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MANAV RACHNA INTERNATIONAL

INSTITUTE OF RESEARCH AND STUDIES

DEPARTMENT OF ARCHITECTURE AND DESIGN

HEALING ARCHITECTURE IN HOSPITAL

DESIGN

A DISSERTATION

BY
BANASHREE GARAI

SEMESTER 9

DECEMBER 2018
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ACKNOWLEDGEMENT

I would like to thank God for getting through all obstacles in my life and always making
my dreams come true. Without you all would not be possible.

To my guide Ar. Vijay Narain for believing in me, motivating me, keeping me geared in
the right direction and also extending his support whenever wherever required. I would
also like to thank our HOD Ar. Sanjay Surya for all his valuable guidance.

To my family for constant support in all I do and helping me out throughout my life.
Thank you for moulding me into the person I am today.

I am also grateful to my friends Tushalika, Vanshita, Tanvi, Pooja and all other pals for
helping me out whenever required and being the support I needed that has taken me
this far.

Appreciation & gratitude is owed to them.

BANASHREE GARAI
Student
(2014 Batch)

Date – 12TH November 201H

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HEALING ARCHITECTURE IN HOSPITAL DESIGN

The arts and art therapy have, over the years, been used to heal different aliments such
as cancer, mental illness, aids, addiction and the elderly have been successful in doing
so as it heals across all ages and race.

Can architecture do the same?

How architecture can inform healing or provide spaces and

events where healing can take place?
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TABLE OF CONTENTS

Chapters Page no.

1 Introduction 5

2 Present and future of healing architecture 8

3 What is healing architecture? 9

4 Space for social support 11

5 The theoretical approach 20

6 Art : The antidote 24

7 Architecture as the healing atmosphere 25

8 Elements of healing 35

9 Salutogenic design models 41

10 Conclusion 50

11 Case study 52
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1. INTRODUCTION

The intent of this dissertation is to explore how architecture can help in healing or
provide spaces and events where healing can take place. We as human beings have an
inner connection with our environment by physical, mental, emotional and spiritual
means. Healing cannot be understood in isolation from the factors that operate in the
dynamic life of an individual. These include the self, the family, the community, the
environmental context within which life is carried forth, and the world of spirit or
essence.

Furthermore, the arts and art therapy have, over the years, been used to heal different
aliments such as cancer, mental illness, aids, addiction and the elderly have been
successful in doing so as it heals across all ages and race.

In our built environment we often interact with the buildings themselves without knowing
the fact of relationship between building and surroundings. Can we create those
interactions by evidence based design methods? This dissertation summarizes the
principals of life enhancing role of architecture and planning in the healing process.

The new term “healing architecture” indicates that the built environment has the ability
to impact patients’ health and psychological well-being. Features such as bright rooms,
access to natural daylight, big windows, local plant life and outdoor views can improve
the healing process by giving patients a psychological and physical lift.

Healing architecture for health care facilities describes a physical setting that supports
patients and families through the stresses that develop as a result of illness,
hospitalization, medical visits, the healing process or bereavement. The concept implies
that the physical healthcare environment can make a difference in how quickly patients
recover or adapt to specific acute and chronic conditions.

AIM- Healing is not only through medical intervention but by adopting

psychological means and methods also. The aim of this research is to
understand the phenomenon of healing spaces which augments and expedites
the recovery of patients.

To study the physical aspects of hospital design and how these physical aspects
play important roles in creating a healing environment. The goal of healing
spaces is they can reduce fear, stress, tension and give relief w4hich actually
results in faster healing of the patient.5
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•Importance of daylight in hospital archite6cture,

• To outline the physical aspects in healing7 environment,

• To investigate the previous and current res8earch available on the subject of health
and environment, design for healing and the effect of day lighting on human beings,

•To study the need for social support during hospitalization,

• To promote social interactions and support,

• To promote homely atmosphere,

•Study the connection of building and nature.

SCOPE- The scope and intention of this research is to focus on the recovery of
patients, by focusing on the physical and psychological aspects of healing architecture.
It will include also highlighting of the importance of behavioral science.

The design concept”healing architecture” is, as described in this research will focus on
recovery of the patient which reduces the rehabilitation time which in turn reduces the stay
time in hospitals. The research intends to change the mind of the designer and improve the
designing techniques used by the architect in designing a hospital.

LIMITATION –

• It will not be a new way of thinking, but is rather a continuation of earlier

assumptions that the surrounding environment, daylight, nature views and access,
etc., had a healing effect on patents.

• It should not influence drastically the basic design.

• Approach should be more corrective than sweeping changes.

• The effort must be gradual and cumulative in nature.

METHODOLOGY- An extraction and assembly of knowledge and research of healing

environment in hospital design. It is intended to identify potential research areas on the
physical aspects of healing environment in future hospital design.

• Methodology employed in this research is literature review, which is followed up

by some architectural functional and planning design ideas.

• The key findings will focus on the physical , social and psychological aspects
affecting the hospital environment.
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What is healing?

Healing is the process of re-establishing harmony within the organism. Illness implies a
loss of this balance and the need for reintegration with the body’s natural ability to heal and
regenerate. Healing cannot be understood in isolation from the factors that operate in the
dynamic life of an individual. These include the self, the family, the community, the
environmental context within which life is carried forth, and the world of spirit or essence.
Healing is dependent on reestablishing successful relationships and developing reciprocity
between these factors. In fact, healing is not a process of curing or fixing, but rather a
return to balance between all of these components. Health, therefore, is understood as
the presence of this balance; illness is its lack. Far from being inert containers, spaces
can be understood to be fully participant in the healing experience. It is possible to
conceive and create structures that heal.
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2. WHAT IS HEALING ARCHITECTURE?

Modern hospital + hermitage = future hospital
Hermitage -
 Homely atmosphere
 Connection to nature
 Social structure institution
 Daylight factor

As introduction, the project will describe and define some of those terms used when considering
health care architecture, and according to the planning of future hospitals, the concept healing
architecture is introduced. For detached spectators it seems obvious that, when building and
planning hospitals, the architectural environment surrounding patients, families and staff, should
support the medical treatment in friendly welcoming and accommodating environments. However,
the majorities of our current hospitals are built on another foundation, and are often considered
the direct cause to stress, anxiety, frustration and generally longer hospitalization due to the
unsuited facilities and environments in today’s health care system. As a response to the current
state of modern hospitals and as a weighty tool in the discussion of our future health care
settings, the term healing architecture has gain ground. It is best described as a design concept,
which represents the vision of encouraged human well-being and healing influenced by well-
designed architectural surroundings.
Thus we have explained an equation that says the importance of architecture in hospitalization
which reduces the healing period through its various examples given below:
1. Homely atmosphere or hermitage -
 Authentic healing modalities
 Individual process
 Spiritual guidance
 Hermitage club spa - anti stress
 Hermitage workshops
 Yoga centre
 Meditation centre in nature
 Architecture of hermitage should be in relation to natural built environment.

2. Connection to nature -
 Nature window views
 Garden accessible to patients
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 Nature art : no abstract at

 Daylight factor
 Internal courtyard connected to ward , patient room
 Quiet in the ccu (coronary care unit)
 Music during minor surgery
 Air quality
 Landscaped courtyard
 Floor to ceiling windows
 Therapeutic benefits
 Landscaped setback
 Front porch - (overhang may scale down the size of the building)
 Entry garden
 Plaza (include trees, shrubs, overall is not of green image, but of a paved urban plaza).
 Roof terrace (potentials for expansive views).
 Viewing/ walk in garden
 Sound of water and attraction of birds to the fountain are particularly appreciated ( roof
garden)
 Roof garden for mood change
 Wide walkways outside patient rooms provide a buffer from garden activities.
 A covered patio style coffee shop provides and shelter for an outdoor eating area within a
garden.

