general hospital design case study

15 Examples of World’s Most Impressive Hospital Architecture

When you think of hospitals, what comes to mind? For many, the first instinct is to think of rectangular buildings , bright white lights, and a sterile and cold environment – a place one visits begrudgingly. Nobody is ever overjoyed at the prospect of visiting a hospital, a place associated with discomfort and illness. However, research has shown that patient-centric design is critical to a positive experience for visitors and employees. Today, architects all over the world are deep-diving into redefining the hospital architecture, and how they can become spaces of healing and rejuvenation , and reduce the negative experiences and stress that come with visiting a hospital. 

Below are 15 such international hospital architecture that are changing how we experience healthcare facilities. 

The Zayed Centre for Research into Rare Disease in Children , United Kingdom (2019) | Hospital Architecture

This research center, designed by Stanton Williams, is the world’s first purpose-built center dedicated to pediatric research into rare diseases, that provides research workspace , laboratories, and outpatient clinics for young people. The building design celebrates the often hidden, yet important, work of clinicians through the transparent façade of glazing and terracotta fins, that allows visual interaction between inside and outside. 

The interiors are designed with concrete and European Oak that make for a ‘non-clinical’ atmosphere, while the interior planning and natural light from the glass ceiling and façade create a sense of openness and calm for the patients and their families. 

New Lady Cilento Children’s Hospital , Australia (2014) 

Designed by Lyons and Conrad Gargett , this 12-level specialist pediatric teaching hospital is designed using a ‘salutogenic’ approach – which incorporates design strategies that directly support patient wellbeing. The planning is based on the concept of a ‘living tree’.  

A network of double-height spaces or ‘branches’ radiates from two atria ‘trunks’, which then extend to frame portals with views towards the city. Green spaces are also part of the healing environment. The brightly colored exterior of green and purple fins is inspired by native Bougainvillea plantings in the nearby parklands. 

Bendigo Hospital , Australia (2017) | Hospital Architecture

Designed by Silver Thomas Hanley and Bates Smart, this hospital is the largest regional hospital development in Victoria. The building design is inspired by the vernacular architecture and the natural environment of the surrounding communities and aims to promote patient and staff wellbeing. 

Nature plays a large part in this mission and is integrated into the project through the medium of landscaped gardens, courtyards, green roofs, and balconies to create a tranquil internal environment. The use of timber provides warmth to the interiors, unlike the sterile, cold spaces of a regular hospital. 

A woven timber ceiling provides dappled sunlight in the interiors , and the building façade of reflective glass and concrete panels provides views to the outside while bringing in large amounts of sunlight. 

The Gandel Wing, Cabrini Malvern Hospital , Australia (2019)

This 7-story addition to the Cabrini Malvern Hospital is built with a design approach of improving the patient wellbeing and experience. The external façade of natural slatted terracotta provides the patients with clear views of nature outside, maintains privacy from the nearby residential buildings, brings in soft natural light, and also visually connects the new wing to the surrounding masonry buildings. 

The combination of the material palette of wood and white on the interiors, and ambient natural and artificial lighting allows for a peaceful environment within the hospital. 

Haraldsplass Hospital , Norway (2018) | Hospital Architecture

The new wing for the Hospital, designed by C. F. M ø ller Architects, lies between the Ulriken mountain and M ø llendalselven River. The façade of oak cladding in white fiber concrete visually connects the hospital to the surrounding buildings and also creates a welcoming entrance for visitors. 

As opposed to the traditional design of hospitals, where long corridors are the main method of getting around, this hospital has no long corridors. Instead, the wards are distributed around two large atriums that also bring in ample daylight.

Adamant Hospital , France (2019)

Designed by Seine Design, this psychiatric hospital is docked by the river and consists of spaces like therapy workshops and staff offices. Regular weather conditions like rain, sun, or wind translate into interesting experiences in the hospital – like the interplay of shadow and light from the shutters or the rocking of the building itself. 

The movable wooden shutters control the daylighting and provide strong visual connectivity to the river and surroundings, which results in a comfortable and peaceful internal environment for the patients. 

