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Healthy Outcomes: Post-Occupancy Study

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Cheryl Atkinson discusses some of the harder-to-measure qualitative aspects of design and the effects of design on the psychological well-being of patients in a hospital setting.

Image courtesy of interviewee. May 12, 2024

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This video video discusses a post-occupancy evaluation of a new chronic care hospital building in Canada, replacing an older facility. It highlights the unique opportunity to compare responses from staff and patients who transitioned from the old building to the new one, emphasizing the importance of architectural design on human experience, particularly in healthcare settings.

The evaluation aimed to assess how the new building’s design, which included more individual and accessible spaces, affected the psychosocial well-being of patients. Researchers observed factors such as wayfinding, social interaction opportunities, and the emotional impact of the environment.

Findings indicated that although patients and staff generally enjoyed improved brightness and cheerfulness in the new facility—enhanced by ample windows and meaningful views—there were fewer chances for social interaction compared to the older building, despite the increased volume and space.

Key takeaways include the significance of design in healthcare environments: well-lit, sociable spaces are beneficial to patient well-being, and people are drawn to areas with more social activity. The research reinforces the idea that while the quantity of facilities is important, the quality and accessibility of common areas significantly impact patient experience. Overall, the study affirms the influence of architectural design on healing and mental health in care settings.

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It was an incredible opportunity to look at a

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building, with a control population.

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Um, so oftentimes post occupancy evaluations are done with,

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new buildings,

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but they don't have, a lot of comparables so

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that you can have, a clean kind of experiment.

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And, because this building was a new build,

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and the new build was happening on the site of the old

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original building, and we had many of the same staff people,

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and many of the same patients

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because it's a long-term care hospital

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going over to the new building.

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So, it was a really great opportunity to,

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conduct an a, an, an evaluation like this, understanding

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human response to architecture.

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Um, so a unique experience.

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And it was, it had a lot of attention.

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It was one of the biggest, if it, well,

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it was the biggest chronic care facility in

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Canada at the time.

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And, it was well funded.

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The, the government

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and the, hospitals themselves wanted,

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this information and they wanted

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to design a state-of-the-art building.

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I think that hospitals have become kind of factory-like in,

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in the 20th century.

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Um, they've gotten bigger

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and further, more internalized.

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Um, there's, they're added to incrementally

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and very difficult to find your way around.

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And, for acute care, maybe

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that doesn't matter quite so much.

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Patients are in and out, quite quickly.

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But for chronic care facilities where patients have,

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long-term chronic diseases, like diabetes

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or, they're going through stroke, therapy

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or cancer therapy, the PE people are in those institutions

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for quite a period of time.

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They're anxious, they're depressed, they have, a lot

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of downtime on their hands, their stress.

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And so in that situation,

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environment does matter quite a bit.

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And, so there has been a fair amount

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of research happening over the past 20 years,

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looking at the impacts of, of design on,

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human state of being.

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And it's particularly important in healthcare,

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because, well, it's a publicly funded thing,

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and at least in Canada, and I think the UK too.

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And, it's, we felt,

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and many people feel that there,

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is strong evidence out there

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that design does impact your motivation, your sense

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of wellbeing, and your ability to heal,

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Faster, at least feel better while you're, while you are,

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managing your, your disease.

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The architects, were kind of following the mandate

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of the administration, which was to,

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create a, a campus of care

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that would be knitted into the urban community.

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They wanted to deinstitutionalize the, the hospital as much

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as possible, with in

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and out, patient staff, visitors

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and researchers coming and going.

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Um, they wanted to, normalize it,

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create a variety of facilities

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and programs for rehabilitation

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of the patients, that were there.

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Blurring, blurring, leisure

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and rehabilitation with gardens,

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facilities like gyms, pool, a therapy pool

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that's quite beautiful set into the garden,

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library and lecture hall.

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Um, so they wanted patients to be motivated, motivated

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by the environment to socialize, to move around,

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the building as part of the rehabilitation,

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and to, with the hope that in doing that,

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that would improve their mobility,

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but also help stave off the depression

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and anxiety that accompanies,

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chronic disease and its treatment.

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The design objectives in a big picture

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way came from the client.

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Um, and, our

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research then was based on what they wanted

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to achieve with the new building.

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And, we used the, the built form

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and the, the

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architect's drawings, and e even their process drawings

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and preliminary drawings as a theoretical basis

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for the development of our methods and measures of the POE.

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Um, so,

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they were interested in daily view.

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They were interested in, way finding

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and, the navigation of the building in a,

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in a clear and, and pleasurable way for, for patients.

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Um, and so they were interested in the program, the,

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the spatial configuration of the building, et cetera.

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So we looked at a lot of those issues,

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both qualitatively and quantitatively.

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Um, so, the, the project was split into two sections.

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I studied with my team, the architecture and,

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and, quantified it as much as possible

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through a whole diagramming process and, and,

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and, analysis process.

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Um, graphing, graphing information as well,

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and the social scientists, they

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interviewed patients.

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They, observed patients and, and staff and, before

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and after and at a third control facility that we use,

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to kind of even out the, the potential bias

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of, of the before and after of this one building.