3. Social structure -
 Green lawn for social improvement in structure.
 Imaginative maze for children.
 Covered sitting terrace or patio within a nature surrounding.
 Single occupancy vs. multi occupancy patient room study.
 Elements in the social dayroom.
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3. PRESENT AND FUTURE OF HEALING

ARCHITECTURE

Every day, in hospitals around the world, thousands of people spend hours, days, and
months for investigations, diagnosis or treatment, in search of healing.
For patients and their families, the experience of the time spent in the hospital is often a
crucial episode of their lives, whether their child was born there, whether it was the
place where the life of a family member or loved one has been saved or a bout of illness
was cured or treated there. The hospital often represents a milestone in people’s lives,
a landmark underlying society life.

The increase in the number of patients with chronic diseases, of the percentage of
aging population and the number of patients requiring treatments influence the
hospital’s contemporary approach, and issues such as the above will become even
more significant in the future.

Future hospitals will have to meet the citizens’ requirements, expectations, but
especially their increasingly higher and more diverse needs. In this context, in order to
gain the citizens’ confidence, hospitals need to become a safety landmark for the
community, where quality care and effective care spaces should be designed and
developed so that they provide a positive contribution to the healing process.
There is growing awareness that the patients’ evolution and healing are influenced
directly by the environment in which the healing process is carried out, so this concept
has become the key to architectural layouts when hospitals and health care
establishments are being designed or constructed.
The aim of this research is to define and present those innovative features of hospital
design – both Spatial and Aesthetic - that would positively impact on the patients’
healing process. By creating an environment with positive psychological stimuli,
reflected in an efficient structure and friendly interiors, the architecture of hospitals
would support a contemporary approach to the treatment, recovery and healing of the
patients.

Space for social support

 Public space elements
 Homely atmosphere (sense of personalized environment)
 Theoretical approach
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4. SPACE FOR SOCIAL SUPPORT

INTRODUCTION

In this chapter, hospitalized patient` requirement for social interaction and social support has been
identified. Day by day patient`s general level of stress and fear increased not only due to
changing pattern in disease. Also struggles to perform normal activities like low level of visits from
family and friends may occur a factor of fear. The future planned single bedroom hospitals is
furthermore increasing the rate of fear and stress , loneliness and the need of social support in
hospitalization is playing a crucial role in future.
Spaces for social support interlinked with hospitalized patients are much more important which
will enable knowledge sharing and diverts inspiration among the patients.
Social support in future hospitals is encouraged through social interaction that may vary in
different levels and variation. The social interaction can be done through informal meeting which
we experienced in our daily lives such as, we experienced in trains, mall, parks, gym, city square,
etc. and complete social relationships like we experienced in our homes in safe and physically
well being surroundings. Through these measures social interaction will increase and knowledge
sharing and inspiration with patient of equal status are potentially responsive. The physical
surrounding has potential to have ideal settings where common areas are constructing both initial
contact and developed social relationships. In this contrary the social space may seen as
intersection between a public space and a homely environment. Usually our everyday activities
are performed with our family and friends, while in the hospital these simple familiar activities
suddenly are occurring with unknown people in a semi-public space.
If we improved these social spaces then the healing power will also get increased and may even
consider as an influential elements in regard to healing architecture. There are, however, not
found any specific EBD (Emotional and Behavioral Disabilities) research that define detailed
aspects in regards to design and physical planning of these spaces. (Ulrich et al 2008) Instead,
the project is stating the thesis that by introducing architectural and anthropological theories, a
more thorough understanding of the human perception of space and even specific transferable
architectural aspects.
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Lobby of American hospital in Dubai

Social spaces in future hospitals may be seen as an intersection between public spaces
and homely environments.
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THE PUBLIC SPACE ELEMENTS

HOW TO ENHANCE SOCIAL ATTRACTION
PUBLIC SPHERE ENVELOPES THE PERSONAL SPHERE

In this chapter will introduce some of the general theories regarding social interaction and human
behavior in the public space that architects and designers have used until now when planning and
designing urban spaces.
Giving the possible privacy with some social spaces are necessary and are stated as a basic
qualification of rapid recovery. But constant withdrawal and always keeping oneself to oneself so
as to be spared social contacts and confrontations is often one of the symptoms of mental illness,
and so care is concerned with developing the patient’s
social capacity.
The social element also has to be gradually stepped
up, but of course depending on individual situations.
The design of the physical environment, accordingly,
must support the individual patient’s gradual expansion
of his / her personal sphere from patient`s own bed to
open door to green or entering to another patient room
and sitting down to such social well being corner to
talk. Moving out to the social green area, sit on a bench Mukthangan De-addiction centre, Pune by
near green plants , having a cup of coffee, Meeting a Sirish Beri, Amphitheatre Space
relative in café, Going on a tour of hospital visit. All
these activities get used to patient daily lives which never make them felt that they are
hospitalized or progressively widening the social context.
There we should shape the rooms, or shape “rooms within the room”, make small niches or
seating areas of varied character where people can “take a pew”. Normally speaking, mentally ill
persons have a larger bubble of personal territory. But the places created must still make people
feel encompassed and secure.
In Pune "Mukthangan De-addiction centre" observed that patient rooms are placed near the
amphitheatre space near the natural elements like trees, sunlight and gentle wind to heal their
agitation. The language of making public activity inside the private spaces are done also in
Mukthanga rehabilitation centre with the help of well lit amphitheatre space in the centre
enclosed by rough wall to give those agitated people a sense of protection.
 Social participation and elective seclusion
 successive expansion of the personal sphere
 parts with different degrees of seclusion and publicity
 secure and intimate seating areas on the fringes of the public zone
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Call for social contact

The call for social contact between individuals is a concept that covers many different
variations, from simple unpretentious contacts to more complex and emotional conversations
and intercourse. From this figure (below), the public space primarily represents the casual and
passive kind of contacts, which compared to the more intense contacts are considered modest.
However, they still possess great quality and worthiness, as autonomous contact, or as the
basis for more developed kinds of contact. For instance, as maintenance of existing
relationships, and especially as inspiration of acts and activities, that other people are
performing. (Gehl2003) If this basic social contact is not obtainable, the boundaries between
isolation and social contact are too pronounced, and you are either alone or in binding
connection with others. The social contact on the low intensity scale is therefore an evident and
important possibility for persons to interact with others on a casual level, and perform as
transition between various kinds of contact. (Gehl 2003). The establishment of such common
attractive and inviting social spaces is very much required for day meeting to interact socially
patient with equal status for social support which enhances their knowledge about such
situation.

Social contacts sorted by their intensity.

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Activities in the public zones

In regards to activities in the public space, Gehl (2003) defines three types; essential activities,
optional activities and social activities – all with different demands to the physical environments.
The essential activities which are performed they are regardless of the physical planning of
social environment, they are not in contact to such areas, this may be the medical treatment.

The optional activities are generally those activities which are done when they are desired and
these activities are only seen if the physical environment is in proper condition. In respect to
this optional activities are common facilities, relaxing walk, informal conversations, etc.
however, if the public or the social space is not in proper condition then only essential activities
will be there.

Sociofugal and sociopetal spaces

The physical environment often performs a very specific character in regards to social
interaction also concerned anthropologist Edward T. Hall (1973). In the writing "The Hidden
Dimension", he refers to a research study performed by doctor Humphry Osmond, who
ascertained that some types of spaces, for instance waiting rooms in train stations had the
ability to keep people apart, while French cafes did the opposite and made people engage
interaction. He defined the arrangements that discouraged social interaction as sociofugal
spaces and the spaces that encourages and enforces the development of interpersonal
relationships as sociopetal. Meanwhile Osmond had observed in his psychiatric ward
apparently patient were talking less to each other. After change in arrangement of furniture in
such a sociopetal arrangement, the social interaction increases in that same ward. When
designing future hospitals we should keep in mind the statement of Edward T.Hall and change
can be made through such small arrangements which can change sociofugal spaces to
sociopetal spaces. Layout of furniture plays a very crucial role in enhancing the social
interaction suppose if the chairs are placed back to back then the place automatically turned
into sociofugal spaces. However, if the layout of the chairs is immediately changed they are
face to face then the place changes to sociopetal spaces.