Rigshospitalet Hospital North Wing , Denmark (2020) | Hospital Architecture

Designed by 3XN and LINK Arkitektur, the North Wing is a 7-floor extension to the Hospital. The building is designed as a series of folded V- structures connected by a main ‘artery’ route, the design of which is inspired by the cardiogram graph lines. 

Patient well-being is central to the design – the glass façade and ceiling bring in large amounts of daylight, a variety of artwork adds color and vibrancy to the interiors, the green surroundings create a peaceful environment for the patients, and the façade of light stone and glass provide a welcoming appearance to the public.

Umeda Hospital , Japan (2015) 

Kengo Kuma & Associates , who was responsible for the existing maternity and pediatric hospital, returned to design the addition as well. The 4-story front of the hospital was replaced with a 5-story L-shaped addition. The 5-story steel-clad structure is fronted by a 1-story wood-clad main entrance. The 1-story storefront’s exterior – with wood louvers and trapezoid sloping steel roof that extends over the sidewalk creates a welcoming and pedestrian-friendly entrance. 

The interiors use cedarwood in the flooring, walls, and ceiling to create a warm and comfortable environment for the patients. The signages are printed on cloth that covers posts, which add to the softness of the interiors. 

EKH Children Hospital , Thailand (2019) 

Integrated Field has designed this hospital to ease the discomfort that children feel when going to the hospital. The hospital façade consists of pastel-colored metal screens with perforations in the form of animal shapes. 

The architects have used various elements to create a friendly environment for the children – pastel-colored spaces, indirect and soft lighting, curved forms used as the design language in doorways, furniture , and windows, playgrounds in the waiting rooms, a giant slide in the middle of the entrance hall – also visible from the glass external façade, and animal-themed patient rooms – all to make the kids’ visit to the hospital an enjoyable experience.   

General Hospital of Niger , Niger (2016) | Hospital Architecture

Designed by CITIC Architectural Design Institute (CADI), this large-scale public hospital is designed to withstand the extreme weather conditions of Niger, whose 80% land area is covered by the Sahara Desert. The local economy, culture, and environment have also influenced the design to make it low cost, good quality, and durable. 

‘Halls’ or buildings separated by department or functionality, interlock and form courtyards , and are connected by covered passages and walkways. Elements like small windows in external walls, shading panels, and ‘jali’ walls provide sun protection. Thermal insulating layers made of prefab concrete panels in the roof reduce heat transmission. 

‘Tyrol’ style exterior wall – which is the local traditional construction method – is used on the wall surfaces for durability and easy maintenance. Worship halls that double as waiting spaces are scattered across the hospital, as Islam is the dominant religion here.

Pars Hospital , Iran (2016) | Hospital Architecture

New Wave Architecture’s aim was to change the perception of healthcare architecture in Iran, and alleviate negative emotions like stress and anxiety that patients and employees typically experience due to the cold and clinical architectural design of existing hospitals. They designed various blocks connected by atriums and porches that created public-private spaces, allowed ample light in, and created visually interactive spaces throughout the hospital. 

Careful attention was given to the interiors – colorful walls and flooring, comfortable furniture, indoor plants, and brightly lit spaces are all meant to create a soothing environment. The dynamic double-skin façade of travertine and glass creates a lively, hopeful, and inviting appearance for visitors. 

Teletón Infant Oncology Clinic , Mexico (2013)

Designed by Sordo Madaleno Arquitectos, this hospital was developed to support children with cancer. The site itself, with its undulated topography , provides extensive views of the city. The building consists of nine conjoint volumes, made up of a series of columns, organized in a circular manner. 

Each volume is differentiated by color and inclination angle. The form is derived from the concept of cell regeneration, where each volume is a ‘cell’ forming a chain of cells. The façade informs the interiors, where each volume serves a different department and purpose. 

The colorful columns allow for column-free interiors, reduce excess solar gain, and create a dynamic, playful, and colorful façade that is visually pleasing for children. The colorful interiors and choice of furniture resemble a play school rather than a hospital, which puts the children at ease.

