Healing Through Architecture by Shivani Tandon

HEALING THROUGH ARCHITECTURE

2018-2019 A Report submitted to Rajiv Gandhi Proudyogiki Vishwavidyalaya, Bhopal Towards the Partial fulfillment of The Degree of Bachelor of Architecture

Under the Supervision of :Er. Ketan Jain

Submitted by:Shivani Tandon 0842AR151069

DECLARATION I hereby declare that the work which is presented in this Dissertation report entitled “HEALING THROUGH ARCHITECTURE” in partial fulfillment of requirements for the award of the BACHELORS DEGREE in ARCHITECTURE, submitted in the ARCHITECTURE DEPARTMENT, SDPS WOMEN'S COLLEGE, Indore, is an authentic record of the initial work carried out under the supervision of, Er. Ketan Jain, ARCHITECTURE DEPARTMENT, SDPS WOMEN'S COLLEGE, Indore. The matter embodied in this report has not been submitted in part or full to any other university or institute for the award of any degree.

DATE:

(SHIVANI TANDON)

This is to certify that the above declaration made by the concerned student is correct to the best of my knowledge and belief.

Er. Ketan Jain ARCHITECTURE DEPARTMENT, SDPS WOMEN'S COLLEGE, Indore.

ACKNOWLEDGEMENT A dissertation cannot be completed without the help of many people who contribute directly or indirectly through there constructive criticism in the evolution and preparation of this work. It would not be fair on my part, if I don't say a word of thanks to all those whose sincere advice made this period a real educative, enlightening, pleasurable and memorable one. First and foremost, I would like to express my deepest appreciation to my dissertation supervisor Er. Ketan Jain, Department of Architecture, SDPS College, Indore for his gracious efforts and keen pursuits, this has remained as a valuable asset for the successful instrument of my dissertation Report. His dynamism and diligent enthusiasm have been highly instrumental in keeping my spirit high. His flawless and forthright suggestions blended with an innate intelligent application have crowned my task a success. My thanks are due to Ar. Soma Anil Mishra, Head of the Department of Architecture of this institute for providing excellent facilities and aid in preparation of the dissertation. Finally, I would like to express my gratitude to my family, for their unconditional support and prayers at all time and constant encouragement during the entire course of my dissertation work. I would also like to offer my sincere thanks to all faculty, teaching and non-teaching staff of Department of Architecture for their assistance. Thank you.

Shivani Tandon Bachelor of Architecture-VII SEM Roll No. 0842AR151069

SMT. DHAIRYA PRABHA DEVI SOJATIA WOMENS COLLEGE Indore (M.P.)

2018-2019

Recommendation

I am pleased to recommend that the Dissertation work entitled “HEALING THROUGH ARCHITECTURE” is bonafide work carried out by Shivani Tandon in Partial fulfillment for Bachelor of Architecture of Rajiv Gandhi Proudyogiki Vishwavidyalaya, Bhopal during the year 2018-2019. The project report has been approved as it satisfies the academic requirement in respect of project work prescribed for the dissertation report of Bachelor of Architecture Degree.

Dissertation Sub-Head: Ar. Khusboo Lahori Asst. Prof. of Department of Architecture

Dissertation Guide:

Er. Ketan Jain Asst. Prof. of Department of Architecture

Dissertation Head:

Er. Utkarsh Jain Asst. Prof. of Department of Architecture

Head of the Department/Principal: Ar. Soma Anil Mishra Department of Architecture

SMT. DHAIRYA PRABHA DEVI SOJATIA WOMENS COLLEGE Indore (M.P.)

Certificate This is to certify that Shivani Tandon (0842AR151069) fourth year student of this institute has completed the Dissertation work entitled “HEALING THROUGH ARCHITECTURE” based on syllabus. The project report has been approved as it satisfies the academic requirement in respect of project work prescribed for the dissertation report of Bachelor of Architecture Degree by Rajiv Gandhi Proudyogiki Vishwavidhyalaya, Bhopal during the year 2018-2019.

Internal Examiner

External Examiner

Date:

ABSTRACT

“We shape our buildings and later they shape us.” Winston Churchill. This dissertation is to explore how architecture can heal or provide spaces and events where healing can take place. In today’s healthcare architecture there is a striving to make better use of evidence to achieve environments that can contribute to patients’ healing, recovery, and well-being. This study will be helpful to strengthen the environment of the healthcare centers in India as it explores the influence of the physical environment, planning and design aspects of the healthcare centers. The main aim of this study is to create a healing environment in the healthcare centers which will reduce the stress on the patients, their relatives and staff, enhance the ability to cope and maximize the effectiveness of the medical treatment on the patient's body. In order to take advantage of the body’s healing pharmacies, environments must prevent the body from weakening due to stress. Stress is the body’s biggest obstacle in healing, and many hospitals inflict so much stress on patients that it actually slows down healing, counteracting the medications and treatments patients receive. The study is executed in a multispecialty hospital of Indore city. The idea was to perceive the physical, emotional and psychological needs of patients in the healthcare centers in relation to planning and design aspects of the healthcare center. The observation and questionnaire responses given by the occupants were recorded. This dissertation explores the relationship between environments and the chemical reactions in the body that enable healing. The proposed design interventions focus on how planning and architecture can have a positive impact on patients.

CONTENTS

Introduction…………………………………………………..…………1-6 1.1 General…………………………………………………………...…2-4 1.2 Healing Architecture or Healing Environments………………….…...4 1.3 The goal of healing architecture………………………………...….…5 1.4 Benefits of healing architecture………………………………………………………………..5 1.5 Holistic planning and design of healing environments…….…….…...6 1.6 Evidence based design…………………………………………..….…6

Case study review……………………………………..………………7-13

Literature Review……………………………………………………14-20

Aim and Objectives of the Study……………………………...……..21-22

Methodology and Problem Formulation……………………………..23-24 5.1 5.2

Problem Definition……………………………………………..…24 Methodology…………………………………………...…….…...24

Analysis………………………………………………………...……25-28

Results……………………………………………………………..…29-40 7.1 Design Considerations………………………………………...30-38 7.2 Product design…………………………………………......….38-40

Conclusion………………………………………………………...…41-42

References………………………………………………….………...43-44

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CHAPTER 1 INTRODUCTION

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1.1

General:

The human body has ability to “self-heal” when put in healthy and positive environment. Environment holds ability to stimulate the senses. This helps minimize negative effects of stress on the body, guiding a positive psychological response. Healing is the process of re-establishing harmony within the organism. reintegration with the body’s natural ability to heal and regenerate. healing is not a process of curing .Health, is understood as the presence of this balance; illness is its lack. Self-healing is enabled by the ability of the body by activating the body’s powerful neurochemicals such as endorphins. Neuroscientists have found “good architecture can positively affect human brain”. "If place can make you happy, can it also make you well?" - Esther Sternberg

Fig. 1.1 Optimal Healing Environment Optimal Healing Environment (OHE) framework is described as “the social, psychological, physical, spiritual, and behavioral components of healthcare support and stimulate the body's innate capacity to heal itself”.

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What will we define good architecture as? It is not about something which looks good, it is about something which makes us feel good. It is not the beauty or aesthetics of a building which makes us stay longer, but it is the feel we get there. “We build the buildings that end up shaping us”- Winston Churchill Hospitals often instill so much fear and anxiety in patients which promotes a stress response and the body becomes weak and unable to handle medications and treatments received in hospitals. Everyone seeks healing for their mental and emotional wounds. Healing has an ability to make us feel better. Any space, view, color, person or anything can make us feel better. In order to create a healing environment, it is necessary to study and understand about the human psychology, feelings, attitude and behavior and also the physical aspects(i.e. day lighting, window design, thermal conditions), which can positively influence the human psychology. The well designed architectural spaces and surroundings is physically healthy and have positive impact on the human psychology. Architecture takes a holographic approach at the effectiveness of art to promote healing. therapy of connecting with the inner-self to bring about change in a person’s lived experience. Healing involves a process where recipient receives a physically external antidote to help them heal. “Architecture has its own realm. It has a special physical relationship with life. I do not think of it primarily as either a message or a symbol, but as an envelope and background for life, which goes on, in and around it, a sensitive container for the rhythm of footsteps on the ﬂoor, for the concentration of work, for the silence of sleep.”-Zumthor, Peter

Fig. 1.2 A design theory for reducing aggression by Ulrich (2012)

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Ar. Roger Ulrich performed the experiment in us hospital in 1984 that proved that window views could affect healing. Ulrich chose 46 patients, half patients had beds near windows that overlooked a landscape of trees and the other half onto a brick wall. After studying their vital signs and their pain medication doses it showed that the patients that were positioned by the window needed fewer doses of pain medication and were healing at a rapid rate than the others.

