The Experience of Lying: designing architecture for a wholesome hospital environment.

Hospital buildings tend to be experienced by patients from a, for architects, atypical perspective, namely lying in a hospital bed. This altered perspective has a significant impact on patients’ spatial experience. Gaining insight into this experience is for most architects not trivial, but crucial if they are to design truly patient-centred hospitals.

This PhD research started from a twofold aim. The first aim was to gain insight into patients’ spatial experience. To this end I investigated which aspects relevant to architectural practice have an impact on patients' experience of a hospital environment. The second aim was to inform hospital design on this experience to anticipate the needs of patients and other users. To this end I investigated how insight into patients' spatial experience can be translated in a format that is applicable for architectural practice.

Researching patients’ spatial experience in a hospital setting requires a research approach that is sensory-rich, experience-oriented, able to address motion, and flexible. Combining multiple methods that take into account the different sensory modalities involved in patients’ spatial experience allowed tailoring the approach to each patient’s particular situation. Face-to-face interviews with patients, participant observation, accompanied walks, photo-, image-, and video-elicitation, and documentation of the built environment, are complementary in offering insight into patients’ spatial experience  in different research settings. To select these settings criteria used in hospital logistics to identify patient profiles were slightly adapted to the experience-oriented aim of the research. Patients were grouped according to the length of their stay, their degree of familiarity with the hospital, and whether or not their admission was planned. This resulted in four research settings covering three patient profiles: long-term patients being transported along a familiar route to dialysis; patients arriving at the emergency department; and patients at two day surgery centres with a distinct managerial and spatial concept.

Across the different patient profiles, patients’ spatial experience is found to be impacted by interactions between material, social and time-related aspects. Each group of patients interprets these aspects and their mutual relationship in a (slightly) different way. Also being static or in motion appears to be a factor of influence. This holds for the different components of experience, including sensory perception, personal interpretation or meaning making, and affordance. By designing hospital buildings architects thus influence also patients’ social interaction and time perception. The insights gained add an experiential dimension to the aspects brought forward by Evidence Based Design studies: whereas most hospitals tend to group patients in wards according to their pathology, from an experiential perspective this does not seem to be the most appropriate approach. Hospital design should also consider patients’ experience in motion: when patients are wheeled around, they experience the hospital building as a concatenation of spaces with each space having a share in the overall experience. Finally the results show that the built environment takes part in patients’ experience a hospital’s care vision.

These insights have important implications for the design of patient-centered hospitals. Paying attention to patients’ relationships with relatives and staff and clear communication are clearly essential elements of being patient-centred. However, as a hospital’s care vision turns out to be enacted not only by what staff communicates explicitly or how it is trained, but also by the built environment, the hospital building can play an important role in the implementation of a concept like patient-centeredness. Because of the importance of motion in patients’ spatial experience, attention should be paid not only to the patient room or examination room, but to each space where patients pass through including hallways, changing rooms, and elevators. Spatial and managerial organisation should thus go hand in hand.

To inform architectural practice on patients’ spatial experience, an information format was developed that is able to communicate 1) the different components of experience: perception, meaning making, and affordance; 2) the aspects identified as impacting patients’ spatial experience: material, social, and time-related; and 3) the conclusions drawn from the fieldwork at different research settings. Five layers of information were identified: static images, both drawings and pictures; video-material to communicate the impact of motion; testimonies from participating patients; text explicating one or more aspects; and articles elaborating on one of the research settings.

Architects were found to value the information for its authenticity and would like it to become part of their tacit knowledge so that they could apply it throughout the design process. This would allow them to speak for those who are often not heard in the design process, e.g. when talking to hospital boards or other stakeholders. Moreover, it would be valuable to substantiate design decisions. If a client does not pay attention to patients’ experience, results from scientific research can offer a persuasive argument to put it on the agenda.

The PhD contains specific contributions for architects, healthcare providers, and researchers. Apart from offering architects guidance to conduct fieldwork in care settings themselves, it formulates explicit recommendations on how to design more patient-centred hospitals: taking into account the altered perspective from a patient in a bed, both physical and social; supporting visual contact between patient and staff in all areas where patients come; providing space for an additional person to spend time in a comfortable way; and designing spaces that communicate a focus on the care patients receive rather than on the medical procedure. Healthcare providers are shown how to pay more explicit attention to the impact of the built environment on managerial organisation and patients’ experience, both in daily practice and during design briefing. For researchers, the PhD documents a research approach specifically addressing motion, a topic that is under-researched on a building scale. It also sheds a new light on the impact of space on patients’ experience, static and in motion, which could add to existing research on patient experience, mostly from a nursing perspective. Finally the scope of design research is broadened by adding experiential information valuable for architectural practice. By adequately translating the insight gained into patients’ spatial experience in motion to these three groups, this PhD contributes to realising truly patient-centred hospital buildings.