The New Hospital Tower Rush University Medical Center , USA (2012) 

Designed by Perkins and Will, the hospital consists of a rectangular 6-story base, connected to an existing treatment facility, which houses diagnostic and treatment facilities topped by a 6-story curvilinear bed tower. The geometry, while unusual, is in response to the site conditions, and maximizes views and natural light for patients, while also creating an efficient and effective layout. 

Nurse stations located along the core of the star-shaped tower encourage quick access of the staff to patients. Facilities like a roof garden with sculptural skylights, and lounge areas for staff and patients creates a comfortable environment for all visitors. 

Buerger Center for Advanced Pediatric Care , USA (2015) 

Pelli Clarke Pelli Architects’ designed Buerger Center is the first healthcare building of the Children’s Hospital of Philadelphi a’s new South Campus. It consists of a 12-story building with a 6-story wing, both consisting of stacked floors with a rippled façade, but the building is rippled on one side to create playful lobbies, and rectilinear on the other where clinics are located. 

The façade comprises glazing and primary colors – which is attractive and uplifting for children and their families. Some great features to help reduce the stress for patients are – an interior material palette of warm wood and bright colors, curved forms, learn and play waiting areas, medicinal gardens, a rooftop garden for rehabilitation and play, and a landscaped plaza. 

Christ Hospital Joint and Spine Center , USA (2015) | Hospital Architecture

Designed by SOM, this 7-story orthopedic care facility is a modern addition to the Christ Hospital’s Cincinnati medical campus. SOM worked closely with patients, medical professionals, and hospital staff while designing the hospital, resulting in a space that supports the healing process of patients. 

Spaces are designed keeping patient comfort in mind – floor to ceiling glazing brings in plentiful daylight, rooms have a residential character with sufficient storage, and flexible seating for visitors and family is provided. Decentralized nursing servers placed next to patient rooms disperse activity across the patient floors. 

Breakout spaces and outdoor green spaces provide respite to visitors, patients, and staff. The exterior façade of red brick and limestone is a nod to the vernacular architecture of the neighborhood. 

Vidhi Agarwal is a practicing architect and designer, striving to be a better person and architect every day. She loves reading fiction, exploring new cities, finding the next best spot for brunch, and drinking coffee. For her, architecture is about resilience and optimism, capable of limitless positive change.

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Improving healthcare through process standardization: a general hospital case study

Affiliations.

• 1 Department of Management and Organisation, University of Ljubljana , Ljubljana, Slovenia.
• 2 Tangram TQC, Medvode, Slovenia.
• PMID: 31017068
• DOI: 10.1108/IJHCQA-06-2018-0142

Purpose: The purpose of this paper is to analyze two process standardization theoretical conceptual constructs: process variants unification; and distinction between standard, routine and non-routine processes.

Design/methodology/approach: The authors analyze two conceptual constructs based on a single case study representing a general hospital's (GH) process standardization, approach and results. The authors research whether process standardization implemented in a GH conforms to the process variants unification concept approach and its assumed benefits and whether implemented process standardization enables process management improvement based on distinguishing standard, routine and non-routine processes.

Findings: In accordance with the process variants unification conceptual construct, the hospital task force determined a uniform basic patient comprehensive treatment process at the hospital level, which allows synergy among departments. Uniform process activities reflect the differences between standard, routine and non-routine processes.

Practical implications: Process standardization through unification improves performance by establishing a common framework enabling shared experience based on improved process understanding. Distinguishing standard, routine and non-routine processes is useful for analyzing process management. This distinction provides guidelines for process implementation and measurement improvement. The paper also shows that increased routinization and standardization represent levers for process improvement.

Originality/value: The authors analyze theoretical constructs based on a single case study and confirm that theoretical conceptual construct application can provide better process management, which is important for practitioners.

Keywords: Healthcare; Process management; Quality management; Standardization.

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International Journal of Health Care Quality Assurance

ISSN : 0952-6862

Article publication date: 11 March 2019

Issue publication date: 11 March 2019

The purpose of this paper is to analyze two process standardization theoretical conceptual constructs: process variants unification; and distinction between standard, routine and non-routine processes.