Fig. 1.3 Effect of view on health outcomes 1.2 Healing Architecture or Healing Environments? Healing environment for healthcare centre describes a physical environment that supports patients and families through the stresses that develop as a result of illness. The physical healthcare environment i.e. physically healthy and psychologically appropriate can make a difference in patients recovery. The physical aspects (i.e. day lighting, window design, thermal conditions) should be designed without compromising the functionality of hospital building.

Fig. 1.4 Interactive space outside a health care center

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1.3 The goal of healing architecture The goal is to engage patients in the process of healing and recovery. As a result, spaces should be designed to reduce patient and family stress. Healing through architecture aims to: 

Eliminate environmental stresses, such as noise, lack of privacy, poor air quality and

glare. 

Connect patients to nature .  Enhance the patient’s feeling by offering options and choices e.g.- privacy versus socialization, type of music etc.  Encourage opportunities for social support.  Inspire feelings of peace, hope, reflection and spiritual connection.

Fig. 1.4 Connection with nature

1.4Benefits of healing architecture  A measurable impact on patient recovery, including shorter hospital stays, fewer infections contracted in the hospital and reduced pain.  Research by Department of Neuropsychiatric Science found that patients with bipolar disorder assigned to brighter, east-facing rooms with morning sunlight had hospital stays nearly four days shorter than those with west-facing rooms.  Research by the Environmental Design Research Association, found that posters of realistic nature scenes were hung in the multipurpose lounge of patients who exhibit “aggressive and agitated” behaviour was 70 percent lower than when the walls were blank.

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1.5 Holistic planning and design of healing environments Healing architecture have major focus on improving the patient experience and outcome. In order to bring healing architecture in healthcare facilities, it is important to adopt a holistic planning approach that includes input and feedback from the end users in addition to the design, construction and operations teams.

1.6 Evidence based design Evidence based design is a decision based on research papers, scientific evidences and evidence gathered from experienced client operations. An evidence-based design should results in improvements to productivity , customer satisfaction and economic estimation. Evidence-based design is linking the physical environment with better patient outcomes by using the best research evidence to guide design decisions. Traditionally, the design of healing environments has been based on practical experience and philosophical considerations, rather than on scientific evidence. Scientific evidence is used to improve the effectiveness of design interventions and to gain the support of healthcare providers, who are trained to rely solely on sound scientific data. The Centre for Health Design (CHD) defines EBD as â&#x20AC;&#x153;the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision- making.â&#x20AC;? It can be used for all design decisions.

Fig. 1.5 Evidence based design

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CHAPTER 2 CASE STUDY

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The use of healing environment in the healthcare center are studied with the help of case studies. Case study on the physical aspects and healing environment of the healing architecture are described below:1. Muktangan Mitra, Pune-Primary Healthcare cum drug de-addiction and rehabilitation centre- Location-mohanwadi, off pune alandi road. Designed by Ar. Sirish Beri. A building contributing to the healing process of the drug addict. It has maintained a balance between the sense of freedom by transparency and disciplinary control. Visual connection with nature is established from the cut-outs, the terraced balconies and the seating, encourage the patients to open up. There are spaces for physical and visual interaction.

Fig. 2.1 Sketch of Muktangan Mitra by Ar. Sirish Beri Site sloping towards south as it is designed according to the natural landform of the site. The faĂ§ade of the building comprises of welcoming entrance in stone random rubble masonry. Building is surrounded by large tress and outdoor seating for visitors. Raised planters and flower bed are planted in the window sill to provide connection with nature. There is a small-enclosed landscaped amphitheatre of capacity 150, breathes light and ventilation in the building, it binds the various functions together, creating a â&#x20AC;&#x2DC;sense of belonging'. It is also used as interaction space and focus point. Corridor have ample amount of light and ventilation and visual connectivity with open amphitheatre. Balcony of general ward open into open amphitheatre, providing visual interaction. Opening in the lobby provide light and ventilation in waiting area. Clearstory windows in the meditation hall provide light in interior from top.

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Fig. 2.2- Landscaped amphitheatre Fig. 2.4-waiting area, lobby and terrace Fig. 2.3- Waiting area of Muktangan Mitra 2. Paimio Sanatorium, Finland-Tuberculosis Hospital-Designed by Ar. Alvar Aalto. Mountainous pine slopes boosted beautiful views on the site. The design of building focused on light, fresh air, sun and connection with nature. Each wing with similar requirements placed according to natural sunlight and views, each having a different character and orientation, linked by common services. The building offered good internal connections. The orientation of the wing allows an abundance of morning sunlight

Fig. 2.5- Landscaped area and walkway Fig. 2.6- South facing balconies The wards with ribbon windows and cantilevered balconies are south facing to allow optimum light and allow patients to come out to enjoy the healthy rays of the sun. Roof top solarium has spectacular views of the surrounding landscapes and tree tops. A serpentine path for walk, linking a series of water fountains which spatially and visually linked the patient balcony and exterior space. The ceilings of the room are painted darker than the walls to have restful gaze. The room light is reflected off the walls and ceiling to avoid harsh light and for a sense of visual relief. HEALING THROUGH ARCHITECTURE

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North Bristol South mead Hospital-designed by BDP Architects. The healthcare centre is provided with single rooms for privacy and dignity rather than multiple shared wards. In every room has view of outside and access to nature and day light. the design focused on minimising rise of falls and infection. It used public art strategy, exterior glazing cladding and ceramic wall pieces for the interiors. the super graphics was used for windows and walls, to define the identity of each building and support way-finding within them. 3.

Fig. 2.7- Aerial view of hospital at construction time

Fig. 2.8- layout of private wards

4. Evelina Childrenâ&#x20AC;&#x2122;s Hospital, London- designed by Hopkins Architects. The existing Children hospital was with long corridors & difficult way finding. Children were afraid to walk alone in the hospital. By integration of art and architecture using ecological theme transformed the hospital. Different areas are zoned according different ecological creature which children found interesting to walk in.

Fig. 2.9- Floor plan of the hospital

Fig. 2.10-Transformation of corridor using ecological theme

5. Tallaght Hospital, Dublin- Long continuous corridors of the hospital were needed to break down. They were converted into permanent exhibition and waiting area with plant and water features. They also gave attention to the design of the seating and furniture in the waiting area according to patient's need.

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Fig. 2.11-Site plan of the hospital

Fig. 2.12-Transformation of the waiting area

6. Karunashraya, Home for terminally ill patients-located in Marathahalli, Bangalore. Designed by Ar. Sanjay Mohe. It is care center for advanced stage cancer patients who are beyond cure. They help patients live without pain and in dignity and peace till their journeyâ&#x20AC;&#x2122;s end. They have been offering in-patient care since 1999.

Fig.2.13-view of entrance area and prayer hall Fig. 2.14-view of the fountain and the kunda Karunashraya is 75 bed home for terminally ill patients of any age suffering from advanced stage of cancer where curing is not possible. Medical treatments for curing the disease is not provided but the nurses take care of the patients by providing them with basic medical support.