In some occasions the sociofugal

setting would be preferable, for instance
when studying or
reading, and what is considered
sociofugal in one context might even be
sociopetal in another situation
depending on the occurring activity and
the people involved.
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The challenge for the architect is consequently to design spaces with accordance between the
physical space and intended function and to maintain diversity between the different spaces in
order to give people the choice for social interaction or privacy depending on the circumstances
and their own state of mind.

Through other studies of human behavior in public spaces, Gehl (2003) argues, that the
social activities has its own self-prevailing effect, where human actions attract attention and
thereby more people. These studies show an instance , that the use of benches are
depending upon their orientation , where those situated where more human activities are
done neither in quite green environment. As well as the sizes of furniture the orientation
and layout also have significant importance in regards to use and social interaction.

Finally, the placement of furniture in the room is noticeable, where seating environments
along with the inner facades of common open spaces or in the transition zone between two
areas usually are preferred. In these places ones individual exposure is limited, and it is
easier to create an overview of the surroundings and to feel comfort in these situations.
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Feeling at home

Home by the anthropologist Mark Vacher (2006) defined as a connection between a

human being and a physical object. This object is usually a building, although more
primitive units also perform as homes with the same psychological characteristics.

A home is personal and intimate, and not something you can buy. When we talk about
houses we are capable of describing them without mentioning the people living there but
when we describe a home it always belong to someone. (Vacher 2006) Houses are not
only frames for people, people are framed by houses and the things they harbor, at the
same time as people project their own emotions, dreams and hopes onto the things
and the spaces that constitute the house.

Sjørslev (2007), who define a building as a house as soon as someone moves in, although
this house is not a home until it is personalized and the resident have supplied his
individual touch. Our home is therefore filled with personal objects, memories, heirlooms,
etc., and even though our daily use of these objects may be of functional or aesthetic
character, the sentimental value often exceeds the functional value by far.

kitchen and dining area in typical room

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Finally, the details and arrangement of furniture should reflect a homely environment.
The size of the room, furniture orientation and the room accessories like artwork,
greenery, light fittings, etc. are important aspects that should be incorporated and
considered along with the design of the space, in order to design a holistic social
space facilitating social interaction and support.
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Home outside Home

Future social spaces with a familiar and homely atmosphere by implementing some
fundamental characteristics derived from our homes and everyday life. One of these
characteristics is the activities and potential functions of the room. Today many of the daily
activities and routines in the hospital are performed without involving the patent, where for
instance meals are planned in advance, cooked in large industrial kitchens and served at
certain times. Another essential characteristic related to the homely atmosphere is believed
to be the materials and textures of the dayrooms. Today these rooms are often marked as
institutional and are often decorated and furnished as the bedrooms, hence the distinction
between the dayroom and the rest of the hospital are often immaterial. The materials used
in today’s hospitals (wood, fabrics, textiles, colors, etc.) may be the same as we use in our
own home but the way they are used have very different conceptions. Textiles are for
instance a material that is used rather carelessly, and does not derive the potential as we
experience in our domestic environment. At homes the textiles are applied for curtains,
cushions, blanket, etc all adding a tactile perception to the material, which imply comfort
and coziness to the space and experience. Today this critique may be noticed in many
hospitals, as the high restriction in regards to hygienic and durability demands have
excluded nearly all tactile materials, including textiles, from many applications. However,
recent research and development in smart textiles is improving the potential use of textiles
in new recognizable ways in future hospital environments, where the use of tactile and
sensory materials, like textiles, would be possible to implement with great beneficial value.
Finally, the details and arrangement
of furniture should reflect a homely
environment. The size of the room,
furniture orientation and the room
accessories like artwork, greenery,
light fittings, etc. are important
aspects that should be incorporated
and considered along with the
design of the space, in order to
design a holistic social space
facilitating social interaction and
support.

Textile use in a lliving area of single patient

room, fortis hospital, gurgaon
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Summary
The homely atmosphere in future hospitals may be difficult to define, as our home is usually
very personal and individual and therefore impossible to transfer directly to a health care
environment. However, it is the research of this project, that by implementing three
fundamental characteristics of our home and everyday life, including functions; materials
and textures and details, it is possible to create a more homely atmosphere in the
social spaces, than we experience today. This atmosphere is considered beneficial for
the more developed levels of social interaction and social support, as the conversations in
safe, comfortable and homely environments are believed to be more outspoken and
emotional than the acquaintances in the regular, standardized and clinical dayrooms we
experience today.
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5. THE THEORETICAL APPROACH

HOW TO ACHIEVE SOCIAL INTERACTION AND SUPPORT

Appealing and attractive spaces for social interaction and support in future hospitals are
depended on the surrounding architecture and the detail of the physical design, seems easily
accepted through evidence-based decision maker, urban planners and anthropologists if the
environment is not providing possibilities for social activities, there will not be any interaction
between patients-hence no social support. The architectural effects described in the previous
chapters, will in this chapter be compiled in three guiding subjects, including functions

(1) Materials and textures

(2) And details

(3) And through a translating description,

Their aspects are defined in regards to the context of hospitals. This theoretical approach will
define the main visionary guidelines for the design phase of this project as well as form the
basis of the evaluation model used in the later following case studies.

People attracts people, if the social area remains unattracted then physical
environment remain empty all the time. When patents or their families have engaged
social interaction, maybe through the attractive functions, they should develop these contacts,
which call for spaces recognizable from their own home, partly achieved through a mix of
functions – reflecting the everyday life. Following the ideas and theories of the described
anthropologists, the materials and textures should overall assist in creating a familiar, sensory
and homely atmosphere. The final aspect considered as one of the main guidelines for future
social spaces are the details and interior planning in human scale, concerning scale, personal
distances and sociopetal spaces. Often small details change the way we experience a room,
and some of the main physical elements in today’s hospitals, like acoustic ceiling sheets,
integrated artificial lightning, vinyl flooring, etc. are only supported by the details of for
instance coffee serving, greenery, arts and furniture, all together defining the social space as
institutional, inhuman and basically unfit for social interaction.
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FUNCTIONS
REFLECTING THE EVERYDAY LIFE

We often see uninspiring and unattractive spaces in hospital which is not used by the
patient. Above all, patient should have choice between social and private space,
ideally a gradual transition between them. Private spaces may appear in single room
but a new concept is needed to get complete framework of common spaces and
dayrooms in the future should appear social. This social aspect may derive from inviting,
attractive and socially obvious functions performed by patents and their families in the
common areas of the patent ward.

Accordingly, the specific programming of the common spaces in future hospitals is essentially
important to design very deliberate. Firstly, the patients should engage acquaintances,
through a process that may be compared to the human interaction in public spaces or the
small talks with our neighbor in the front yard. In a future patent ward these informal meetings
may occur in the common dayroom or even in natural flow intersections and recesses along
the hallway. Secondly, the patents should develop these initial relationships, through deeper
conversations and social interaction, which may cause for more recognizable and familiar
settings, reflected in the patents’ everyday life. When considering functions in the common
spaces, these might actually be quite parallel to the activities performed in our daily life and
the planning of a patient ward may even be compared to a regular single-family house having
rooms for: conversations and drinking coffee in the living room, relaxing in the lounge area;
dining around the kitchen table; simple cooking in the kitchen; entertaining around the
television, etc. By introducing these social activities in new-designed patent wards, and by
making them optional and inviting for both patients and their families, spaces for social
interaction and support are believed to have improved conditions in future hospitals.
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MATERIALS & TEXTURES

