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'Healing Hospitals': Better Lighting, Gardens, Peace, and Quiet

A room with a view, access to a garden, warm-tone light settings, and quiet areas: A clinic's atmosphere can contribute to a patient's recovery, studies find. Such insights are gaining more and more importance in hospital planning processes.

In 1984, a Swedish architect called Professor Roger Ulrich conducted a study published in Science, showing that a patient's view through the window influenced their recovery after surgery. The study included 46 cholecystectomy patients in a suburban Pennsylvania hospital. Half the patients were placed in rooms with a window view of a park with trees; the other half in rooms with a window view of a brick wall. All patients were cared for by the same doctors and nurses. 

The patients in the room with a view of a natural setting took fewer potent analgesics, were less likely to be depressed and despairing (1.13 vs 3.96, according to staff notes) and had a 1 day shorter postoperative hospital stay (7.96 days vs 8.7 days) than the patients in the room facing the brick wall.

Evidence-based Health Care Design

With Ulrich's study, a new scientific field called evidence-based health care had emerged. Those studies scientifically investigate such correlations of atmosphere and wellbeing, especially in Denmark, Great Britain and the USA. Scientists in Denmark, for instance, have compared risks of contracting an infection in single-bed and multi-bed rooms, and have investigated how sound pollution influenced patients. Scientists have also done research on whether cultural programs in hospitals promoted healing.

From the very beginning, people who design 'healing hospitals' take the patients' wellbeing and their fast recovery – which is also cost efficient – into consideration, said Claudia Küng, General Manager of WISO Consulting in Germany.  

'Healing hospitals' is one of the topics experts will be discussing at the Gesundheitskongress des Westens, a large healthcare congress in Cologne, Germany, in March and hosted by WISO.  

Patients who are treated in 'healing hospitals' are permitted to adjust room temperature and ventilation. Circadian lighting follows the human circadian rhythm and the patients' sleeping patterns. You won't find any beeping machines in a 'healing hospital'. Some clinics in the US even train their staff on how to reduce noise disturbance.

"In Denmark, people adopt a holistic approach when planning a hospital", Küng said in an interview with Medscape. "The Danish have created an international board on how a 'healing hospital' is supposed to look. Studies have shown that single rooms not only benefit patients, but also save costs, compared to multi-bed rooms", said Küng. Accordingly, there won't be any multi-bed rooms in a new super clinic in Aarhus, Denmark, which is currently being built.

What is Being Done in Germany? 

In Germany, there are no studies like the ones that have been conducted in Denmark, Küng said. "This might change, if the Danish prototypes prove to be successful. Focusing on a few superbly equipped hospitals is a huge experiment", she remarked. 

Compared to Denmark and the US, Germany is currently a bit behind in terms of innovative approaches, but something is getting underway, said Küng. Head of the the Department of Health Care Management at the Berlin University of Technology, Reinhard Busse, has been commissioned to compare locations and facilities in clinics worldwide.

Structurally, something is happening in Germany as well, she added. A new annex of the clinic in Aachen is featuring some aspects of a 'healing hospital'. "However, so far no German hospital has been entirely designed according to the guidelines of a 'healing hospital'," Küng said.   

Lighting, Noise, and Green Spaces

Lightning is an important feature in a 'healing hospital'. At the health care congress in Cologne, Günter Hohensee from Philips lighting will explain how circadian lighting and noise management can be part of a multi-faceted preventive approach for patients at risk of a postoperative delirium.

As many as 80% of patients in the intensive care unit develop a postoperative delirium. Darkness in the daytime and light at night increase the risk. Thus, adapting the lights to a patient's circadian rhythm and creating comfortable surroundings could reduce the incidence of postoperative delirium, said Hohensee. Referring to light settings, noise management, access to gardens and a view of natural settings, Küng said: "Such soft factors at first sight should not be overlooked." In the mid-1990s, clinics in the US started to focus on gardens. In an interview with the blog The Dirt, Clare Cooper Marcus, professor emerita of architecture and landscape architecture at the University of California, Berkeley, USA, said: "There are certainly studies now that show if people have certain conditions and then have access to nature, they may call for fewer pain killers. Studies of Alzheimer's facilities where residents have access to a garden have shown that there is less need to prescribe drugs to reduce agitation or deal with insomnia."

Cooper Marcus said that, in the US, there is hardly a retirement home, hospital or hospice left without a garden. "Many hospitals are now providing gardens and that is good. However, in their marketing, some use the term 'healing garden' as a buzzword. Sadly, in some cases I see in the trade magazines, there's a photo of a chaise lounge on a roof with two potted plants, and it's labelled a "healing garden". Some of us in the field are beginning to say perhaps there's a need for a certification of 'healing gardens', although, just how that would work is very complicated."

Access to outer space is also significant for the staff, said Cooper Marcus. The average lunch break for a nurse in an American hospital is just 38 minutes. "So, even if there is a garden, and it's at a distance, they're not going to go there because they don't have time. A trend now at hospitals who are aware of this is to put smaller gardens close to break rooms, so that staff can at least get outside for 10 or 15 minutes. That's very important. Research has shown that is long enough for a significant reduction in levels of stress."

Translated and adapted from Medscape's German Edition.