Fig. 2.15-Rooms on one side of corridor

Fig. 2.16- landscaped seating on another side

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The building is constructed in 8200 sq. m plot and the total build up area is 3400 sq m. It is designed so that all rooms of the patients receive natural lighting and ventilation. The entrance drive way to the parking is shaded by several trees. The entry towards the building is designed elegantly with the stone structure with composite masonry, creepers and flowers. The patients can relax with a view of greenery on one side and water on other of their ward. Individual spaces leads out to a Veranda overlooking the water. The Balance is maintained between the sizes and forms of courtyards with relation to the green spaces and water.

Fig. 2.17-view of landscape area

Fig. 2.18-Wards of the patient

There is prayer room for all religion. There is relaxation area which involves pool on one side. There is a meditation room. Spaces for recreational activities include indoor games, watching T.V, newspaper are provided. A 100 seat auditorium is provided which is fully equipped with modern communication facilities for conferences and training. There are several open courtyards with plants, trees and benches accessible by patients and their relatives. The simple ambience is kept with use of stone masonry and green environment, without use of loud colour.. The centre offers flexibility to patients to select to sit in the place wherever they want.

Fig. 2.19-Site plan of the Karunashraya hospice, Bangalore

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CHAPTER 3 LITERATURE REVIEW

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The healing environment and evidence based design is used in many countries. Researches on the physical aspects and healing architecture are described below:Bryan Lawson (2010). Healing Architecture. The School of Architecture, University of Sheffield, Sheffield, UK This paper presents the evidence based design approach by applying empirical research and complex scientific knowledge to creative design process. It focuses on improving the quality of patient experience, health outcomes ,saving of time and cost. It emphasizes on the patient experience by creating places of healing rather than machines for treating. According to Roger Ulrich, it may increase 5%additional cost but will give 20% operational savings by providing-large private space, large windows for better views, air handling plant, noise control facilities. Role of environment for psychological needs- stimulation, security and privacy.

Fig. 3.1-Large private space with large windows with view of sky Ar. C F Moller- Healing architecture for the common goodThis article presents knowledge of healing architecture and evidence based design in hospitals and rehabilitation centre. According to him, people navigate and form “mental map” of the premises, so it should be simple and uncomplicated. He created small world within larger one-personal space as well as space for close interaction. This paper primarily focus on Creating private, social, and public spaces, so that patient can decide degree of interaction with outside world  Creating security and an affinity  Creating homely atmosphere with outdoor activities  Environment that inspires atmosphere confidence, giving calm and attentive care  Pleasant and high quality spaces, warm and familiar materials.  Able to see and use green settings with trees and vegetation has appositive impact on people’s physical and mental well being.

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Fig. 3.2- Factors affecting healing environment Jennifer Beggs (2015). Healing through Architecture. University of Waterloo, Ontario, Canada

Fig. 3.3-Opening to admit daylight

Fig. 3.4- Plants in the interior

This article presents the holistic approach to treat patient’s illness, psychological health, emotional hardship, psychological response for cancer patients in Grand River Hospital, Ontario. It mainly focuses ,body’s ability to “self-heal” when put into positive healing environments by activating the body’s powerful neurochemicals such as endorphins and by stimulating the senses. Healing refers to the alleviation of a person’s distress, environment can minimize negative effects of stress on the body, that maximize the effectiveness of crucial medical treatments and procedures. Stress slows down healing, counteracting the medications and treatments patients receive. Environments must prevent the body from weakening due to stress.

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Jenny E. Young (1996). The Role of Architecture in Promoting Healing Environments in the Design of Small, Rural Hospitals. University of Oregon.84th ACSA Annual Meeting Open Sessions This paper presents healing role of architectural qualities in health care facilities. Role of architecture is to create environments that supports healing and enhance the quality of the life. The focus is on rediscovering alternative therapies, which may heal and comfort, if not cure. The paper mainly focuses on The façade-As it provides the interface between the community and the health care facility. The façade could be canopied entrances and atria, natural features of plants and water, art and music, and open to the public.

Fig. 3.5- Coridor at Blue Mountain Hospital 



Fig. 3.6- Outdoor space at Berkeley's Hospital, UK Corridor- Quality way finding in healthcare space reduced stress levels for patients and visitors. It was examined-"reduction of walking distance for staff results in better patient care”. Corridor is the spatial entity that unites the building. The corridor links rooms for patients and staff should have interaction spaces, a quiet space with views. The Outdoor Room - A retreat which fosters casual interaction among patients, staff and the public, and a place for formal community gatherings. Outdoor rooms, courtyards and atria can be a natural focus for a building and make active connections to the healing properties of the natural world.

Gary J. Coates. Seven Principles of Life-Enhancing Design, The Architecture of Erik Asmussen. Department of Architecture, Kansas State University This paper presents the thoughts of Ar. Erik Asmussen to create healing environment that stimulate all the senses and rebalance the body, soul and spirit. It focuses on healing through art of architecture, by the same healing qualities we experience in nature. By revealing unity between architecture, place and environment. An environment that have healing effect even when cure for illness cannot found.  Colour - a powerful means to support building activities and the moods. Layer of white allows light that penetrate outer layers of colours to reflect outward, illuminating tones

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from inside, it enlivens and reveals material used. Soft transparent colours dissolves the boundaries of room. Light filled colours changes patterns according to sun.  Dynamic equilibrium of spatial experience-the balance of contrast- constancy and change, up and down, in and out, symmetry and asymmetry, sheltered intimacy and expansive openness to create dynamically polarized spaces for sense of freedom.  Unity of form and function- Building should express the inner spirit and activities inside. One should sense the function by its perceptible form. E.g.-a truly organic building must have qualities of nature rather than outward appearance. It should be experience as alive as nature is felt.  Polarity- architecture embodies endless plays of differences out- contrasts of colour, form and material as link of opposites to create rhythmically alternating repetition. Pervasive presence of polarized spaces, colours, forms and material energies the building. Polarity shows direction and form

Fig. 3.7- Gallery arcade as the boundary Fig. 3.8- metamorphosis relationship of the courtyard. between entrances of vidar clinic  Metamorphosis- forming and transforming through gradual, stepwise progression of changing forms, that are different in shape but similar in kind. Use of metamorphosis of forms, surfaces, colours and spaces to give unity to buildings and building elements.

Fig.3.9-Harmony with the existing forest Fig. 3.10- Auditorium in culture house  Harmony with nature and site- building should be placed and shaped so that it creates appositive and useable outdoor space. By responding to existing site features, building should

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be differentiated from surrounding as well as connected to them. Architecture could help people to connect with healing power of nature and give feel of sense of belonging and hominess in natural world.  The living wall- walls and windows should express combination of security and freedom.eg -culture house, Jarna provides sense of connectedness to world and isolation from distraction of outside world-by carved wooden walls and colour glass windows Cayser Hussain(2015) Healing Spaces in Architecture – A Study that explores the ability of space to enhance healing This paper focuses on interconnection of human being with built environment and surroundings by physical, mental, emotional and spiritual means. It presents architecture is a artistic expression and it takes a holographic approach at the effectiveness of art to promote healing. Therapy of connecting with the inner-self to bring about change in a person’s lived experience. Four connections that has to be addressed while designing.  The connection to Self: space of own retrospection. The space must be comfortable and a reflection of oneself.  The connection with the City: site in part of the city to arrive conveniently with public transport) but detached from the fast pace of the city.

Fig.3.11-Meditation-Connection with self Fig.3.12- Connection with nature and sunlight  The connection with Nature: A physical and visual link. access to the gardens and light courts gives sovereignty. Outdoor spaces with lusting green and the sound of water to heal the agitation.  The connection with Light: Natural sunlight kills harmful bacteria and it is symbol of growth and life. controlled natural light provide sensual space an emotive quality. Indoor towards the sunlight and ventilation for conformability. Rob Ryser (2015). Healing in Architecture  This paper presents Ar. Barry Svigals’s design approach for the Sandy Hook elementary school (rebirth after school shooting in 2012)Newtown. Building is designed to stimulate healing by connecting to nature, to stimulate good moods, to establish a secure

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environment without creating a prison and to take advantage of natural landscape of site designed. They had to affirm life and create a positive peace for children to grow.  According to svigals- “nature was heart of our inspiration because of its healing effect on people". The front façade is designed to feel like open arms. Classroom wings extend like fingers in wooded landscape of campus, replicating an open hand and central courtyard are second floor-breakout spaces designed to feel like tree house.

