the physical surroundings resulted infeeling “somewhat” or “a lot” better physically.

5) Natural light is rated among the top 3 – 4most important elements

We asked patients and staff to rate the impor-tance of various elements to their sense of well-being while in the hospital and grounds – “veryimportant”, “somewhat important” or “noimpact”. Natural light was consistently ratednear the top, both for “very important” alone,and for “very important” and “somewhatimportant” combined.

Key Results to Date – Sense of Wellness

Key Results to Date – Natural Light


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Natural light can be introduced into variousparts of the hospital, from large “view” win-dows, to indirect light shelves. Even in areaswhere privacy is paramount, sandblasted glasscan maximize access to natural light.

6) Staff gives a higher priority to having exter-nal views in work spaces than in patient areasor public spacesWe wanted to look a little more closely atwindows and views, so we asked staff to tell uswhere they thought external views wereimportant. They put work areas first, lobbiesand public spaces second, and patient andfamily spaces third.




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7) Wayfinding is very important to patients;somewhat less so to staff

Many older hospitals confront patients with aconfusing array of corridors, structures andeven street entrances which are difficult to find.It's no wonder patients rate wayfinding (signa-ge, orientation and route markers) near the topof their list of important elements. The percen-tage of staff who rate wayfinding as “veryimportant” is lower – but the combined total

Key Results to Date – Access to External View Key Results to Date – Wayfinding


rating it "somewhat" or "very" important is vir-tually identical for staff and for patients. Newdesign approaches can make a huge difference.For example, adding a new entrance to this exis-ting hospital has created a point of entry soclear it already has become a city landmark.

8) Materials affect most respondents

Use of wood, glass, metals, stone, etc. appearsto have an impact on most people’s sense ofwellbeing.

9) Colour scheme is rated similarly to materialsWell designed colour schemes can create anatmosphere of calmness, warmth, elegance,welcome, or fun, depending on the facility’s goals.Accent colours can help peopleidentify key destinations, and assist in wayfinding.

Key Results to Date – Materials


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10) There is a definite impact attributed tolandscapingGood design can bring the best elements of naturetogether to create environments that contribute towellbeing, both inside and outside the facility.

Key Results to Date – Colour




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Key Results to Date – Landscaping Key Results to Date – Artwork


11) Even though artwork is rated lowest, itsscore is still impressive

Although the number of people rating it “veryimportant” is lowest for both groups, only a quar-ter of patients (and fewer staff) said it had “noimpact” on their sense of wellbeing while in thehospital and grounds. Inpatients may rate artworkmore highly. We intend to investigate this further.


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Comparative Summary – Patient Perspective

Key Findings – How they compareThese charts compare the ratings given to the vari-ous architectural elements by patients and by staff.

The first chart is organized by patients’ ratings of“very important”, from highest to lowest. Thesecond chart keeps the elements in the same orderpatients assigned, but shows the ratings given bystaff. This helps to point out differences betweenhow the two groups rated various elements.

For patients, the top four elements identified as“very important” are: air quality, wayfinding,natural light and temperature.

For staff, the top four elements identified as“very important” are: air quality, noise/quiet,temperature and a tie between natural light andamount of space. Staff also rated personal con-trols over light and temperature, and windowviews, as far more important than patients did.Again, we believe that inpatients would rate bothof those elements more highly than the ambula-tory care patients did.




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“Headwaters is the most pleasant …

Comparative Summary – Staff Perspective



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“Surroundings made my tests less … “I had a windowless office for one year …

““I find the staff … surely architecture must influence this.”


dunlop architects inc. surveys on hospital design

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