Design/methodology/approach

The authors analyze two conceptual constructs based on a single case study representing a general hospital’s (GH) process standardization, approach and results. The authors research whether process standardization implemented in a GH conforms to the process variants unification concept approach and its assumed benefits and whether implemented process standardization enables process management improvement based on distinguishing standard, routine and non-routine processes.

In accordance with the process variants unification conceptual construct, the hospital task force determined a uniform basic patient comprehensive treatment process at the hospital level, which allows synergy among departments. Uniform process activities reflect the differences between standard, routine and non-routine processes.

Practical implications

Process standardization through unification improves performance by establishing a common framework enabling shared experience based on improved process understanding. Distinguishing standard, routine and non-routine processes is useful for analyzing process management. This distinction provides guidelines for process implementation and measurement improvement. The paper also shows that increased routinization and standardization represent levers for process improvement.

Originality/value

The authors analyze theoretical constructs based on a single case study and confirm that theoretical conceptual construct application can provide better process management, which is important for practitioners.

• Process management
• Quality management
• Standardization

Rusjan, B. and Kiauta, M. (2019), "Improving healthcare through process standardization: a general hospital case study", International Journal of Health Care Quality Assurance , Vol. 32 No. 2, pp. 459-469. https://doi.org/10.1108/IJHCQA-06-2018-0142

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• Healthcare Architecture

Symbiosis University Hospital and Research Centre / IMK Architects

• Curated by Hana Abdel
• Architects: IMK Architects
• Area Area of this architecture project Area:  449930 ft²
• Year Completion year of this architecture project Year:  2020
• Manufacturers Brands with products used in this architecture project Manufacturers:   Saint-Gobain , ACP , KK Engineering , LEGERO Lights , Nyati Engineers & Consultants , Parryware , Shandar Interior Private Limited , Weathercool Sales , Wipro Lights , cera
• Structural Consultants : The Axis Structural Consultants
• Mechanical Consultants : Radiant Consulting Engineers
• Electrical Consultants : Radiant Consulting Engineers
• Civil Consultants : The Axis Structural Consultants
• HVAC Consultants : Radiant Consulting Engineers
• Lighting Consultants : IMK Architects , Radiant Consulting Engineers
• Principal Architect:  Rahul Kadri
• Client:  Symbiosis Society
• Design Director:  Nithin Hosabettu
• Plumbing Consultants:  Radiant Consulting Engineers
• Facades Consultants:  IMK Architects
• City:  Lavale
• Country:  India
• Did you collaborate on this project?

Text description provided by the architects. Occupying the lower slopes of a hill within Symbiosis International University’s 260-acre estate in Lavale , Symbiosis University Hospital and Research Centre (SUHRC) is a 41,800-square-metre, 216-bed, multi-specialty hospital that represents a new and progressive face for healthcare infrastructure in India. With its state-of-the-art healthcare facilities and a research centre to enhance skill development, it is firmly anchored today as a COVID-19 quarantine and treatment facility, contributing to Maharashtra’s fight against the pandemic.

SUHRC’s design draws from the ideas of biophilia (an innate human tendency to seek connections with nature and other forms of life) to promote recovery and rejuvenation for patients and healthcare professionals. Two large courtyards landscaped with flowering shrubs and trees bring in ample daylight and views of the outdoors into the interiors, while creating buffer zones to reduce cross infection. Critical areas such as ICUs are endowed with soft and soothing hues to reduce anxiety; while the OPD has no air conditioning but allows for fresh, natural air – thereby reducing the AC load and power consumption for these areas.

Functionally, the building comprises four sections; three of them belong to the hospital and the last one being the Skill Centre. The hospital is planned across five levels; departments such as the OPD, casualty, radiology, MHC etc. This helps in keeping the departments separate, and thus maintaining the sterility of each floor function-wise.

Carefully and strategically planned, the building attempts to make gestures that are grand, yet local and responsive with attention to details such as the brick-art and the exposed concrete. The project is an exemplar of passive design and sustainability.