Fig.3.13- Site plan of the school

Fig.3.14- View of the school from woods

A Visual Reference for Evidence-Based Design  This paper focuses on the built environment as there is a continuous interplay between a building, its layout, and its functions. It enables care providers to do their work more effectively and it has the potential to enhance patient safety. Major forces include patient safety, information technology interface, the family for care and healing environments. EBD as research coming from the neurosciences initiatives design to improve patient outcomes, care processes, physical environment and patient safety.  The perception of a healing environment, a setting that feels comfortable or that provides pleasure . A pleasant environment keeps norepinephrine levels low so that patients actually experience less pain, more restful sleep, less anger, less muscle tension, and lower risk of stroke (Rabin 2004).  Overall care environment influence patient outcomes and satisfaction as well as dignity, privacy, confidentiality, safety, patient and staff stress, and facility operations. Healing environments focuses on operational efficiency and productivity to improve quality and patient safety, reduction of stress and fatigue of its occupant. A more comfortable, less stressful hospital experience leads to higher patient satisfaction which potentially affect clinical outcomes. SUMMARY OF EXPERIMENTAL RESEARCH PAPERSS. Aripin (2007). Healing in Architecture: Daylight in Hospital Design. School of Geography, Planning and Architecture University of Queensland Australia. Conference on Sustainable Building South East Asia, Malaysia

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AIM: To investigate the role of day lighting design in Malaysian hospital on patient's health outcome in creation of healing environment. METHODOLOGY: 4-bedded ward indoor environment of three hospitals were assessed for five days at each hospital through critical observation and data acquired from the staff members. RESULTS: Day lighting as one of the physical aspects having a significant impact on the well being of the patients, staff and visitors in a healing environment. The day lighting of the hospital building is affected by building orientation, window design, view, visual comfort, interior colors. Mohamed Yusoff Abbasa, Roslinda Ghazalib (2011)- Physical Environment: The major determinant towards the creation of a healing environment?- Centre for EnvironmentBehavior Studies, Malaysia AIM: To explore the degree of influence of the physical environment in the creation of a healing environment in Malaysian pediatric wards. METHODOLOGY: Post-Occupancy Evaluation studies were conducted in eight pediatric wards on 215 nurses and 217 patients through questionnaire response, which evaluated the physical qualities and staff & patients satisfaction levels. RESULTS: The most favored pediatric wards amongst the staffs and patients differed which concludes that the creation of a healing environment in pediatric wards do not solely depend on physical environment but also on other components, such as the social, psychological, spiritual, and behavioral components of healthcare support. Folmer, M.B.;Mullins M.F.;Fransen, A.K- Healing Architecture- space for relations. Aalborg University Denmark. AIM: To compare the influence of 1 and 3- bedded wards on the interaction between relatives and patients in Intensive units in Denmark. METHODOLOGY: The explorative study is conducted in two Intensive units for three years on the relatives of 1-bedded and 3-bedded wards. RESULTS: The study indicates that the perception of a space differs according to individual and the duration of stay. The ones who stay for shorter period does not noticed the physical features, but with increase in duration of stay relatives felt the need of window and day light. Few relatives felt lack of visual and audible privacy in 3-bedded ward because of partition with curtain while few felt lack of privacy in 1-bedded wards also because the doors are always kept open. Some relatives were annoyed with the lots of people coming inside the ward all the time, some were fine with that. Every relative of the patient wanted to be see the patient all the time. Relatives feel that in 3-bedded ward, staff are present all the time in the ward which makes them less worried.

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CHAPTER-4 AIM AND OBJECTIVE

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AimThe aim of this study is to create a healing environment in the healthcare centers which will reduce the stress on the patients, their relatives and staff, enhance the ability to cope and maximize the effectiveness of the medical treatment on the patient's body. To explore the relationship between architecture ,built environment and the health outcomes on human body.

ObjectiveThe objectives of the study are:       

Research to promote the creation of a healing environment by design. Exploration of the factors which lay positive impact on human health outcomes. Review of the healthcare centers with healing environment. Investigation to enhance the smooth and efficient running of healthcare facilities by the provision of recommendations on creating a comfortable healthcare environment Evaluation how these factors can be implemented in healthcare centers to create healthy and healing environment. Study to provide a source of reference on design efficiency of healthcare facilities Review to make an assessment of the physical form of the healthcare building and its response to enhance patient's expectations.

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CHAPTER-4 METHODOLOGY, PROBLEM DEFINATION

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MethodologyTo achieve the objectives of the study the following methodology is proposed:      

Detailed live and desktop case studies related to healing through architecture and healthcare center is carried out Detailed literature review related to healing through architecture is carried out. Analysis on the basis of requirement of doctors, staff, patients and their families is carried out. Analysis of different healthcare centers in Indore is carried out The need and requirement of physical aspects(daylight, window, views) and architectural features(corridor, interactive spaces) in healthcare centers is studied. Exploration of design considerations and interventions.

Problem definition:The purpose of the present work is to study the physical aspects and the factors that lay positive impact on the human health. For this purpose of healthcare centers are considered. The need of healing environment in healthcare centers to reduce stress and fatigue of its occupants, improve the quality of service and patient safety. Various physical aspects and their physical and psychological impact are studied and the knowledge from the case studies, literature review, survey and analysis are noted to increase the health outcomes in the healthcare center

ScopeThe main objective of conducting the study is to investigate the aspects which help in creating healing environment. The study will be helpful in reducing the stress on the patients, their families and staff in the health care centers. The aim is to enhance the process of healing.

Limitation 

Research is restricted to healing through architectural spaces and environment, there is no provision of healing through medication. Research only deals with healing and positive impacts of factors on human psychology and hence it is quite limited.

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CHAPTER 6 ANALYSIS

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The use of theoretical or empirical knowledge obtained from the surveys and questionnaires by the patient, their family and staff in design consideration to reduce pain, stay in the hospital, level of medication and stress.

 Subsequent conclusions are derived from the survey conducted by BM Association on depression patients, of exposure to sunlight. Little sun light Ample sun light Control of Stress 35 % 48 % Sleep performance 75% 80% Overall Performance 49% 56% Willing to heal 89% 93% Tolerance of pain 56% 62% Contentedness 68% 74% TABLE I: RESULTS OF EXPOSURE TO SUNLIGHT 

Following are the results of the survey conducted by Ulrich, of view through a window on recovery days from surgery. Year

Number of days in ICU, Number of days in ICU, without window with window 4.9 3.8 4.7 3.9 4.6 4.2 4.9 4.5 TABLE II: VIEW FROM WINDOW

2000 2001 2003 2005



Following are the results of the survey conducted by Hamilton, on single occupancy and multi occupancy room

Cost of treatment Length of stay Medication error infection rate Level of medication Privacy and comfort Stress level

Single occupancy room More Shorter or Less Lower More Lower

Multi occupancy room less longer more higher less higher

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Interaction with family More less and relative Interaction between Less more patient Surveillance of doctors More less Sleeping hours More less TABLE III: SINGLE OCCUPANCY VERSUS MULTI OCCUPANCY WARD ď&#x201A;ˇ