FAMILIAR AND HOMELY ATMOSPHERE

Besides reflecting the everyday life through planned activities and programming of the
social spaces, materials and textures also have significant influence on the way we feel,
act and interpret the room, and should reflect the familiar and homely environments we are
accustomed to from our own house. A deliberate choice of materials for any room, i.e. the
visual surface and the tactile perception, are often under prioritized in many projects, and in
health care architecture, the high demands for hygiene, cleaning and durability are usually
decisive factors when considering materials in both bed rooms and common areas.
Consequently, the spaces often appear clinical and institutional, with standard equipment
and furniture, acoustic ceilings, white plaster walls, etc. As regards to social interaction,
these spaces are predicted to limit the potential, as the patients will adapt their behavior to
the institutional surroundings with no conclusive benefit for engaging social interaction and
social support. Today human qualities are competing against hygienic standards and
general call for durability, and the predominant challenge for the health care architect is
therefore to balance between the homely expression and the rational clinical demands,
keeping in mind that the close compromise may determine the success or failure of the
spaces for social interaction.
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6. ART: THE ANTIDOTE

Art has always been a part of our culture, tradition and society. The human race has
evolved with some form of art within cultural practices since our early beginnings and it
seems inherent in all of us whether it is through praising of the gods, healing or rites of
passage. Yet, as evident as this may be, many disregard the healing qualities that art
possesses and the enhancement of lateral creativity that it can bring to us. To look at art
as a tool for healing we have to transcend thresholds that rigidly bind us to the
confinements of our rational consciousness. We need to understand art beyond the
traditional technical approach of artist and canvas. We need to free the boundaries from
the terrestrial rules of art and explore the therapeutic qualities that it can enhance in all
of us.

Meditation as healing medium Visual art as healing medium

The arts, whether in the performing arts, painting, sculpting, cooking or gardening
are a form of meditation where the creator is in tune with his/her centre. In this
sense, art is a spirit that one unconsciously experiences with a sense of a
healing.
For me, art is the creation of what the soul is crying out to express. It is the
harmony that tunes the soul with what is tangible. If we are all architects of our
reality, then art is an expression of how we see ourselves within ourselves in
relation to the world around us. This means that artistic expression is personal and it is
a journey of self-discovery -much like healing. “...If Illness and health are nouns, then
healing is a verb. It is movement in a desired direction- a journey that takes you
from illness to health.” By this interpretation, therefore, healing is an action: a decision
one makes in search of better well-being.
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7. ARCHITECTURE AS THE HEALING ATMOSPHERE

With this in mind, I would like to explore architecture to see how architecture can
promote healing. Architecture takes a holographic approach by looking at the
effectiveness of art to promote healing. It is a therapeutic experience aimed at
connecting with the inner-self to bring about change in a person’s lived experience. The
question that needs to be asked is that, if art does have a healing effect how can
architecture as an artistic science contribute to this? Can our environments heal or can
it make us sick? I would like to explore the architecture which can be used as a tool for
healing.
Healing in psychology, medicine and even nature involves a process where the patient or
the recipient receives a physically external antidote in order to help them heal. It is then up
to the patient to take the inward step of acceptance and observation in order to progress
the healing.

Piamo Sanatorium, Alvar Aalto – View of Corridor

However, if we ignore the qualities of physical context it could involuntarily slow the healing
process. The study published in Science magazine in 1984 showed that when hospital
wards looked out to nature the patients healed faster. It was modernist architect, Roger
Ulrich who performed the experiments that proved that window views could affect healing.
Ulrich chose 46 patients, 23 of which had beds near windows that overlooked a landscape
of trees and the other 23 looked 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.
This meant that hospital wards provided for treatment facilities in the ward where
medication and rest were provided for, and healing facilities where one could relax and
enjoy nature and the healthy rays of the sun. In addition, natural sunlight and air were
the most effective ways of purifying the air and killing bacteria.
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CONVIVIAL ENTRANCE
First impressions matter a great deal. The first encounter deeply tinges our further
experience and thus means a very great deal. Almost instantaneously we create for
ourselves an image, not just of the building but of all its activities. Indeed, Stefan Lundin
in his book Architecture as Medicine wonders whether the response and expectations
thus generated do not make an important difference to our own response to the care
which is to follow.
In many instances, the entrance situation has been a neglected point in the design of
healing spaces. Descriptions from the world of psychiatry testify to obscure, shabby
entrances next to loading bays and waste bin rooms. This has the effect of degrading
the patient, making him / her feel unworthy of neatness and a decent reception, but the
basic intent to make it as simple as possible for the patient to seek care.

Mukthangan De-addiction centre, Pune by Sirish Beri, Entrance View

In Architect Sirish Beri’s Muktangan de-addiction centre, Pune, he disposed transparent

entrance to have controlled flow of traffic and the easy supervision. The recessed
entrance with the integrated landscape and the flight of steps give the sense of
welcoming entrance. He also housed kitchen and other services at the rear side of the
site to allow service access, without any chaos in the main entrance. From this
precedent, the coherence between the entrance and the good first impression is
interpreted.
 a good first impression
 a welcoming entrance
 an entrance for everyone
 a special entrance for emergency cases
 28

ADDRESSING THE NORMALCY

Normalcy should be the main objective if the architecture is aimed for healing. This
attempt should permeate the whole of the design process, from overarching zoning to
the tiniest detail. The normal is what is recognizable and familiar. It is the normal – the
healthy – side of the patients which has to be encouraged and supported. The skills
people have lost or have never had must be developed so that the patient will not
relapse into apathy.

Certain patients have a low functional level and inadequate social skills. This being so, it
is essential to create routines for such everyday occupations as personal hygiene,
laundry, cleaning and cooking and to provide a functional, pleasant solution for them. It
seemed especially important to highlight the sensual qualities and social atmosphere of
mealtimes. For this reason too, staff and patients should eat together – a sometimes
disputed tenet. Maintenance of these everyday routines is most important to persons
who will be staying for a long time and who have got over the most acute stages of
illness but, for some reason, are still being detained. If institutionalization is what we
seek to avoid, then normalcy is what we have to look for.

But what exactly is normalcy? The term can be framed in a variety of ways. What we
normally mean by normal is, I suppose, normally interpreted quite broadly. Stefan
Lundin characterize normalcy as, “Often we perceive a wide span of behaviors or
attitudes as normal. Perhaps the word “normal” can also express what a psychiatric
environment is not to be. It must not be a hospital, a prison or an institution – to quote
the imagery often employed with reference to psychiatric care. Pursuing the distinctive
atmosphere of the hospital or penitentiary does not feel natural. But where the hospital
is concerned, surely what we want to avoid is not the care situation itself but its
frequently bare and none too cozy physical setting? The concept of nursing includes the
feeling of care and security, which is intrinsically positive if it refers to a brief period
during which one is in need of support. Correspondingly positive associations are
harder to find in the concept of criminal welfare (“prison care”), even though the
requirement of social protection is a valid one. Finally, the term “institution” seems to
have various connotations, not all of them pejorative. Some maintain that the
expression conveyed by the building must in fact be that of the institution – society’s
expression of its exercise of authority.

