MATEC Web of Conferences 396, 07001 (2024) https://doi.org/10.

1051/matecconf/202439607001
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Healing architecture - A different approach of

hospital design
Danina Zubcov1*
1Center of Architectural and Urban Studies, Ion Mincu University of Architecture and Urbanism,
str. Academiei nr. 18-20, 010014, București, România

Abstract. Every day, in hospitals around the world, thousands of people

spend hours, days, months for investigations, diagnosis or treatment, in
search of healing. For patients and their families, the experience of the time
spent in the hospital is often a crucial episode of their lives, whether their
child was born there, whether it was the place where the life of a family
member or loved one has been saved or a bout of illness was cured or treated
there. The hospital often represents a milestone in people's lives, a landmark
underlying society’ life. The increase in the number of patients with chronic
diseases, of the percentage of aging population and the number of patients
requiring treatments influence the hospital’s contemporary approach, and
issues such as the above will become even more significant in the future.
Future hospitals will have to meet the citizens’ requirements, expectations,
but especially their increasingly higher and more diverse needs. In this
context, in order to gain the citizens’ confidence, hospitals need to become
a safety landmark for the community, where quality care and effective care
spaces should be designed and developed so that they provide a positive
contribution to the healing process. There is growing awareness that the
patients’ evolution and healing are influenced directly by the environment
in which the healing process is carried out, so this concept has become the
key to architectural layouts when hospitals and health care establishments
are being designed or constructed. The aim of this paper is to define and
present those innovative features of hospital design – both spatial and
aesthetic - that would positively impact on the patients’ healing process. By
creating an environment with positive psychological stimuli, reflected in an
efficient structure and friendly interior finishings, the architecture of
hospitals would support a contemporary approach to the treatment, recovery
and healing of the patients.

1 Introduction
The healthcare environment has an important impact on the patient’s welfare, on the
community and at a global scale on the entire society.
This environment is in constant change and adaptation in line with the evolution of the
medical world, the diagnostic and treatment technology evolution, the changes in the society;

* Corresponding author: [email protected]

© The Authors, published by EDP Sciences. This is an open access article distributed under the terms of the Creative Commons
Attribution License 4.0 (https://creativecommons.org/licenses/by/4.0/).
MATEC Web of Conferences 396, 07001 (2024) https://doi.org/10.1051/matecconf/202439607001
WMCAUS 2023

meanwhile it is strongly influenced by the degree of patient satisfaction, the increased

competition and the need for replacing of the obsolete facilities.
A healing environment is one that is based on research evidence used to inform design
decisions. The research comes from the fields of evolutionary biology, neurosciences,
psychoneuroimmunology (the effect of the emotions on the immune system and
environmental psychology). [1]
The future should recognize the healing environments as a vital part of the therapeutic
treatment in which the design of healthcare settings contributes to health rather than adds to
the burden of stress.
This article aims to define how the elements within the healing environments can be
balanced with the global project requirements for a successful result, including positive
outcomes for the patient.

2 Patient needs
A person is an embodied, intelligent being with the free will to act in fulfilment of his human
needs [2]. As healthcare providers, the healthcare units, the doctors and all the healthcare unit
staff should realize that they are not providing services strictly to the patient, the sick, but to
the individual, to the human being, who most of the time, he and his family are having a
difficult moment in their lives, being in pain, stressed, scared, worried.
We are asking ourselves “What do patients or patient’s families think?” as if patients and
their relatives had somehow different thoughts or feelings than normal human beings. We
are asking this question because the traditional notion of a patient is someone to whom we
do things; someone who needs to be fixed; someone expected to give up at least a portion of
his or her free will to undergo the clinician’s decided course of treatment; someone treated,
manipulated, and in short dominated – at least in the traditional, perhaps unconscious, view
[3]. In designing medical facilities, we are making the mistake of relating directly to medical
protocols, to the patient pathology; these result in a sterile project that albeit meets medical
standards and procedures, does not relate to the person in the context of his or her daily
existence.
When speaking of a person's existential context we should relate to his/her needs.
The Abraham Maslow’s Hierarchy of Needs is an important milestone for the health care
units’ design (Fig. 1).
A person should satisfy his/her physiological needs (first level) in order to getting to
satisfy his/her needs from the next level. Physiological needs include food, water, shelter,
and we may also include here the basic health services and life-savings interventions. The
next level is the need for safety. A person must feel protected in a secure environment, to
trust others and to have comfort and peace knowing that this psychological need can be
satisfied. The next level consists of the social needs (often considered psychological). These
needs are met through social interaction, attention, spiritual and emotional support.
Maslow’s Hierarchy fits very well in the way in which healthcare units have worked in the
past 50 years.
Maslow created this hierarchy to explain how a perfectly healthy person is motivated to
satisfy his/her needs and necessities. But the limitation of this hierarchy in terms of units and
medical services is insufficient to meet the needs and necessities of a sick person and its
family.

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Fig. 1. The Abraham Maslow’s Hierarchy of Needs.