Naturally-compressed, sundried earthen bricks (CSEB) were produced on site and are used to create a double-skinned façade with boxed forms and deep shading projections to reduce heat gain. CSEB through its own porosity and its use in elements such as cavity walls and jaalis enables the structure to cope with climate of the region by allowing the building to breathe. This reduces the internal heat gain allowing for maximum thermal comfort, reducing energy consumption. The bricks were produced on site using a block-making machine, thus providing additional employment opportunities to the locals as well as ensuring minimal carbon emissions. This is the first time CSEB has been used in a project of such a large scale.

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Address: lavale, maharashtra 412115, india.

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印度共生大学医院与研究中心 / IMK Architects

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Why hospital design matters: A narrative review of built environments research relevant to stroke care

Julie bernhardt.

1 Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia

Ruby Lipson-Smith

Aaron davis, marcus white.

2 Centre for Design Innovation, Swinburne University of Technology, Hawthorne, Australia

Heidi Zeeman

3 Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

Natalie Pitt

4 Silver Thomas Hanley (STH) Health Architecture, Australia

Michelle Shannon

Maria crotty.

5 Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia

Leonid Churilov

6 Melbourne Medical School, University of Melbourne, Parkville, Australia

7 School of Education, Health and Social Studies, University of Dalarna, Falun, Sweden

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.

Introduction

Imagine (re-)designing the very hospital you work in. What would you design differently? What would you change, to benefit you, your patients, and their families? What evidence might help guide those design decisions?

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. 1 Once built, hospitals remain in service for decades and are difficult to modify. With stakes this high, considering how building design best supports healthcare services is important. In this narrative review, we outline why the built environment matters, with particular focus on stroke care. We also discuss challenges inherent in designing healthcare environments, undertaking research and evaluating completed architecture.

The planning and design process for new healthcare environments is incredibly complex, but, in general, it occurs in three overlapping stages: (1) the planning stage in which the healthcare provider describes the users’ needs, model of care, and clinical program in a functional brief that summarizes the requirements for the new hospital; (2) the design stage in which these requirements are interpreted by architects to develop an initial concept which is then refined to a more detailed design; and (3) the delivery stage in which the building is constructed. The extent to which hospital staff and patients are included at each stage of this process can vary significantly between projects. 2

Healthcare professionals have long advocated for design features thought to benefit health and well-being, such as natural light, ventilation, and space between patients—for example, the circular hospital design proposed by the physician Antoine Petit 3 and long “Nightingale wards” proposed by Florence Nightingale. 4 Hospital design is now informed by a process termed “evidence-based design” (EBD), in which research evidence is used alongside other considerations such as the healthcare context, budget, and architects’ experience, to inform the design of the healthcare built environment. 5 , 6 In this context, the “healthcare built environment” encompasses: (1) the physical construction (layout, room dimensions, doors and window placement, outdoor and community access, etc.), (2) ambient features (noise, air quality, light, temperature, etc.), and (3) interior design (furniture, signage, equipment, artwork, etc.). 7 Analogous to evidence-based clinical practice, hospitals designed following best research evidence garnered from EBD processes have better safety, patient outcomes, staff retention, and operation costs. 8 , 9 The Center for Health Design, established in 1993 to advance EBD, now maintains a repository of over 5,000 articles on healthcare design ( https://www.healthdesign.org ).

The field is growing; however, many healthcare contexts, including stroke, have a limited built environment evidence base. 10 Establishing geographically organized stroke units has been an important focus 11 ; however, these studies rarely address specifics of the built environment, and we know little about optimal stroke unit design. Stroke clinical guidelines rarely mention the built environment nor provide guidance on how the environment might best support care. There are currently no stroke care-specific building standards, nor standardized checklists to evaluate the quality of these environments. 12

Why is the built environment neglected? Clinicians may identify as knowing less about how the environment might influence patient care or staff well-being. They may also feel uninformed about the design process and how to contribute their clinical expertise to influence decision-making. To begin to address these gaps, our objectives for this review were: (1) to introduce readers to healthcare built environment research and (2) to highlight evidence that underpins acute, subacute, or rehabilitation stroke care facility design. This review is in three parts:

• Overview of healthcare built environment research;
• Stroke care built environment evidence; and
• Planning and design of new healthcare environments: Challenges and opportunities.