Following are the answers of the questionnaire conducted by us, on few doctors and staff of a health care center in Indore. Q. How the stress of patients could be reduced? A. By diverting their mind to beautiful view or art displays, and engaging them in different activities. Q. Which types of material and textures should be used? A. It should make patient feel comfortable and it should not look clumsy. Q. On what factors the built environment should focus? A. Environment should be comfortable. Welcoming entrance and waiting areas. Calm and peaceful interior spaces. Social and interactive spaces for patients, their families and relatives. Outdoor spaces like terrace and balconies. Interrelationship between different internal spaces. Q. Requirement of public and private spaces? A. For privacyVisual and acoustic privacy. Infection control regimes. For public spacesGood interaction between patient and staff. Spaces for interaction between families of patient Q. How can make a patient feel comfortable? A. Temperature should be comfortable in all season. Good acoustic rooms. By providing privacy and dignity. Fresh and good air quality. Q. How day light and artificial light should be used? A. Day light All the spaces should have ample daylight. Day light should not create discomfort because of glare. Artificial light-

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It should enhance the interior of the building. The building should not have maximum dependency on artificial light. TABLE IV: INTERVIEW WITH DOCTORS AND STAFF OF A HEALHCARE CENTER ï&#x201A;·

Following are the results of the survey conducted by Ulrich, of relationship of design factors with health outcomes. Health outcomes

Single bed unit

dayligh t

Approp riate light

Views Family from zone in window patient' s room

Noise reducin g finishes

Reduced infections ** Reduced medical errors * * * Reduced patient's fall * * * Reduced pain * * ** * Improved patient sleep ** * * * Reduced patient stress * * * ** * ** Reduced depression ** ** * * Reduced length of stay * * * Improved privacy ** * * Improved interaction ** * * with family Improved social * * support Increased patient ** * * * * * satisfaction Decreased staff stress * * * * * Increased staff * * * effectiveness Increased satisfaction * * * * * * Indicates relationship between design factor and health outcomes by empirical studies ** Indicates relationship between design factor and health outcomes by strong evidences TABLE V: RELATIONSHIP OF DESIGN FACTORS WITH HEALTH OUTCOMES

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CHAPTER 7 RESULTS

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7.1 Design considerations:The physical aspects affecting the healing environment in the health care centers are identified on the basis of case studies, literature reviews, analysis and the critical observation. Subsequent design considerations can impact the wellbeing of its occupants• Welcoming entrance- As studied from the analysis. Entrance is the first view of the patient which depicts the environment inside. To generate a good impression, it should be alluring. It should be easy to supervise and should have controlled flow of traffic. It could be shaded with tress or canopies, well landscaped with trees, plants and water body. A separate emergency entrance can also be provided.

Fig. 7.1- Entrance with landscape garden

Fig. 7.2-Sunlight according to the seasons

• Qualitative day lighting- The research shows that the exposure to sunlight gives better health outcomes. To optimize the quantity of light, design of openings, different materials e.g. tinted glass and building orientation, colors in the interior, visual comfort plays an important role. The light should not create undesirable glare. • Human comfort- As studied from the analysis, comfort is the most important need of the healing environment. As everyone has different comfort level, in terms of visual, thermal and acoustical comfort. Liberty of regulating temperature, opening of window, control of light through curtains and blinds should be provided. Room should be acoustically comfortable. The ceilings could be painted in darker colors than the walls to have restful gaze. The room light should not be direct or focus lights, it could be reflected off the walls and ceiling to provide a sense of visual release. • Privacy- As studies suggested that there is faster recovery rate in single bedded wards. They offers more privacy and dignity, hence they are more preferable as compared to multiple bed shared ward. Spaces should respect the privacy of the occupant. There should be degree of liberty to the patient to decide the level of interaction with the world. Use of curtain,

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partition walls, noise reducing material and finishes can be helpful in providing privacy in general wards.

Fig. 7.3- Private ward

Fig. 7.4 - General ward

• Normalcy- The patient feels comfortable, encouraged and supported in presence of familiar and recognizable environment. The feeling of being cared and supported increases the health outcomes. The friendly atmosphere and homely environment faster the rate of recovery. • Proximity of spaces- All the interactive spaces such as gathering spaces and activity rooms should be close to wards, and centralized to increase involvement and participation. It should be beneficial to all. There should not be long corridors. There should be good internal connections between spaces so that it will not lead to fatigue. • Open spaces- Open and free environment fasten the recovery rate. If a person is isolated, concealed and restricted, it is injurious for his health. Wards on one side and landscape on other side make spaces beautiful. Openness provides aliveness in healing space. Large window, open window, windows with deep sill sized, shaped and positioned according to views gives more sense of freedom.

Fig. 7.5-Outdoor Seating space

Fig. 7.6-Outdoor landscaped spaces

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• Access to Nature- Nature has therapeutic abilities. Access to landscape to occupants offers feeling of liberty and seclusion .Contact and access to nature increases the recovery rate and decreases the stress, blood pressure and maintains normal heart rates. Building should be placed and shaped so that it will create outdoor space in relationship to landscape, climate and place. Use of large sliding doors that join inside and outside, for sun and fresh air could be helpful.

Fig. 7.7-Access to nature through large openable doors

Fig. 7.8- View from the window

• Views and vistas- All the spaces should have views and vistas of nature from maximum spaces of the health care center. Openness and views make the rooms spacious. Calming and interesting and stimulating views decreases the blood pressure level. The quality of outside view depends highly on the site selection, building orientation, wards layout, bed positions and windows design. Translucent windows provides better view. Use of open sliding door, operable windows and glass partition with seclusion safeguards(curtains) could be used. • Dignified environment- To increase the rate of desire to cure and self heal, the patient should get dignity. The staff and spaces should respect the privacy and dignity of the occupant along with providing care. • Spaces for interaction- There should be freedom to the patient to decide own level of social interaction. There should be various interactive spaces of different seating capacities so that the patient would be able to interact according to his comfort level. It has been observed that sharing problems and listening to other's problems reduces the attention from one's own problem. A landscaped amphitheatre, garden, courtyard, atrium could also be used as interaction space.

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Fig. 7.9(a), (b)- Outdoor Interactive spaces • Minimizing the risk of fall and infection- The spaces should have minimum risk of fall. It could be achieved through using non-slippery and anti-skid floor tiles, carpet. The materials should be used such that there should also be minimum risk of infection through them. Contact with water in landscaped area should be avoided to avoid the risk of infection. • Easy way finding - Study has proved that difficult way finding may lead to stress and anxiety. It should have easy way finding by use of different art, colors, textures, materials and signage for ease of patients, their family and relatives. Graphics can be used on walls and windows to give each space an identity so that it will support way-finding. There should be short travel distances between destinations. • Quality corridor- It has been proved in studies that staff and caretaker spend most of the time in wandering between different rooms and spaces, which decreases the amount of time and care given to the patients. The corridor should be centrally placed and should have minimum necessary length with visual connectivity with open space. The corridor links rooms for patients and staff should have interaction spaces like an atrium, plants, a quiet space with views, display area for art pieces. The narrow corridors and dead ends should be avoided. A care unit without corridors is a dream. • Creating positive distraction- Integration of art in architecture through art strategies, mural paintings, sculptures, illustrations on wall, sketches mounted on walls, demonstration of artwork divert the attention to the beautiful side of life from the pain and suffering. Involvement of patient in painting and artwork can also make forget the patient his problems. Books, literature, wall pieces, music, yoga, colors, meditation, prayer and aroma also have the power to heal. Various types of sensory experiences aquarium or water feature, massage, acupuncture, guided imagery and visualization can boost the immune system and develop coping skill.

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Fig. 7.10- Involvement in sketching to reduce stress

Fig. 7.11- Rooms according to need of patient

• Respecting patient's choices- Research shows that when individuals have options or choices to select, it reduces the stress. A healing environment will offer as many choices and options to patients as possible in every setting.eg- freedom to order favorite foods, freedom to select programming on a wide-screen television and access to guided imagery videos. Rooms on patient’s preferences & terms and for activities like writing and communication. • Air quality -fresh and clean air and natural ventilation is cure to many health problems such as tuberculosis, respiratory diseases etc. Air quality of the health care center can be improved by planting pollution controlling tress, air cleaning tress. The healthcare center could also be located away from the pollution of the factories, industries and vehicular traffic. • Furniture design- As studies suggested the comfort of the patient is very important. The design, sizes, shape and materials of the furniture should be according to the comfort of the patient, his problem and situation. There should be legibility of adjusting the position and placement of the furniture.