It is very important to understand that a person is not limited to the satisfaction of the
basic needs; each person is a whole psycho-emotional universe reacting to the environment
stimuli and whose energies often find their physical expression in the health and wellbeing
of the body.
Thus, the design approach of the medical units should be viewed from a broader
perspective and more open in terms of overall needs and patient needs.
Patients want to benefit from advanced medical technologies and treatments,
overqualified staff and available in a humanized environment that is comfortable and
aesthetically pleasing.
Patients know they will receive the best medical care in any medical facility, where their
basic needs are met; but the difference between medical units comes from the fine
architectural details that create the healing design of the healthcare environment meeting the
deeper needs of the patients, having a positive effect on the healing process and improving
health. Thus, the patient requires beyond the satisfaction of its basic needs, a healing
environment: a place to heal the body, the mind and the soul.
There is now a growing body of research with more than 1000 papers relevant to the
relationship between design and outcomes, including topics such as patient safety and stress
reduction for patient safety and stress reduction for patients and stuff [4]. Zimring notes, “It
is now widely recognized that well-designed physical settings play an important role in
making hospitals less risky and stressful, promoting more healing for patients, and providing
better places for staff to work” [5].
While debate is still ongoing about an exact definition of healing environments, many of
the basic the components / patient needs of a healing environment have been clearly
identified. According to Malkin (1992, p.10) they include: [6]
 Air quality,
 Thermal comfort,
 Noise control,
 Privacy,
 Light,
 Views of nature,

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 Visual serenity for those who are very ill,

 Visual stimulation for those who are recuperating,
 Access to nature,
 Positive diversion,
 Access to social support and family,
 Elimination of environmental stressors.

Patient and staff safety and elimination of stress remain at the top of any definition of a
healing environment, but a healing environment is more than a safe building. It is one that
embraces patients, visitors, and staff while supporting them during the time they are in the
building. [6].
The healing environment is the one that meets and satisfies, in a more complex way, the
needs of the patient and his family.

3 Stress and healing environment

One of the main concerns in the design of medical units is the elimination of stress because
it has a negative influence and is both the most common emotional state among patients and
is based on most of the generator factors.
The negative effects of stress in patients are felt and expressed at a psychological,
neuroendocrine and behavioural level. In stressful (negative) situations, the body feels
overloaded and fatigue sets in. When stress continues, the body’s reaction may result in
illness, memory loss, nausea, and many other problems [6]. Stress responses mobilize a
person for dealing with a taxing or threatening situation, but they can consume energy and
increase fatigue. Much research also had demonstrated that stress responses, via their
central nervous system, suppress immune system functioning. Stress-related immune
impairment decreases resistance to infection and slows or worsens recovery outcomes.
When patients are stressed, for example, wounds heal more slowly (Kiecolt-Glaser et al.
1995) [7].
Stress levels are increased in hospitalized patients. Many factors of stress are impossible
to be controlled or eliminated, such as painful medical procedures, fear generated by different
pathologies with prognosis or fear of surgery, reduced physical capacity, interruption of
professional activities and social networking during hospitalization. There are some factors
of stress that can be reduced or even eliminated, such as: poorly designed physical
environments, the lack of privacy, the noise, difficult way finding, lack of natural light, lack
of nature views, hinder the presence of family.
Senses impact the individual’s perception of the environment and aid in recovery when a
stressful situation occurs. Design is a powerful tool for reducing the stress that impacts the
senses of both patients and staff [6]. We need here to mention design interventions in medical
units, that reduce: a) stress due to sound, b) stress due to difficult way finding, c) stress due
to sight, d) stress due to lack of privacy, e) stress due to lack of family presence.
a) It is common knowledge that hospitals are loud environments with far exceeding
noise levels - World Health Organization guideline values. Hospitals are excessively
noisy due to many sources of noise: the noise produced by medical equipment,
patient transport by stretcher and cart on surfaces that are sound-reflecting
inappropriate, noises produced by mobile phones, alarms, automatic coffee
machines, juices and food, etc. New building designs should place high priority on
creating much quieter environments. Fortunately highly effecting design strategies
are available for quieting hospitals and other healthcare settings. The key to
achieving a quite healthcare building is found mainly in appropriate design of
physical environment, not in modifying organizational culture or staff behaviour [7].