We include research from recent, relevant systematic reviews, other evidence summaries, and selected qualitative and mixed-methods research focusing on healthcare environments and design. Healthcare environments are complex and context-specific, with many interdependent variables that can rarely be isolated. This complex system does not readily lend itself to highly controlled experimental research designs in real-life settings. 13 Qualitative methods, such as case studies and pre- and post-occupancy evaluations (before and after a redesign or redevelopment), are common. With research still developing, heterogeneity exists in research designs, outcomes, environments, populations, and theoretical frameworks employed. 14 Hence, robust summary evidence derived from meta-analyses is lacking.

Healthcare built environment research

Research is dominated by studies conducted in acute environments such as emergency, surgery, and intensive care units (ICUs) ( Figure 1 ). 6 , 15 , 16 Older people, including those in dementia care, are frequently studied post-acute populations. 17

The volume of built environment research conducted in different healthcare settings. Circle size indicates the number of published research articles based on systematic literature review in preparation 18 and articles listed in the Centre for Healthcare Design research repository. Pink circles represent all built environment research, and the dark gray circles indicate stroke-specific research. (The aerial sketch in this image has been adapted with permission from Architectus + HDR.)

In this section, we introduce three topics relevant to most healthcare contexts: (1) design of internal spaces; (2) outdoor spaces; and (3) ambient features including light, noise, and air quality (with particular focus on infection control).

Internal spaces

The design of internal spaces, such as ward configuration, corridor design, and nurse station placements (centralized vs. decentralized), can influence patient visibility, safety, teamwork, distances staff walk in a shift, and time spent providing direct care to patients. 10 For example, open-plan, larger convex spaces can lead to greater patient visibility, and corridor width impacts staff circulation, informal communication, and teamwork. 19 In ICU, designs with centralized nurse stations and visibility of most patient rooms from that location are increasingly being replaced with decentralized nurses’ stations, arguably without strong evidence. 19 In emergency departments, with similar critical visibility requirements for teamwork and patient monitoring, some authors argue that physically separated zones or “pods” are neither efficient nor safe. 20 Decentralized nursing stations can lead to more patient room visits by staff. 21 , 22 This highlights current uncertainties.

The layout of hospital spaces and line of sight influences patient and visitor orientation and their ability to find their way around (“wayfinding”). 23 Signs, information boards, and “landmarks” (artwork, furniture, views, etc.) are typical wayfinding elements. 24 , 25 Inadequate wayfinding leads to delays in accessing services or finding people or places, associated stress, and higher staff burden as they provide directions for lost individuals. 25 While some standards exist, wayfinding is often not optimized in healthcare. 26

The proportion of single versus multiple(two or more)-bed rooms is a prominent ward design consideration. There is evidence that single rooms can support staff/patient communication, privacy, infection control, and noise reduction, but they are also associated with patient isolation and increased falls risk. 27 This evidence is, however, of mixed quality, limited to certain populations, with neutral and/or contrary results. 27 A higher proportion of single rooms generally results in longer corridors, longer staff walking distances, perceived decrease in patient visibility due to compromised sightlines, and higher construction and cleaning costs. 28 The inherent trade-offs will be different in every healthcare context. Less controversial is location of sinks and hand sanitizers; highly visible and standardized positioning promotes more consistent use. 29 , 30

Outdoor spaces

Hospital gardens were historically commonplace 31 ; however, less priority has been given to green space over time. Access to the outdoors and time in nature has been linked to stress reduction, improved physical symptoms, and emotional well-being in many healthcare settings. 32 Views of nature have been linked to reduced length of stay. 33 Good hospital garden design principles include creating opportunities for exercise, exploration, socialization, and to engage with and escape in nature. 32 Surprisingly, patients and visitors are often not aware of hospital gardens, and proactive approaches to increasing patient and family use of gardens have been recommended. 34 Usually conceptualized as spaces for patients and visitors, staff are often their primary users. 32 Outdoor spaces can be restorative for hospital staff, helping to reduce stress and improve attention, which may improve patient care and staff retention. 35

