How good design could give us healthy hospitals

A Cork hospital designed to reduce stress may point the way in showing how to make patients better quicker. Léan Doody on how good architecture can help recovery - and save cash

Imagine a hospital ward. The television is flickering in the corner. Machines are beeping. Doctors are paged urgently over the loudspeaker. Their feet clatter on the hard floors, running to the next emergency.

Your neighbour drones on to his daughter about the traffic. Did she take the new bypass, he enquires. You haven't slept properly since you were admitted. Visitors chatter away, oblivious to your glares.

At least your bed is beside a window. You've got a great view of the car-park. It reminds you of your daily commute.

Suddenly you realise you're more stressed here than you were in rush hour. How are you ever going to get better? It's well understood that too much stress can make you ill.

But the very places that you would hope would be least stressful - hospitals - are often the most stressful. Anxiety about illness, lack of information, lack of privacy and lack of orientation make patients nervous and tense.

These factors would be aggravating enough in normal circumstances, but coupled with the loss of control that patients endure when they submit themselves to the medical system, it's not hard to see how getting better can be an uphill struggle.

Roger Ulrich, professor at Texas A&M University, is a leading expert on the effects of art and architecture on patient health - the link, in other words, between design and medical outcomes.

Medical outcomes are a way of measuring the quality of healthcare. They include clinical indicators such as the length of the patient's stay, blood pressure, the number of medical errors, and economic outcomes, such as staff turnover and the cost of care.

Dr Ulrich has carried out extensive research into how these outcomes can be improved by changes in the design of hospitals.

As he told the Royal Society in London, changing hospital surroundings can reduce stress and promote healing.

Design issues tend to take a back seat in our health system. It's easy to understand why - the health system is already buffeted by understaffing, lack of funds, bureaucracy and new policy changes.

It's easy to overlook the patient in the midst of this, even though it is clear that the hospital environment can help patients to regain some sense of control.

Dr Ulrich's research demonstrates that design can affect patient satisfaction and quality of care. The key is to use architectural features to reduce stress, making patients more relaxed and comfortable. These are generally simple expedients relating to noise, windows, air quality, furniture, carpeting and a garden.

St Joseph's Hospital in Cork is a good example of a healthcare environment which uses design elements to enhance the inhabitants' quality of life.

Recently completed for the Bon Secours order by architects BDP, it received an award from the Royal Institute of British Architects last June.

It successfully delivers "an environment that provides quality of life and dignity to people with a range of physical and mental disabilities", according to the RIBA assessors.

A total of 62 high-dependency bedrooms with en suite bathrooms and seven flats for long-term patients are provided for convalescents in a series of fingers that radiate from a curved "main street".

Each finger terminates in a cedarwood-clad lounge. As a design element, cedar is an especially appropriate choice of material as it contains a painkilling ingredient. In this case, the building could be even be a direct source of healing.

The scheme includes meeting places designed to stimulate informal interaction and physical exercise. Landscaping is also a vital part of the design, providing enjoyable views from the residential accommodation.

Landscaping and gardens are especially important, as nature is one of the single most powerful stress reducers. Think of a scene that relaxes you and the chances are it will feature trees, flowers or water.

Dr Ulrich studied how viewing scenes of nature could affect patients recovering from open-heart surgery. Various scenes were placed at the end of each patient's bed - from nature to abstract art, and even a blank screen. He found that patients viewing the nature scenes experienced reduced anxiety and pain.

Another study focusing on window views studied patients with a view of a tree versus those with a view of a wall.

The patients who could see the tree spent less time in hospital and needed fewer potent narcotics.

The important thing here is that not only was it proven that nature could help patients, it could also help the cash-strapped health system. Shorter stays and cheaper drugs obviously add up to big savings.

Noise is another key problem in hospitals. Several studies have found that noise increases patients' blood pressure as well as interfering with their sleep.

Recent findings suggest that even low noise, say about the level of a loud conversation or typewriter (40-55 db), combined with poor acoustics, negatively affect patients.

Noise also affects staff, increasing their stress levels and making them tired.

This increases the likelihood of medical errors.

What can be done? Well it's hardly brain surgery. For example, replacing standard ceiling tiles with high performance ones can make a measurable difference. A recent study used ceiling tiles to improve the acoustics.

The new tiles absorbed the sound, reducing the echo so that the reverberation time was reduced from 0.9 sec to 0.3 seconds. This doesn't seem like much, but it made a huge difference to staff and patients alike. Patients reported fewer awakenings and lower blood pressure.

Significantly, fewer patients were re-hospitalised than would have been the norm. This saves money. Staff experienced lessened demands from patients, increased social support from their colleagues and better speech comprehension.

This would also increase patient safety because not only would staff be able to hear and thus treat patients more accurately, patients would also be able to hear their instructions more clearly.

Stress reduction through better design of hospital environments is a goal worth pursuing. Research shows that it's good for patients and good for staff. Better design can also help to save money through lower incidence of re-hospitalisation, less need for more expensive high potency drugs and faster recoveries.

St Joseph's Hospital in Cork illustrates the kind of designs that could be implemented in this country.

But many interventions could be carried out without the need for new building. Better landscaping and noise reduction measures are just a couple of ways that the healthcare environment could be improved.

Given the potential gains, even in terms of saving money, the Minister for Health, Mr Martin, and the Minister for Finance, Mr McCreevy, would do well to consider it seriously.

• Léan Doody is an independent consultant specialising in urban regeneration.