Fig. 7.12- Furniture according to patient's need Fig. 7.13- Climbers on the window sill • Indoor planting- As studies suggested that it is not possible for every patient to access to nature, so indoor plantation is the option for that. Creepers and flower beds could be

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planted in the window sill and balconies. Studies shows that patients who were shown a video of natural scenes during burn dressing had significantly reduced anxiety and pain intensity. Images and photographs of natural scenes could help the patient against anxiety and pain. • Water body- Studies shows that water has therapeutic effect on human health. Quiet pools, as well as flowing streambeds have ability to relax the mind. fish tanks, and fountains and ponds could reduce anxiety and pain. However, contact with water should be avoided because there is high risk of infection through it.

Fig. 7.14- Therapeutic garden with water feature

Fig. 7.15- Landscaped garden

• Therapeutic gardens -As studied suggested that nature has therapeutic power. There are various trees, plants, herbs and shrubs that are beneficial for cure of different diseases. Arcaded walkways, serpentine pathways with water fountains, water body spatially and visually linking with the balcony and exterior space. Seating in the garden could vary from movable chairs and tables to a curvilinear seat-wall, for different comfort levels and positions in sun and shade. Use of earth-toned tint for decreasing the amount of glare. • Color- It has been that with pastel color scheme patients seem to be satisfied. Colour schemes and tones may vary around the healthcare centre to stimulate and soothe. Perimeter walls could be painted with dark colors to increase the luminance contrast with adjacent windows. The layer of filled colours allows light that penetrate outer layers of colours to reflect illuminating tones from inside. • Security, safety and affinity-The health care center should be under security surveillance. Use of adequate handrails within facility, clearly marked and visible fire exits, fire extinguishers, slip-proof tiles in washroom and flooring could be the safety measures. • Outdoor rooms, terraces and balconies- A retreat which fosters casual interaction, it could be atria, terraces, exterior gardens, rooftop courtyard, outdoor rooms, landscapes organized around central courtyards. It could be the small-enclosed landscaped interaction

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space with large trees and outdoor seating. Balcony of general ward opening into open space and roof top solarium with views of the surrounding landscapes and tree tops.

Fig. 7.16- Outdoor Room

Fig. 7.17- Outdoor Seating space

â&#x20AC;˘ Calm and quiet atmosphere-An environmental research indicates that stressors e.g. noise in the built environment can add to the burden of illness. The healing environment should be peaceful and quiet, free from the noise of the surroundings.

Fig. 7.18- Effect of noise on human health â&#x20AC;˘ Facilities -Spaces for recreational activities include indoor games, watching T.V, newspaper and access to guided imagery.If there is a common space for such activities, it should be at the heart of the building for social gatherings and communal spaces e.g. lounge, dining, activity rooms. As such activities draw the attention of the occupant from their problems.

Fig. 7.19- Toys and books in children's hospital

Fig. 7.20- Facility of indoor games

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• Surveillance of staff and doctors- There should be constant surveillance of the staff and doctors, for the quick access in emergencies. An effective communication system should be there. Glazing in certain areas could also be provided at the right height for the staff and doctors to peek into the ward without disturbing the patient.

Fig. 7.21- Surveillance of doctor

Fig. 7.22- Support of family and friends

• Spaces for family and relatives-Social support and care of the friends and family contributes to emotional and psychological wellbeing. There should be spaces for the friends, family and relatives within or near the patient's ward, it leads to faster recovery. Visual connection of the family members with the patient most of the time leads to the satisfaction of the family. Whether it is a social support group or a family member, sympathy and compassion offered by caring individuals are essential. • Building orientation -Building orientation influences the design of the physical aspects (i.e. shading devices, window opening, placement and profile) and quality of day lighting and access to outside view. Wards facing North-South direction, have no direct bright light appears on the floor surface of the ward and discomfort glare are avoided. By responding to existing site features, building orientation can be decided to get the best possible view and day light.

Fig. 7.23- Building orientation

Fig. 7.24- Considerations for specially-able

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â&#x20AC;˘ Considerations for impairments: There should be consideration for persons using assistive devices, wheelchair, walkers, gurneys, and wagons, access at every place. There should be adequate space to move around room using wheelchair. Bathrooms should be large enough for wheelchair and specially able accessible. â&#x20AC;˘ Sense of freedom- There should be a balance between the sense of freedom and disciplinary control. If it is not possible to provide physical freedom, sense of freedom could be provided. There should be visual connection with nature. 7.2 Product Design:The design iterations are proposed to address the challenges of stressful environment of the healthcare center. They focus on use of scent to stimulate stress reduction and healing properties in patients. The traditional drugs such as morphine are potentially harmful and addictive, plants can encourage the body to release certain chemicals such as dopamine in the brain which works same as morphine. These proposals are conceptual basic studies to aid healing.

Fig. 7.25- Natural scents and their uses DESIGN 1: PLANTER WALL This wall introduces natural plants into the interior space, a wall hosting multiple compartments for different plants. This removal compartment allow patients and staff to alter the plants according to treatment and interest. The scent from the intended plants can be drawn out for the patient. Different plants release different chemicals and can be very effective in making a person feel calm, less aggressive, sleepy, awake, or boost the immune system, depending on the undergoing treatment, specific scent and plant is selected. The multiple compartments allow flexibility of a variety of plants and scent selection. Each patient has choice over plant scents. The compartments are perforated at the bottom to allow water to drain and get collected in a trough at the bottom

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Fragrances from plants directed towards patient Patient view Opening when plants are not needed for fragrances and they are removed Colored LED strip lights, when there is absence of day light Water drains through soil from one plant to another

Fig. 7.26- Planter wall and its .

Water from drains can get collect dimensionsinto trough of size 100mmx50mmx1500mm

Fig. 7.27-View of Planter wall DESIGN 2: ROTATABLE PLANTERS Plants represent life of patient during treatment: growth, renewal, life, cycle, and healing. Plants have the power to instill hope in people. The rotatable and movable garden is a unit in which patients can gather around it and are able to see the plants, while also receiving their scents. Psychologically, a visual connection with plants has tremendous healing abilities. It is open for watering, for receiving scent and maintenance of the plants. Patients can help to upkeep and watering the plants, which provides another way for patients to interact and hold some control over their situation. Patients are given a visual connection with the plants and observe the changes in the plants. This growth and life cycle provides hope to patients in the process of growing themselves, mentally and physically.

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Pipe through which water is send Water reservoir Water is sent through gravity when needed by plants Water drains through plant shelves which are removable for maintenance Axial rod Plant shelves which are removable as well as rotatable

Fig. 7.28- Rotatable Planter Planters need periodic watering. Perforated shelves allow excess water to make its way down the different plants. Left over water is stored in a water reservoir at the bottom. When the plants need watering, the water reaches through tubes due to gravity which can be manually stopped. The flexibility of this system allows different patients to have different scents delivered by rotating the plates along the rod. Plants get direct sunlight from back. Plants are visually stimulating, as well as actively working through the scents. The gardens are selfcontained systems that allow patients to interact with them. The patients can touch, move, or water plants.