Ambient features

Ambient features, such as light and noise, can impact patient well-being and comfort, sleep, and communication with staff. 36 , 37 Light and noise also impact staff well-being and attention 38 and contribute to medication errors and other safety concerns. 39

Air quality is important for both comfort and infection control. Infection control is particularly prioritized in acute environments and is receiving deserved attention in the COVID-19 pandemic. A recent review of COVID-19 transmission showed that spatial configuration can affect patient density and thereby transmission. 40 Optimized systems for heating, ventilation, and air conditioning (HVAC) can filter microparticles such as viruses. Different HVAC systems also affect humidity, airflow velocities, air pressure—all important for exposure to active aerosols. Window ventilation, daylight, and electric UV light are recommended to aid disinfecting surfaces and use of surface materials that affect pathogen survival. 40

Stroke care built environment evidence

In this section, we outline how the built environment can influence important outcomes such as: (1) evidence-based stroke care, including rehabilitation; (2) efficiency of stroke care, staff processes, and communication; and (3) patient safety and well-being. The evidence-base specific to stroke care is small. 41 In Figure 2 , we summarize the design features and how they may influence a range of outcomes including patient and staff behavior. This should be considered illustrative rather than exhaustive. Where possible, we draw directly from stroke or brain injury-specific evidence, supplementing evidence from other populations where relevant.

A summary of the evidence specific to stroke care environments. Dotted lines = a hypothesis, garnered from research in other populations; thin lines = limited evidence, < 3 studies; thick lines = moderate evidence, ≥ 3 studies, based on systematic literature review. 41

Evidence-based practice including rehabilitation

We found no stroke-specific research to underpin built environment recommendations for optimal delivery of either time-critical acute stroke treatments or evidence-based care, including rehabilitation. Guidelines recommend early commencement of both structured and incidental physical, cognitive, and social activity for all stroke patients, 42 , 43 although recommended levels vary. Patients in both acute and subacute environments spend most of their day alone and inactive in their bedroom. 44 , 45 While we can hypothesize that providing “draw-them-out” features on a ward may improve activity and engagement, evidence is limited. These features may include green spaces and indoor communal (social) spaces. Unfortunately, communal spaces, when present, often appear to be underutilized in both acute 46 and rehabilitation environments. 47 Many factors may influence whether patients use communal spaces, including not knowing they exist or where to find them, difficulty accessing them without help, or feeling they don’t have permission to use them. 48 In a Norwegian study across 11 stroke units with communal areas, patients were more active and spent less time in their bedroom in units where meals were served in the communal area. 49 Providing resources (games, music, books) in personalized activity packs and in communal spaces (“environmental enrichment”), with the aim to improve physical, social, and cognitive activity, has recently been tested in acute and subacute settings with mixed results. 50 – 52 Importantly, this approach relies on staff to encourage use and engagement, rather than embedding activity opportunities into the building itself. Hallways and circulation spaces are generally underrecognized as providing spaces for incidental activity and interaction. 53

There is limited stroke-specific research about the value or harm of single- versus multiple-bed rooms. A higher proportion of single rooms may be associated with lower levels of patient activity in acute stroke. 54 , 55 A systematic review of single- versus multiple-bed rooms in older people and those with neurological disorders found potential benefits (e.g. infection control, patient satisfaction) and harms (e.g. falls, isolation) with single rooms. 56 In rehabilitation facilities with a high proportion of single rooms, patients emphasize the importance of communal areas. 57 Further work is needed to identify and test how modifications to layout and communal and circulations spaces could enhance patient engagement, activity, and optimal care provision.