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So, yeah, we had a control building.

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We looked at, quantity, location,

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and proximity of things like meaningful views for patients,

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which were important to the architects.

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We compare the number and proximity of lounges

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and other key recreation spaces for patients and staff,

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and documented their popularity

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and liveliness at various times

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of the day and days of the week.

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The social scientists, over a period of several years, pre

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and post-construction, interviewed, observed

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and collected impressions from both patients

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and staff in a, in a range of methods

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and ways, again, to eliminate bias

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and, as much as possible.

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Um, and looked at patients in the space

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as they were interviewing them in these kind

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of things they called go along interviews.

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Um, so they also took into account variables like the,

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the jobs,

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or the, you know, the kind of employment,

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socioeconomic status, age, cultural background

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of both patients and staff as well, to eliminate bias

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as much as possible.

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Um, and they focused on the response of

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patients to their space with a huge range of questions,

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but directed at understanding their mood, their sense

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of connectedness, sense of wellbeing,

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and, while also observing improvements clinically

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to their mobility

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and, ease of navigation through the building, their

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express mental states and, and their self-efficacy

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and in managing their own care.

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So the, you know, to summarize I guess the objectives

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of the, of the clinical scientists, it was about social

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psychosocial wellbeing, so depression,

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social connectedness, sense of community motivation, mood,

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stress, re reduction in coping,

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and, some functional health.

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So they tried

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to observe whether it actually impacted their experience

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of pain or their ability to, to move about the building.

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And, whether it actually had Im impact on,

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organizational efficiencies like their predilections

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to falls, reduction of infections and

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Reduction of medical errors.

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There's some very interesting,

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outcomes and observations.

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I mean, one of the things that was quite interesting about

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going from a building built in 19, 63

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to a building for the same number of patients,

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opened in 2014, was that the, the,

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the new building, contemporary buildings are much bigger

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and, there's,

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there's just a lot more volume.

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This building is four times the volume

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of the heritage building.

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It is, twice as big in terms of its floor plate.

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So, well qualitatively there,

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there are a lot of observed improvements.

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Um, and, and patients, clearly, patients

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and staff both clearly enjoyed, the,

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the design of the new building.

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So the impact of, the abundance of Windows,

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the attention to the location of those windows to,

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to address meaningful views in the building.

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Um, the huge variety of, spaces that

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were, are, were now available in the new building.

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Um, this beautiful therapeutic pool with

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glass opening onto the park, setting the,

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gymnasium, multiple lounges of library activity spaces.

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They all enjoyed it.

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It was clear that these were all beneficial things.

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Um, but I think the big takeaway was that,

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because the building was so much larger, we moved from,

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I think 60%

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of the rooms in the original building were quads.

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And in the new building, 60%

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of them were individual buildings and 40 individual rooms

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and 40% were doubles.

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So, it just meant that there was, a lack of density

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to, in the new building to a certain extent.

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So, well, people enjoyed the improved,

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brightness and cheerfulness of the, of the new building.

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They, there were some perceived,

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lack of opportunity for social interaction as much

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as there was in, in the older building.

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Um, I, I mean, I guess to be clear that there was,

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it wasn't, it was more that they didn't go to as many

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of the rooms that were provided.

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So what we learned was that quality was more important,

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important than quantity.

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Um, but the quantity was kind of an impact of

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creating more rooms, creating more floors,

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dispersing the rooms using contemporary,

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design parameters for mobility and equipment, et cetera.

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Just spread everything out.

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Um, but in, in both the new

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and the old building, one constant was

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that the favorite places were places

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where there were more people.

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Um, so people are drawn to people to places

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where there are other people.

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And, they were in the old building

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and they were in the control building.

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So the lobby space, the rooftop terrace,

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and the cafeteria were the most popular spaces for

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patients, even though they didn't always

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provide the most spectacular views,

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or the most daylight.

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So that, that was kind of an interesting thing

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to learn from the whole process.

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The implications for this work are that, you know, we,

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we certainly observed that there, that design does matter.

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People, people do feel better in brighter,

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more cheerful spaces in meet

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what we call meaningful views are, are quite important.

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People are drawn to them.

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Um, and we had a lot of them in this building.

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One of the advantages of the building being bigger

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and taller was we had we suddenly achieved in this building

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that was on the same site views to the, the lake.

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So expansive views, distant views.

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Um, so I think all of that is important.

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Um, and is a, is a, I think we're quite confident

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that the evidence proved all of that.

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Um, and, I guess the other major takeaway is

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that people value the proximity to other people

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and the opportunity that, design provides to,

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create crossroads for people.

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So think that, you know, designed for hubs, places

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where people would congregate,

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because as, as I was saying earlier, people are drawn

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to other people and,

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it's just like the empty restaurants syndrome.

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People want to go to a place that's busy and lively.

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So, people also want, patients also want to engage

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with the general public.

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And so, again, just as in the old building,

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people tended to hang out by the entry lobby

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to the building quite a bit.

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Patients would spend time in that lounge,

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because that's where the comings

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and goings were of the non-resident population.

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