Moreover, Christopher Alexander in his book, A pattern language expressed “the

explicit recognition of the life cycle as the basis for every individual life will do a great
deal to help people's health in the community life cycle; this pattern describes the more
specific institutions which help people to care for themselves and their health. More than
90 per cent of the people walking about in an ordinary neighborhood are unhealthy,
judged by simple biological criteria.”
In this he criticise the health care that tends to create sickness rather than haling that. A
system of space that is capable of keeping people healthy, in both mind and body, must
put its emphasis on health, not sickness. So it must be physically decentralised, to
 29

encourage people in daily practices that lead to health, otherwise this ill health cannot
be cured by hospitals or medicine.
• aim for normalcy
• avoid institutionalisation
• characterize everyday occupations

FREE AND OPEN ATMOSPHERE

One of the very foremost challenges the architect has to face is that of “creating a free
and open atmosphere” – which again is a proposal to achieve something which will feel
normal. In some cases the desiderata presented by psychiatry are downright self-
contradictory. The desire for a care unit which will be experienced as open is coupled
with the need for a care unit which will be closed and locked. The desire to give the
patient an identity of his / her own and the ability to choose, for example, between
seclusion and sociability, is coupled with the staff’s need to know the patient’s position.
Mental care has elements of coercion – unavoidably so. The patients often spend time
in a locked care unit and temporary coercive measures occur in the form of isolation,
medication and shackle restraint. The safety of society – that is, the safety of citizens –
requires certain patients to be kept under lock and key and escapes to be prevented,
because certain patients can turn violent. Other patients, like the staff, also demand
protection from patients with acting-out behaviour within the care unit itself, added to
which, patients need in certain cases to be protected from their own self-destructive
behaviour, the ultimate consequence of which is attempted suicide. The smuggling in of
drugs is another major problem. Nearly half of all psychiatric patients have a dual
diagnosis, i.e. a substance abuse problem on top of their mental illness.
All the things that have now been listed are realities which cannot be overlooked.
Psychiatric work involves a constant intersection of the care and security perspectives.
The issues which the department has to take a stand on are very complex and
complicated and are a perpetual source of discussion and disagreement, but they
occupy a central and quite crucial position in discussions concerning the design of the
facilities. If the security perspective has the last word in everything, we risk ending up
with a “prison environment”, with all the negative associations and provocations this
implies. In their physical form, should be concealed or anonymously designed.
As stated by Pallasmaa ”Aalto wanted to lessen the strain between the client and the
interior environment he was living in, especially concerning the technology in the
space.” 11. Alvar Aalto in his design of Piamo Sanatorium concentrated more on
creating social environment with the view of seclusion by proposing each wing oriented
in the direction optimally required by its function. At the same time, rooms with the same
requirements were grouped together in their own wings. Separating functions was also
favourable from the point of view of seclusion. The aim of getting natural light into the
rooms from a favourable direction was also achieved. A single building, on the other
hand, offered other advantages compared to a design solution where each function has
its own completely separate building: in the former, efficiency and internal connections
were improved.
 30

Associations with coercion and power should if possible be avoided so as to counteract

the institutional stigma and encourage normalcy. In this way we try to avoid constantly
reminding the patients of their plight, of the potential threat they are judged to constitute
– resulting in self-reproach, feelings of claustrophobia and so on. Paradoxically enough,
one sine qua non of being able to create a free and open atmosphere is a simple,
unconstrained way of maintaining necessary control. With more numerous and spacious
facilities, with separate rooms to live and perhaps access to a garden of one’s own, this
surveillance, generally speaking, is harder to maintain, and so it is of the utmost
importance to create concentrated care units with great proximity and a good overview.
The often highly specialised facility programmes which are initially desired for the
activities should be thoroughly penetrated. A high level of facility pooling is proposed. If
the layout is organised in such a way that certain parts can be closed, this is an
advantage, not least in the evenings, when there are fewer staff on duty.

Excessive soundproofing in relation to receptions, care unit stations and consultation

rooms and clean utilities has in some cases proved a security problem, due to the staff
being unable to hear if anything special is going on in the care unit, which deprives them
of the sense of overview and control. Sounds can also be sophisticated signals setting
up unwanted associations and arousing traumatic experiences. Rattling keys are a
classic of this kind in the context of psychiatry. For this reason it is desirable to minimise
the number of locked doors. In the design of lighting, lamps must be safe and robust
without being seen as clumsy or factory-like. Alarm and call systems should be
designed so as not to be conspicuous and dominant when not in use. Can perhaps
certain systems such as engaged-wait-enter be dispensed with entirely? There are
patients in compulsory care and patients with certain types of diagnosis who set the
level of security and escape prevention measures of different kinds. One point to
consider, then, is whether there may be cause to have the patients with the severest
illnesses in special care units, so that other care units can be kept entirely open. This in
turn begs the question as to whether the general design of the care units, whatever the
patients’ diagnosis, has been properly thought through.
• a free and open atmosphere
• Avoidance of associations with power and coercion
• Overview
• address every separate facility
• beware of acoustic requirements
• use large expanses of glazing and curtains adjacent to areas frequented by patients
 31

DIRECTLY ACCESSIBLE GREEN

Nature has a rehabilitating effect on all of us, included the people with mental illness.
This insight appears to have grown of late, among other things because rehabilitation in
a natural setting has proved highly successful in connection with fatigue depressions.
Being outdoors endows a confined person with many positive benefits. They can go off
by themselves, get away from other patients and achieve the seclusion they want. A
patio also multiplies opportunities of movement. The uneasy “wanderer” can move more
freely so as to experience greater personal liberty and so as to cause less irritation to
others by his / her constant to-and-fro. The possibility of moving about, feeling space
and breathing one’s fill of fresh air or having a smoke alleviates the sense of
confinement and increases the possibility of physical activity. The changes of the hours
and seasons grow more palpable.

A garden makes a difference! But there are also other ways in which we can absorb the
qualities of nature. Views from individual rooms and social areas, but also from
corridors, help to achieve healing. Windows which can be opened give us birdsong and
natural fresh air. The question is how far these arguments can be taken. Can the good
qualities of nature also act through natural materials? Through the polished stone of the
floor, through the oiled planks of the oak flooring, through the stained veneered
panelling of the walls, through the birch of the handrails through the inherent sensuality
of materials? Alvar Aalto’s Piamo Sanatorium, brings out the idea of rehabilitation by
accessing the green, framing views with well lit and ventilated spaces. The main
building has been organised into five independent entities: the main entrance, the
patients’ rooms, the communal rooms, the operating theatre, and the kitchen/
maintenance. Each activity has its own wing, with each oriented in a direction most
favourable to the activity in question. Those rooms or groups of rooms that have similar
requirements with regards to, for instance, natural light and views, have been placed
together. This planning principle has produced a building which is naturally organised
into parts, each with a different character and orientation, offering a dynamic whole with
varying views outwards into the landscape. Despite its size, the building does not come
across as crushingly large.

Piamo Sanatorium, Alvar Aalto, Exterior View

 32

The building is dominated by a 7-storey patient wing, the tall and narrow west facade of
which forms the accent point for the whole area. The glazed lift shaft of the narrow west
facade is a reflection of the Aalto’s admiration at that time for the machine age and
modernity. The horizontal strip windows of the north-west façade facing the entrance
forecourt reveal the side corridors behind them. Even though the external facades are
white, due to the different colouring of the corridor walls on each storey of the north-
west facade, when the internal lights are on at night time the windows form distinct
different coloured strips of light. The orientation of the wing allows an abundance of
morning sunlight to reach. Aalto also designed for the hospital grounds to the south of
the patients’ wing a serpentine path linking a series of water fountains, where patients
could take walks. Some of the water fountains have been preserved as flowerbeds. The
path network itself is presently overgrown. The path and pond basin system was a
unique composition which both spatially and visually linked the patient sun balcony wing
and the adjacent exterior space. Furthermore, it had an essential role in rehabilitating
the patients.

• Access to a garden within the care unit

• A view of natural surroundings and landscape
• Windows that can be opened
• Use of natural materials

PROXIMITY AND FLEXIBILITY

Stefan Lundin defines, “The heart corresponds here to the desire for a concentrated
care unit in which all the most important facilities are “near” and “in the middle”. All
activities of interest to the patient must be based there. An obvious centre where
everyone knows what is going on and where anyone wishing to do so can take part in
activities and social gatherings.
 33

CONTINUUM CENTRE FOR HEALTH AND HEALING, PATIENTS ROOM

A strategically positioned care unit system connected with this point, of course, are
activity rooms, the TV, lounge, and an open dining area and kitchen with generous
serving spaces for a breakfast buffet, lunch and coffee. In this periphery of the heart,
and in keeping with our previous argument, care should be devoted to creating intimate,
cosy and secure places for the patients where they can observe what is happening and,
hopefully, be induced to join in communal activities. From a caring perspective, care
units with a limited number of patients are a desideratum, but this normally comes up
against funding constraints. A good solution may then be to divide the care unit up into
smaller groups of 3-5 patient equivalents each. A unit of this kind will then be the
smallest social unit, a part of relative quiet. A communal, semi-public common room,
possibly with a pantry of its own, will also be linked to a smaller group of this kind. In
such a unit, sometimes rather formally termed a care module, patients with similar
diagnoses can be brought together. The unit can also be used for separating certain
patients from each other or for excluding someone from the communal parts. The care
load varies from time to time in the various care units. Solutions whereby one or more
rooms could be added to the different care units for a period of time would represent a
substantial efficiency gain. This, originally, was one of the main points of departure for
the architectural design of the care unit, but unfortunately we architects did not succeed
in combining this with other important program desiderata, and so solutions of this kind
were gradually edged out.