Efficiency of care, staff processes, and communication

Interprofessional communication and teamwork between physicians, nurses, and allied health professionals supports best practice stroke care. 11 Shared staff spaces support team communication and collaboration, enabling better understanding of patient needs, and greater knowledge about other team roles. 58 , 59

Therapy spaces are often discrete locations (e.g. gym, occupational therapy rooms), rather than being holistic, context-based environments that reflect the connectivity and continuity necessary for rehabilitation and transition beyond discharge. 60 , 61 Separation of clinical and therapy spaces can impact staff travel time, patient practice and activity, and even clinical decision-making. For example, Blennerhassett et al. 47 found that patients spent less time engaged in physical activity and more time in corridors when the ward was located further from the gym, on a separate floor. This also impacted wheelchair use and patient travel time. 47 Inaccessible therapy spaces can also change therapists’ intervention choices. 62

Safety and well-being

Falls are common after stroke, 63 yet the relationship between the built environment and falls is largely unexplored. The presence of a fellow patient (multiple-bed room) may help reduce falls, especially for older patients with neurological injury. 56 , 64 Roommates play an important role in monitoring the physical and mental health of others in stroke rehabilitation. 48 Stroke patients often experience loneliness when in hospital, 65 , 66 and some patients will choose a shared room over the privacy of a single room. 57 Sleep is important for recovery. Unsurprisingly, visual and aural privacy is less in multiple-bed rooms. However, noise traveling between corridors and bedrooms and lack of dedicated staff spaces for confidential conversations are also important. 48

Planning and design of new healthcare environments: Challenges and opportunities

Healthcare environments research and design is a multistakeholder endeavor involving government, healthcare providers, managers, clinical staff, patients, architects, quantity surveyors, construction companies, building managers, etc. This collaborative process can be challenging, 67 , 68 considering interdisciplinary differences in knowledge and approaches. 69 The complexity of hospital procurement and the fact that design and construction processes are foreign to many healthcare professionals adds further challenge. Clinicians often do not understand what the “user group” consultation process is supposed to achieve, and their involvement may be inconsistent throughout the design process, which limits their contribution to the process and ability to influence decisions. 67 While collaboration between architects and healthcare professionals is not new, 70 limited evidence informs current consultation processes. 67 , 71 High-quality healthcare environments are produced when shared decision-making and collaboration happens across healthcare, construction, and architecture to create designs based on evidence and end-users’ perspectives. 69

A number of research approaches are suggested to facilitate this collaboration, including participatory design, co-design, and Living Labs. 2 , 72 , 73 Over many years, our team has built partnerships between healthcare environment practitioners, clinicians, researchers, and people living with stroke, which have served to create a common understanding of the barriers and opportunities for redesigning and optimizing stroke care environments. With the creation of the Neuroscience Optimized Virtual Living Lab (NOVELL) for stroke rehabilitation redesign ( www.novellredesign.com ), we are working to develop new models for stakeholder engagement and research, and to contribute new evidence to stroke rehabilitation design.

In addition to collaboration challenges, research is infrequently embedded in the planning and design of new healthcare environments, and leaders in EBD have long called for appropriately funded, transparent, and freely available evaluations of completed buildings. 74 – 76 Given the cost of constructing and running healthcare buildings, the absence, or non-disclosure, of evaluations to determine whether desired outcomes were met is concerning. 77 , 78 Hospital design and construction is underpinned by technical and generic building guidelines and standards that differ within and between countries. The degree to which these standards are “evidence-informed” varies. In stakeholder consultations, understanding what is evidence-based and what is open to change can be difficult. Design innovation is essential if hospital buildings are to respond to new healthcare models or processes. For example, the recent COVID-19 induced surge in utilization of telehealth and other e-health technologies for rehabilitation, other treatment, and communication with people with stroke has implications for healthcare design, increasing demand for spaces for videoconferencing, equipment storage, and potential changes to waiting rooms and on-site consultation spaces. 79 , 80 Future design considerations for stroke recovery should also extend to the home environment. 81

The built environment matters. It can impact healthcare delivery and patient and staff outcomes. An evidence base is growing in some areas of healthcare design, while others require significant further research. The potential for both hospital and health services design innovation is strong. By continuing to build this evidence base, EBD can complement architectural processes to deliver high-performing healthcare assets. Involving engaged and informed clinicians in built environment design and research will help shape hospitals of the future.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: NOVELL is funded by the Felton Bequest and the University of Melbourne. Julie Bernhardt is funded by an NHMRC Research Fellowship (1154904). The Florey Institute of Neuroscience and Mental Health acknowledges support from the Victorian government and in particular funding from the Operational Infrastructure Support Grant.