Fig. 7.29-View of Rotatable Planter HEALING THROUGH ARCHITECTURE

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CHAPTER 8 CONCLUSION

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“In general hospitals are not patient friendly. Illness shrinks the patient’s confidence, and arriving at a hospital is often a time of unnecessary anxiety. Simple way finding around is exhausting. The environment often contribute to extreme mental and physical enervation. Patients who arrive relatively hopeful soon start to wilt.” Healing is beyond treating physical symptoms, hospitals have gradually moved away from a holistic healing with the rise of technology. More technological advances do not necessarily equate to better care, Evidence Based Design studies are findings. Environment is one of the most common and most detrimental factors working against a patient’s recovery. However, in many hospitals when patients enter the spaces they got restricted to little or no connection with sunlight, smells, or natural elements. According to many researches, when people feel happier and more comfortable, their body responds in a positive way, which will boost healing by strengthening their immune system, it starts with the environment to which a patient is subjected. This environments have a number of elements in common: light, color, privacy, and connection with nature. Although these design considerations cannot cure an illness, they are vital assets in a healing environment for healing and recovering of the patients. In an attempt to explore the ability of environments to augment healing, design considerations were proposed. It focused on a communal usage. The gardens encourage patients to feel part of a larger group and offer an opportunity to focus on living plants that represent hope, growth, and renewal. Presently, the healthcare center design include the very strict regulations to meet health standards. This dissertation focused on the exploration of potential designs that could stimulate the senses to reduce stress and aid healing.

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CHAPTER 9 REFERENCES

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1. Bryan Lawson (2010). Healing Architecture. The School of Architecture, University of Sheffield, Sheffield, UK 2. Gary J. Coates. Seven Principles of Life-Enhancing Design, The Architecture of Erik Asmussen. Department of Architecture, Kansas State University 3. Jenny E. Young (1996). The Role of Architecture in Promoting Healing Environments in the Design of Small, Rural Hospitals. University of Oregon.84th ACSA Annual Meeting Open Sessions 4. Rob Ryser (2015). Healing in Architecture-Little fanfare but great hopes as Sandy Hook school construction begins By. Hearst Connecticut Media Group

5. Rudolf Arnheim.(1997) Art and Visual Perception. A Psychology of the Creative Eye. University of California Press Berkeley and Los Angeles, California and University of California Press, Led. London, England 6. Jennifer Beggs (2015). Healing through Architecture. University of Waterloo, Ontario, Canada. 7. S. Aripin (2007). Healing in Architecture: Daylight in Hospital Design. School of Geography, Planning and Architecture University of Queensland Australia. Conference on Sustainable Building South East Asia, Malaysia 8. Cayser Hussain(2015) Healing Spaces in Architecture â&#x20AC;&#x201C; A Study that explores the ablity of space to enhance healing 9.

Ar C F Moller. Healing Architecture for the common good.

10. Folmer, M.B.;Mullins M.F.;Fransen, A.K- Healing Architecture- space for relations.Aalborg University Denmark. 11.

Alex Stark. Buildings that heal: Energetic criteria for healing environments-New York

12.

A Visual Reference for Evidence-Based Design

13. Mohamed Yusoff Abbasa, Roslinda Ghazalib (2011)- Physical Environment: The major determinant towards the creation of a healing environment?- Centre for EnvironmentBehaviour Studies, Malaysia

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International Journal of Advanced Research in Management, Architecture, Technology and Engineering (IJARMATE) Available online at www.ijarmate.com ISSN (ONLINE): 2454-9762 9762

ISSN (PRINT): 2454-9762

CERTIFICATE OF PUBLICATION This is to certify that

Shivani Tandon Fourth year student, Architecture, SDPS Women's college, Indore, India Published a research paper titled

“Healing Healing Architecture: An approach towards Healing Environment” in IJARMATE, IJARMATE Volume IV, Issue IX, September 2018.

Executive Head www.ijarmate.com .com

Editor – in – Chief www.ijarmate.com

International Journal of Advanced Research in Management, Architecture, Technology and Engineering (IJARMATE) Available online at www.ijarmate.com ISSN (ONLINE): 2454-9762 9762

ISSN (PRINT): 2454-9762

CERTIFICATE OF PUBLICATION This is to certify that

Ketan Jain Asst. Professor, Architecture, SDPS Women's college, Indore, India Published a research paper titled

“Healing Healing Architecture: An approach towards Healing Environment” in IJARMATE, IJARMATE Volume IV, Issue IX, September 2018.

Executive Head www.ijarmate.com .com

Editor – in – Chief www.ijarmate.com

ISSN (ONLINE): 2454-9762 ISSN (PRINT): 2454-9762 Available online at www.ijarmate.com International Journal of Advanced Research in Management, Architecture, Technology and Engineering (IJARMATE) Vol. IV, Issue IX, September 2018

Healing Architecture: An approach towards Healing Environment 1

Shivani Tandon , Ketan Jain

Fourth year student, Architecture, SDPS Women's college, Indore, India1 Asst. Professor, Architecture, SDPS Women's college, Indore, India2 Abstract— This study explores the influence of the physical environment and architectural features which help to enhance the environment of the healthcare centers in India. The main aim of this study is to create the healing environment in the healthcare centers which will reduce the stress on the patients, their relatives and staff, enhance the ability to cope and maximize the effectiveness of the medical treatment on the patient's body. The study is carried out in a public hospital of a city to understand the physical and psychological need of healthcare center in relation to physical environment by observation and questionnaires response by patients and staff. “Ultimately it is the senses that need to be revitalized as it is an integral part of healing.”[1] The key findings on healing environment of the healthcare centers are noted. Index Terms—Healing Architecture, Healing Environment, Healthcare center, Physical Environment

I. INTRODUCTION The design of the healthcare center is a complex task, which focuses on both functional needs and psychological needs. In order to utilize the maximum functional area i.e., to accommodate maximum number of patients, the physical environment of the space is often compromised. The spaces having no or very less natural light, views of dead wall of the premises or the view of the road are the results. But the building itself can help to reduce the stress on the patients, their families and staff by creating healing environment. “We build the buildings that end up shaping us.”[2] The goal of the healing architecture is neither to cure nor to heal but to create the healing environment that will stimulate the process of healing. Traditional healthcare centers were used to be located in the outskirts of the city to provide natural, pollution free, peaceful environment to heal the patient. Non-traditional healthcare centers are getting established in the city, but with the same concept of providing natural and peaceful environment. In modern times, with the increase in population and need, the healthcare centers are now getting established in limited area of land in the city, trying to achieve maximum functional needs and accommodate maximum number of patients, paying very little attention on the physical and psychological needs.

This study is an approach of understanding the need of the patient, their family and staff, how they experience the space and the evidence based design criteria that are necessary for creating a healing environment. Many researches prove that the stress has negative impact on the health as it slows down the recovery rate. The healing environment can help to reduce the stress by providing positive distraction by beautiful view, art, access to landscape etc. It is also found that the comfort and feeling of relaxation also quickens the recovery rate. The thermal and visual comfort must also be included in a healing environment. II. RELATED WORK The study of the healing architecture is carried out through multiple case studies to understand the relationship between space and patient. The following projects illustrate the relationship between built-up environment and human being creating healing environment1. Muktangan Mitra, Pune-Primary Healthcare cum drug de-addiction and rehabilitation center: It is designed by Ar. Sirish Beri. It has welcoming entrance in random rubble stone masonry. The balance is maintained between the sense of freedom and enclosure by providing visual connection with nature through balconies, cutouts and corridor. Flower-bed and planters are planted in window sills for connection with nature. Landscaped amphitheatre is designed as the focus point to provide visual and physical interaction as well as source of light and ventilation. All the spaces have ample amount of light and ventilation and views of landscaped areas.

Fig. 1.Sketch of Muktangan Mitra by Ar. Sirish Beri

interaction, thermal and visual comfort, integration of art to create positive distraction etc. An understanding of the subject of ‘healing architecture’ is established to provide evidence based on the link between the built environment, its physical aspects and human health physically and psychologically. Four public hospitals in Indore have been selected and observed for the pilot studies. III. SCOPE OF RESEARCH

Fig. 2. Karunashraya Hospice Center 2. Karunashraya, Bangalore- Home for terminally ill patients: It is designed by Ar. Sanjay Mohe. It is a care center for the advanced stage cancer patients who are beyond cure. It has welcoming entrance, the building has stone structure with composite masonry. The balance is maintained between the sizes and forms of courtyards with relationship between the green spaces and water. All the rooms are designed to receive natural light and ventilation with the view of green landscaped spaces on one side and water on another. Individual spaces lead out to a Verandah which has a view of water. Spaces are designed for recreational activities and for religious activities to create positive distraction of patients from sufferings. 3. Paimio Sanatorium, Finland-Tuberculosis Hospital: It is designed by Ar. Alvar Aalto on the mountainous slopes to provide beautiful views on the site. Its every space is designed by focusing on sunlight, fresh air, sun and views of nature. The wards are provided with cantilevered balconies facing roof top solarium and pathways have beautiful views of the surrounding landscapes and water fountain which visually and spatially connect the environment. The room lights are reflected from ceiling to provide visual comfort.