• look for the natural midpoint – the heart

• break the care unit down into smaller units of 3-5 patient equivalents
• create a social space for each unit, possibly complete with a pantry
• facilitate a limited degree of screening-off
• vary the care unit size by attaching rooms to different care units

SCHEDULING OF VISTAS

There is a boundary where we feel that someone has got too close to us, a boundary
which is individually and culturally defined. We back away or repel the stranger. Alan
Botton in his book Architecture of happiness says, “To the mentally ill person, this
territorial bubble is for the most part far bigger than for healthy persons, and violation of
it is experienced as more threatening, especially by people in psychotic states. This
infringement of seclusion then leads more often to stress and outbreaks of aggression,
resulting in threats and violence. It benefits neither the tranquility of the care unit nor the
healing process in the individual.” 16Thus areas should not be so small that people “trip
over each other”. Narrow passages and corridors can be a problem. One must be able
to step aside if one wants to. Dead ends should if possible be avoided.
 34

ROOMS ON THE PATIENT’S TERMS

The room in which a patient lives is their first real abode in their encounter with in-
patient care, a place which should as far as possible be governed by the patient’s
preferences. At the same time, this is the place where the patient is most left to his / her
own devices, even though suicidal patients are never left unsupervised. The need for
preventing self-destructive behavior is also at its greatest here, at the same time as
demands for a cost environment free from associations with force and power are more
important than elsewhere. In the room the patient can find seclusion if he / she wants it.
They should be able to lock the door behind them. A patient desiring company must be
able to receive other patients or staff members to talk to. But all this must proceed on
the patient’s own terms, according to his mood and wishes. Planned talks must normally
take place in one of the consultation / therapy rooms.
The room should be designed and furnished so as to be suitable for more than just rest
and sleep. Perhaps with a writing space, an armchair, and space for a few people to sit
round a table. The bed should be positioned so that the patient can look out of the
window, even if this means the staff not being able to see the patient’s face directly
when he / she enters the room. The size of the room should be limited. Installing an
extra bed should not be easy. That way, we thought, we could avoid building in a
potential for oversubscription. But at the same time, in reality, this makes it impossible
for family to stay the night and for doctors to allow certain flexibility in the number of
patients admitted. Can patients themselves exercise control over their immediate
surroundings? If not, stress and feelings of insecurity may ensue. Can one open the
window if the room is too warm or too cold, can automatic sun-screening be dispensed
with or can the patient control it directly if it is needed? Can the lighting be varied? All
these questions should be answerable in the affirmative. And control of lighting and
heating, for example, must be possible by simple means, so as not to cause irritation –
this is important. If sprinkler heads and ventilation grilles etc. be more discreetly
designed, this will reduce the risk of reactions from people in psychotic or manic states.
Possibilities of controlling one’s own surrounding also include the possibility of opening
one’s own window, but open able windows are beset with great complications regarding
the smuggling in of drugs and blunt instruments. Black-out arrangements and sun
screens are also a problem.
In Alvar Aalto’s Piamo Sanatorium, rooms are designed based on the type of user who
is using the space. The intricate detail of the room interiors and the products used give
them the coziness but at the same time to avoid vandalism. The glazed surface on the
south side of the room brings in the diffused light to give those patients the enough
radiation required for healing.
 35

Piamo Sanatorium, Alvar Aalto, View of Patient room with the overlooking windows

 patient’s preferences must be paramount in his / her own room,


 rooms and cupboards must be lockable,
 take a close look at safety aspects of the patient’s room, from the viewpoint of
both patient and staff,
 plan for more activities than just lying in bed,
 take the view into account and try to use windows that can be opened,
 Support the patient’s need for control of his or her immediate surroundings.
 36

8. ELEMEMNTS OF HEALING

COLOUR
The thoughtful reader must have observed that thus far I have avoided touching on the
department’s vision “Colour and design promoting healing processes”. That statement
greatly perplexed me on the level of principle, and continues to do so. What is it that has
colour and design and promotes healing processes? An appealing exterior, direct
communication routes, small-scale building development, sheltered patios and so on in a
never-ending flood of questions? But, does not everything have a design (shape) and
colour? Surely these are properties which all architecture possesses, from detail to entirety,
from door handle to façade? After all, you don’t first design or construct a building and then
tack on the colour and shape of it!

In Paimio Sanatorium by architect Alvar Aalto

Piamo Sanatorium, Alvar Aalto, View of Staircase, Bright use of colour to enhance movement
 37

• The architecture is different: it has an intrinsic value and is strongly creative of identity,
• It is expressive in details, rooms and exterior alike,
• The materials are sensual – beautiful to see and touch; the intrinsic materiality of the
wood and concrete is palpable,
• The colours are often bright, applied in several coats and stained over; the surfaces
make a shimmering or patinated impression,
• The buildings possess simplicity and austerity, at the same time as great care and
refinement has gone into the detailing,
• Use of daylight is primary, resulting in narrow volumes and well-lit rooms,
• The care devoted to lighting is unmistakeable: the lighting strengths are low in relation
to present-day medical care; the light is sparing, sometimes verging on darkness,
• Only warm filament bulbs are used, never fluorescents,

Colour often has different meanings to different cultures and is an immensely evocative
medium, possessing powers to provoke immediate and marked reactions in the viewer.
Its use in the architectural field dramatically affects everyone’s perception of
architectural space and form. Even in western societies, the meaning of various colours
has changed over the years. One of the biggest issues with colour is that each person
reacts differently based on their culture, gender, and own personal experiences, and it
has always been one of the most unpredictable areas within the built environment.
According to Harold Linton in Colour in Architecture “Almost any generalization that can
be made about colour can be overturned in practice.” There is power in colour. Each
colour has ability to affect architectural planes which allows it the power to accentuate
shapes and forms. Also it can contradict the true form and expression the building
wants to be. Colour can imply proud architecture or display the building as abstract art.
With the many applications of color, it has the power to change our environment to
make a connection with our environment, body, mind, and spirit. Leonardo da Vinci
believed that the power of meditation increases 10 times when done in a purple light, as
in the purple light of stained glass.

While some colours aid the mind others, green for instance, helps to build muscles,
bones and connective tissue. It even has a cooling, soothing and calming effect on
individuals, both physically and mentally. It does so through the sympathetic nervous
system by relieving tension in blood vessels which then lowers blood pressure.
Nonverbal activity is influenced by the colour violet and is often associated with religious
and spiritual issues. The slightly different colour purple affects the brain and central
nervous system. In doing so it promotes health, creativity, inspiration, mental balance
and also supports both artistry and spirituality.
 38

WATER
“Water is symbol of the vitality in life and is a key to the sacredness of a healing
architecture. Water can be metaphorical of peace, tranquillity and calm. Conversely, it is
also associated with vitality, fertility, abundance, fluidity and movement. Water opens up
the contemplative nature of the soul and helps to elicit memories and a sense of
belonging. Because water is a feminine energy, it is also associated with the land and
with the genius loci”.