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Noise can be reduced or eliminated by various measures such as: using finishing
with high quality sound absorption, for the ceilings, walls and floors, use carpets on
corridors and public spaces, design rooms with a single bed, creating spaces where
medical staff can meet for discussion, plan the facility with no or minimal overhead
paging systems, individual nurse call systems, use of water features in public areas
because the noise of flowing water has a soothing effect, introduce music as therapy.
b) Among the most intimidating aspects of large hospitals are the obstacles they present
to way finding. Patients, already under stress, can easily feel buried or lost in a
forbidding technological maze of equipment and hallways, while visitors are fearful
of inadvertently wandering into some restricted, embarrassing, or even frightening
space [8]. There are some strong studies that deal, for example, with designing better
signage, optimal spacing and location of signage, or types of information that are
most effecting in way finding. Other studies at the global level have looked at the
properties of building layout that facilitate or impede movement. It is essential that
these different pieces of information come together while designing new hospitals,
where there is opportunity to develop an effective way finding system at multiple
levels [7].
c) For most people, the first impression influences mood and feelings toward a person
or place. A small waiting room, crowded, degraded in terms of finishes, an old metal
mobile cabinet with tiles on the walls, old medical equipment, obsolete, worn
furniture stored in the corridor between wards, are just some of the images that
facilitate the discomfort and stress for the patient. Providing a hospitality-like
environment where patients feel cared for the moment they enter the facility can be
well worth the upfront costs. Features can include the following: appropriate carpet,
wood and wood tones, harmonious colours and a unified colour scheme through the
facility, comfortable seating arranged in groups for families to talk in private,
abundant art. Think about everything patients see, from the minute they walk into
the facility until the minute they leave. Create an experience for them [6].
d) The lack of privacy in wards with more patients is an important stress factor. The
presence, in the same room, of strangers who in turn have health problems that
require different care creates a tension which adds stress and inconvenience that the
admitted patient lives. In many cases, the hospitalized patient is bedridden being
forced to solve his physiological needs in bed with the help of hospital staff, and in
these moments, the presence of other patients in the same room, is a major stress
factor that must necessarily be avoided. Moreover, the patient admitted to a room
with several beds has no control over the moments of tranquillity and privacy needed
for recovery, because each patient in that room needs different types of medical care
at different times, receives visits from family, talking on the phone or watching TV,
etc. The most important design measure in order to reduce this stress factor is to
provide layouts with single-bed rooms. Private rooms reduce infections and stress
for the patient and family members.
e) The hospitalized patient is often in need of the support and presence of his family.
In most hospitals this meeting is going after a well-established program, at fixed
hours of sightseeing. The patient is not in good condition at the time visitation is
allowed, he has not rested or he is in need of more time spent with his family. By
designing rooms with a single bed and an area to comprise family members, it can
be ensured that his family is unconditionally around him, when he needs it and as
long as he needs it (Fig. 2).

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Fig. 2. Hospital room design.

4 Design to provide the healing environment

Generally, healing environments are considered to be:
 A place to heal the mind, body, and soul.
 A place where respect and dignity are embedded into everything
 A place where life, illness, and healing define the moment and the building
supports those events or situations [6].

Healthcare interiors are famously difficult to design because one must fully understand
the ins and outs of medicine and technology to truly grasp the needs of patients and medical
staff. The patient room, the waiting room, and the physician’s office each have a specific
purpose where the design and use must be complementary and durable. Although
functionality should be at the forefront of the designer’s mind, interiors do not have to look
“funcstitutional” – just because a space needs to be functional does not mean it needs to look
institutional. Comfort and aesthetics need to play a large part in the functionality of a room
and need to be considered equally important. The function of a patient room is to provide a
healing space. If the interiors and aesthetics promote healing, then the architect and the
interior designer has succeeded in providing an aesthetic that complements the function of
the space [9].
Layout, elimination of environmental stressors, positive distraction, use of art, connection
to nature, lightning, colour, finishing materials, furniture are some of the key design elements
that define how comfort and aesthetics can contribute to the overall hospital aesthetics.
When the project starts how a healing environment is going to be achieved must be
defined from the beginning.
There are some important factors to be considered when defining the project goals for a
healing environment:
 The age of patients – age generates different needs, different diseases, different
approaches and protocols for treatment and diagnosis
 The pathology to be treated in the hospital –hospitals which include many
specialties (cardiology, neurology, gastroenterology, orthopaedics, gynaecology,
etc.) or hospitals that provide diagnosis and treatment for a single specialty
 The culture – demographics and culture play a significant role in defining what a
healing environment might be for a given population.
 The theme – a theme or a story can help define the hospital and make it unique and
memorable [6].

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 Aesthetics – it is critical to determine how the project owner wants its facility to be
perceived by the public. Should the facility be sleek and contemporary? Or cozy
and friendly? [6].
 Technology - the design team must find the most aesthetic and flexible option, at
the same time to include medical equipment that is in a continuous and accelerated
process of evolution.
 Evidence-based design – the degree to which the evidence-based design will
impact the project decisions needs to be identified early in the process.
 Hours of operation – will it be a 24/7 hospital or a day time clinic?

5 Conclusion
Just as retail stores or hospitality environments are designed to create a message to the
consumers, healthcare settings can benefit by having a clear direction for the physical
environment. A well-designed environment conveys an experience that can differentiate one
brand from another in consumers’ minds [10].
The healthcare setting should provide a clear message about the organization to all who
enter the building, and preferably from the moment they first see the campus.
Creating a healing environment for the patient is the driver in any new health care facility
plan. Consumers and staff have an expectation that a new healthcare building will not only
cure but also help heal the patient [6].
A healing environment is a holistic entity and not merely a set of separate components. It
is as simple, and as complicated, as that [11].
Future hospitals will have to meet the citizens’ requirements, expectations, but especially
their increasingly higher and more diverse needs. In this context, in order to gain the citizens’
confidence, hospitals need to become a safety landmark for the community, where quality
care and effective care spaces should be designed and developed so that they provide a
positive contribution to the healing process.

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