The main objective of conducting the study is to investigate the aspects which help in creating healing environment. The study will be helpful in reducing the stress on the patients, their families and staff in the health care centers. The aim is to enhance the process of healing. IV. PROPOSED METHODOLOGY AND DISCUSSION The use of theoretical or empirical knowledge obtained from the questionnaires by the patient, their family and staff in design consideration to reduce pain, stay in the hospital, level of medication, stress and anxiety. Following are the results of the survey (source unknown) conducted on 6 patients suffering from same disease in a multispecialty hospital for 4 daysTABLE I: EXPOSURE TO SUNLIGHT

Stress level Sleeping performance Overall Performance Willing to heal

Little sun light 63% 75%

Ample sun light 51% 80%

49%

56%

89%

93%

Following are the results of the survey conducted by Ulrich, of view through a window on recovery days from surgery. TABLE II: VIEW FROM WINDOW

Year

2000 2001 2003 2005

Number of days in ICU, with no view 4.9 4.7 4.6 4.9

Number of days in ICU, with good view 3.8 3.9 4.2 4.5

Following are the results of the survey conducted by Hamilton, on single occupancy and multi occupancy room TABLE III: SINGLE OCCUPANCY VERSUS MULTI OCCUPANCY WARD

Fig. 3. Paimio Sanatorium The aspects of healing environment in healthcare center and its effects on patients are reviewed through various literature studies. These aspects include the physical aspects, natural light and its control, views of the nature, visual and physical link with nature, spaces for privacy and dignity as well as for

Cost of treatment Length of stay Medication error or infection rate Level of medication Privacy and comfort Stress level Interaction with family and relative Interaction between patient

Single occupancy room more shorter less

Multi occupancy room less longer more

lower more lower more

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Following are the answers of the questionnaire conducted by us, on a doctor of a health care center in Indore

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TABLE IV: INTERVIEW WITH A DOCTOR OF A HEALHCARE CENTER

Q. How the stress of patients could be reduced? A. By diverting their mind to beautiful view or art displays and engaging them in different activities. Q. Which types of material and textures should be used? A. It should make patient feel comfortable and it should not look clumsy. Q. On what factors the built environment should focus? A. Environment should be comfortable. Welcoming entrance and waiting areas. Calm and peaceful interior spaces. Social and interactive spaces. Outdoor spaces like terrace and balconies. Interrelationship between different internal spaces. Q. Requirement of public and private spaces? A. For privacyVisual and acoustic privacy. Less risk of infection. For public spacesGood interaction between patient and staff. Spaces for interaction between families of patient.

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V. EXPERIMENTAL RESULT The physical aspects affecting the healing environment in the health care centers are identified on the basis of a pilot study and the critical observation. The following are the factors which influence health outcome• Welcoming entrance- As studied from the analysis. Entrance is the first view of the patient which creates the further image of the healthcare center, it should make good impression. It should be an inviting element. It should be easy to supervise and should have controlled flow of traffic. It could be well landscaped with trees, plants and water body. • Daylight- The research shows that the exposure to sunlight gives better health outcomes. The building orientation, design of windows and use of different materials such that tinted glass should be designed to optimize the amount of light and the light should not create undesirable glare. • Respecting patient’s choice- As studied from the analysis, comfort is the most important need of the healing environment. As everyone has different comfort level, in terms of visual comfort, thermal comfort and acoustical comfort, there should be freedom of adjusting the temperature, opening the window, control of curtains and blinds. Room should be acoustically comfortable. • Proximity of spaces- All the interactive spaces such as gathering spaces and activity rooms should be near to the wards, so that everyone can join easily and it should be centralized if possible, so that it should be beneficial to all. • Normalcy- The patient feels comfortable, encouraged and supported in presence of familiar and

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recognizable environment. The feeling of being cared and supported increases the health outcomes. Open spaces- Open and free environment fasten the recovery rate. If a person is isolated and not getting freedom, it will have adverse effect on his health. Openness provides life to the healing space. Large window and open window gives more sense of freedom. Access to nature- Nature has healing powers. Studies had shown that, access to nature gives sense of freedom to the patient and feeling of seclusion. It increases the recovery rate and decreases the stress, blood pressure and maintains normal heart rates. Views and vistas-All the spaces should have views and vistas of nature from every space of the health care center. The center having rooms on one side and landscaped views on other side is a dream. Openness and views make the rooms spacious. Dignified environment- To increase the rate of desire to heal and self heal, the patient should get dignified environment. The staff and spaces should respect the privacy and dignity of the patient as well as it should also provide care to the patient. Spaces for interaction- There should be freedom to the patient to decide own level of social interaction. There should be various interactive spaces of different seating capacities so that the patient would be able to interact according to his comfort level. Minimizing the rise of fall and infection- The spaces should be accessible to all the age groups as well as specially-abled persons and it should have minimum risk of fall. There should also be minimum risk of infection. Contact with water in landscaped area should be avoided to avoid the risk of infection. Easy way finding - Study has proved that difficult way finding may lead to stress and anxiety. It should have easy way finding by use of different colors, textures and materials for ease of patients, their family and relatives. Quality corridor- It has been proved in studies that staff spends most of the time in travelling from one space to another, and cannot give much attention to the patients. The corridor should be centrally placed and should have minimum necessary length. Creating positive distraction- Integration of art in architecture through art strategies, wall paintings, painting-exhibition creates the distraction of patients from their illness. Giving chance to the patient to get involved in painting can also make forget the patient about his problems. Literature, music, yoga, meditation and aroma also have the power to heal.

VI. CONCLUSION The evidence based on researches and the pilot study of the public health care center of Indore suggest that the healing environment has significant role in better health outcome of the patient. It has been observed that following links are

important to the patient in order to create healing environment• link with sunlight • link with nature • link with self • link with surroundings The above aspects should be incorporated in the design of the healthcare center to gain better health outcomes. VII. REFERENCES [1]

Grandnm, “Healing Architecture”, Scribd., Sept, 2014, http://www.scribd.com/ doc/216951537/HealingArchitecture. [2] Winston Churchill [3] Bryan Lawson "Healing Architecture", 2010, The School of Architecture, University of Sheffield, Sheffield, UK [4] Gary J. Coates. "Seven Principles of Life-Enhancing Design, The Architecture of Erik Asmussen". Department of Architecture, Kansas State University [5] Jenny E. Young, "The Role of Architecture in Promoting Healing Environments in the Design of Small, Rural Hospitals", 1996, University of Oregon.84th ACSA Annual Meeting Open Sessions [6] Rob Ryser, "Healing in Architecture-Little fanfare but great hopes as Sandy Hook school construction begins By", 2015,Hearst Connecticut Media Group [7] Juduth Holdershaw and Philip, 'Understanding and Predicting Human Behavior ", 2008 [8] Rudolf Arnheim, "Art and Visual Perception.-A Psychology of the Creative Eye." 1997, University of California Press Berkeley and Los Angeles, California and University of California Press, Led. London, England [9] Jennifer Beggs, "Healing through Architecture", 2015, University of Waterloo, Ontario, Canada. [10] S. Aripin, "Healing in Architecture: Daylight in Hospital Design", 2007, School of Geography, Planning and Architecture University of Queensland Australia. Conference on Sustainable Building South East Asia, Malaysia [11] Ar C F Moller. Healing Architecture for the common good.