Water helps to distribute vital energy throughout the landscape, both as surface rivers,
creeks, and lakes, as well as in underground streams. This force can be tapped by
enhancing naturally occurring water in site planning of by introducing it into the site or
the structure in gardens, water features, and vistas.

Surface water has the ability to enhance both healing and prosperity, provided it is
located on the proper direction in relation to the building and the site. Geomantic
practices the world over (such as feng shui) refers to ideal locations for water in the
landscape. Surface water can be incorporated into a site in many ways: as a gushing
stream in a fountain it is symbolic of the life force, of surmounting obstacles, and
initiating new life. As a slow moving, meandering stream or creek, water is symbolic of
the river of life and our personal life path, and is also symbol of progress and
attainment. As a waterfall, it is symbolic of a leap into the unknown, of courage, and
triumph over fear.

As a still pond, water is symbolic of contemplation, of the soul’s yearning for truth,
renewal and healing. Water that disappears into the earth, a cave, or crevice is allegoric
of the cycles of life and death and can be a reassuring symbol of our ability to overcome
even the direst circumstances.

Adding a bridge over moving water is a powerful symbol of our ability to overcome
obstacles. It also helps to define our journey within the landscape and to create a sense
of natural transition into more pristine environments.
Underground water (rivers, aquifers) have the potential to greatly augment the healing
power of a site. These can be reliably located by dowsing. Dowsing is a time-honored
skill which allows its user to perceive energies such as underground water despite the
fact that they cannot be seen. Experienced dowsers can locate underground water on
site or remotely using maps.

Water that rises towards the surface from below the site is particularly beneficial. If the
water does not break the surface it is called a blind spring (see photo opposite).
Underground water, like the energy lines, can also be traumatized; geopathic stress
often involves compromised underground water known as dark streams. In such cases
it is necessary to perform earth acupuncture in order to heal the problem. As with other
forms of geopathic stress, it is important to cure or avoid such areas as they have been
implicated with many serious medical conditions.
 39

LANDSCAPE
A healing garden is a link to the divine, to the creative force of the Cosmos. A healing
garden needs to work with Nature and its forms: it should discourage rigidity, conceptual
thinking, and preconceived notions of design. It must recognize the polarities and
organic forms present in nature. Consequently, it needs to avoid straight lines, sheer
volumes and planes, and excessive use of symmetry.

A healing garden is a micro cosmos of the larger world: each feature in the garden has
the power to represent a larger feature in the landscape: mountains, rivers, lakes. It is
through this holistic modeling that a healing garden can stimulate the senses, improve
vitality, and promote recuperation from physical, emotional, mental and spiritual illness.

A successful healing garden is a co-creative process in which humans and Nature are
intimately connected through the bonds of reciprocity and stewardship. A healing
garden is a symbol of the possibilities, obstacles, and hardships that need to be
overcome in order to reach higher levels of consciousness and a sense of our own
divinity and interconnectedness with all that is. This potential allows a successful garden
to have a healing role even in those situations where physical healing is not possible.
Consequently, its users should be a driving force in its design and should be involved in
its maintenance.
Healing is achieved through careful alignment with the forces of earth, water, air and
fire. It implies recognition of orientation in space in a cosmological sense, and of the
anthrop cosmic relationship between man and the larger body of the planet, its
creatures, and the invisible forces behind material reality. It can also include formal
religious allusions as well as iconographic additions. Its end product is a space where
many activities are possible: stillness / movement, contemplation / interaction, wonder /
discovery, mystery / creation, relaxation / work.
Gardens should encourage healing through the interaction of patients with healers,
family and friends, the old with the young, staff and colleagues, and even the act of
being in solitude. The garden also needs to provide subspaces and seating
arrangements that allow gathering in larger groups. It needs natural, spatially enclosed
settings for talk and conversation.
 40

Figure 21 : Ayurvedic farm in Valley de Bravo, Mexico, View of Landscaped

Healing space

In all cases, however, there is also the interaction of humans and nature: plants, wildlife,
and the forces of wind, water, light, and color.

A healing garden should afford opportunities to make choices: private areas and public
spaces, contemplation and people watching, various walking routes, different kinds of
seating, interaction with humans and nature, participation in the garden’s maintenance.
A healing garden should allow its users to experience a sense of control: users must
know it exists, how to gain access to it, they should be able to use it in ways they prefer.
They should enjoy a sense of physical and psychological security. Design should
encourage clarity of layout and movement. The garden should provide a sense of
enclosure and a special entrance to convey a feeling of structure, permanence and
groundedness. It should avoid dead end paths and complex formations.
Design needs to create opportunities for movement and exercise; this brings physical
and emotional benefits and helps to combat depression. Create paths for walking, make
the garden visible from corridors that can also be used for exercise, place rehabilitation
units in view of the garden or nature, add a walking or jogging route for staff.
 41

MATERIALS
Materiality has a direct influence on the overall sense of the environment. Materials
have the ability to affect the sound environment, circulate movement, increase
/decrease comfort, and various other actions. With this, the form in which the material
becomes a part of will also determine the powers of its placement. The associated
dimensions of the material also will play a factor in the design. For instance, wood is a
material that retains heat, is soft and comforting, and can be associated with the
concept of natural environments. Another material like sand has a therapeutic value to
it, soft to touch, and gentle on feet. However, stone is cool and smooth to touch, but
hard on feet. When the materials become integrated in the program, the quality of the
materials will embody the vision of the space and become another dimension in the
healing environment. Other, not usually thought to be materials, like light, sky, water,
and vegetation will be manipulated with the built environment to evoke specific
responses in order to stimulate the mind and its perceptual visioning of a space.

The following perspectives provide a vision for the “garden.” These are intended to be
spaces that integrate all the senses; vision, taste, smell, hearing, and touch. The study
is done through a phenomenological lens, designing with a multiplicity of textures,
materials, and interests to engage the mind in a playful manner of distraction. The
awareness of these physical things in the space and their properties provides the
necessary information for the occupant to draw their own conclusions. This awareness
of one’s self is the beginning to any healing process in the mind.

SUN
Sun exposure is one of the key environmental factors that designers can look at in order to
provoke the process of healing and to help relieve symptoms in those who have already
incurred the illness. Sun exposure is one latitude dependant environmental factor that is
inversely related to MS instance and prevalence according to Dr. Islam of the University of
Southern California from the department of preventative medicine.

People have begun to shelter themselves indoors, due to more indoor activities, indoor
building climates, minimizing the key environmental factor. These shelters cut us off from
our nourishment, mainly sunlight, which may be a reason for the spike in diagnosis of
illness. Our body relies on sunlight in order to produce adequate amounts of vitamin D.
Vitamin D helps with our immune system; in fact, it has strong immune regulatory affects.
It has also been shown that periods of low Vitamin D precede occurrences of high lesion
activity whereas periods of high vitamin D precede low lesion activity.

The knowledge that adequate light is needed to help heal weak bodies is no new theory.
Years ago, before antibiotics, the only known “cure” for tuberculosis was to get lots of rest
within an environment containing clean air and plenty of sunshine. Thus the age of
sanatoriums was born.
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9. SALUTOGENIC DESIGN MODELS

Antonovsky’s Theory of Salutogenesis

In contrast to the traditional study of the sources of disease, known as pathogenesis,

Salutogenesis is an approach to medical treatment and healthcare that focuses on the
origins of health. It was developed in the late 1970s by Aaron Antonovsky, a professor,
researcher and medical sociologist who was interested in answering the question of
how most people manage to live relatively healthy lives despite being faced with
disease, emotional and physical stress, social struggles and other challenges: “Given
the ubiquity of pathogens—microbiological, chemical, physical, psychosocial, social and
cultural—it seems to me self-evident that everyone should succumb to this
bombardment and constantly be dying” (Health Stress and Coping ). He wrote: “the
question then becomes not how some concentration camp survivors or poor people
manage to stay healthy, but how any of us manage to stay healthy—the question of
Salutogenesis” . By shifting his focus from disease to health, Antonovsky began to
develop a systematic research methodology with a focus on what promotes health, as
opposed to what causes disease.

Finally, Antonovsky was concerned that the pathogenic approach implies a dichotomous
relationship between health and disease; that is, a patient is healthy in the absence of
disease. This idea precludes the possibility of disease and health being interrelated,
simultaneous and multi-dimensional conditions. In the 1990s, architect Alan Dilani
suggested that Antonovsky Salutogenic approach be applied not only to medical
treatment and research, but also, to the physical design of healthcare facilities as a
means to promote health. He suggested the use of Antonovsky theory to create
Psychosocially Supportive Design, a theory and framework that promote health through
the design of the physical environment. In order to understand how Salutogenesis can
be applied to design, it is necessary to identify some key concepts of Salutogenesis, the
most notable being the dis-ease/ease spectrum, the relationship between stress and
tension, the role of personal and social resources that one has available—or as
Antonovsky calls these, Generalized Resistance Resources—and sense of coherence.
Antonovsky placed health and disease, or ease and dis-ease, together on each end of a
continuum.

He defined the health ease/dis-ease continuum as a: “multi-faceted state or condition of

the human organism” . He emphasizes that Salutogenesis is not about making a sick
person well, rather it is about identifying their location on the continuum, and mitigating
 43

the stress that may move them towards the dis-ease side . One of the key defining
characteristics of the Salutogenic model is what Antonovsky refers to as a sense of
coherence. He defined sense of coherence as: “a global orientation that expresses the
extent to which one has a pervasive, enduring though dynamic feeling of confidence
that

(1) the stimuli derived from one’s internal and external environments in the course of
living are structured, predictable and explicable;

(2) the resources are available to meet the demands posed by the stimuli; and

(3) these demands are challenges, worthy of investment and engagement”

According to Antonovsky the strength of one’s sense of coherence is determined by

three key factors: comprehensibility, manageability and meaningfulness
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Alan dilani - psychosocially supportive design-

In the 1990s, architect Alan Dilani, proposed that Antonovsky’s principles be applied
to the built environment, specifically to the design of healthcare facilities. Since
then, Dilani and many other architects, designers and theorists have begun to further
explore Antonovsky’s theory and to approach architecture, interior and urban design
through a Salutogenic lens,.

Alan Dilani conceived this idea to promote health “The Psychosocially Supportive
Design
approach is offered as a useful theory and framework to guide healthcare designers and
planners who consider how the physical environment impacts wellness factors in order
to promote health”. According to him Salutogenic design not only identifies the cause of
stress it can also introduce the wellness factor that can strengthens health. “The theory
suggests that we not only design for stress reduction, but focus on salutary rather than
risk factors”.

Based on his vast research he created a list of design qualities that he argues
strengthen an individual`s sense of coherence.

This includes the designers and developers, as well as the doctors, staff and possibly
the patients and their families. If the entire team understands the impact that design has
on a sense of coherence and in turn on the success of a project, they may be more
likely to support the design process and to encourage the upkeep of the facilities. “The
organization should measure the sense of coherence; the staff should comprehend it
and act on it”

Psychosocially supportive design

The quality and character of the designed environment should be considered to be a
powerful instrument capable of improving and strengthening health processes. The
 45

question how health care environments could promote the patient’s health should be a
major issue for designers and planners. Since the new care philosophies (Salutogenic
based perspective) involve both the human body and its psychosocial context the
interaction between the nursing staff and the patients will become increasingly important
in the future.

One of the conditions for health promotion in hospitals is to create an organization that
provides the major parts of care services as close to the patient as possible, within the
patient’s familiar environment. An emphasis on patient-focused care presupposes a
different building structure, as it requires a decentralization organization. Instead of the
traditional grouping structure the new model for RIT 2000 (University Hospital in
Trondheim), in Norway, has been organized around the patient and his/her disease.
The planning for RIT 2000 has broken important new ground by integrating and
extending concepts such as a patient-centered care philosophy and environmental
design, and multi disciplinary care teams.

Traditional wards where the staff is based somewhere in a room far away from
patient rooms will disappear. In modern wards, there will no longer be a nurse
station but a centrally placed workstation, which is easy to reach, and where the
staff is always available.

From there, the staff should be able to survey and watch a group of patients within a
very short walking distance. This arrangement is called a “cluster”. A ward can consist
 46

of two or three clusters which can easily be coordinated and flexibly used depending on
the patients’ demand for care. Communication and contact between staff and patients is
made easier in this way, creating a feeling of security for both staff and patients.

Research has shown that access to nature, daylight and other wellness factors like art
and music can result in the patient using fewer drugs and spending less time in the
hospital. Nature can affect our emotions positively. It can easily catch a person’s
attention or interest and in turn can stop or reduce anxiety while bringing about
desirable psychological changes. It can reduce blood pressure, ease pain and stimulate
our senses positively.

An increase in the consideration of wellness factors within design could have beneficial
effects on well being and health processes and thereby creates environments that are
not only functionally efficient but also highly psychosocially supportive.
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48
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Roger Ulrich - theory of supportive design

Although Roger Ulrich’s Theory of Supportive Design does not specifically follow
Antonovsky’s Salutogenic approach, it does support the physical characteristics of
Salutogenic
design. The Theory of Supportive Design is a stress-based model that is a marriage of
semi scientific and scientific research. It looks at how design affects healthcare
outcomes in a traditional design setting, using stress as a starting-point. According to
Ulrich, manifestations of stress can be psychological, physiological and behavioral.
Ulrich states that instead of working to mitigate these negative manifestations, the
design of traditional healthcare facilities actually worsens them. Noise, lack of privacy,
and visually un-stimulating design elements can undermine a patient’s sense of
personal control or autonomy, whereas, supportive design can aid in coping with stress
and foster improved medical conditions.

Ulrich focuses on three supportive design guidelines :-

1. Design that fosters a sense of control with respect to physical surroundings;
2. Design that facilitates access to social support;
3. Design that provides access to positive distractions

Some of the scientific research done by Ulrich on the :-

A. influence of gardens and plants in hospital and in other healthcare settings.
B. view through the window may influence recovery from the surgery.
C. new spaces where patents through social interaction and support may reduce their
experience of loneliness and fear in the hospital environment.
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JAN GOELBIEWSKI - NEUROLOGY OF SUPPORTIVE DESIGN

Jan Golembiewski, a leading researcher of the relationship between the built

environment and mental wellbeing, states that: “Salutogenic theory is a particularly
useful tool as it is specific and easily applied to an architectural application” Similarly to
Dilani, he maintains that comprehensibility, manageability and meaningfulness— which
support a strong sense of coherence and foster a natural healing process—have clear
architectural ramifications.

He studies the architecture and design of psychiatric healthcare facilities through the
lens of
comprehensibility, manageability and meaningfulness.

1.Comprehensibility- he says, is making sure that perceptual cues are present to assist
perceptual processes. These include attention to texture and materiality, controlling the
size of spaces and the numbers of patients and normalizing environmental features.

2.Manageability- making provisions for patients to exercise control of their environment.

Features such as operable windows or access to sporting facilities can make a
significant difference in the level of manageability a patient may feel. Meaningfulness
refers to a personal or cultural connection and can be enhanced by aesthetics or by
consideration of spatial organization, such as providing spaces for visitors or for special
personal belongings. it is the most special ingredient of sense of coherence.

Golembiewski states that: “Under normal circumstances people have a great deal of
ability to adapt to new surroundings—even in stressful situations… However, when
environmental factors start to erode a general sense of coherence—when meaning,
control and comprehensibility are lost—resistance to disease weakens and perceptual
difficulties are exacerbated, often creating a vicious circle of increased vulnerability and
anxiety”.

In his research he found that manageability, comprehension and meaning have

significant architectural ramifications and they are central to Salutogenic design. As
well, his studies that show how environmental factors may erode a sense of coherence
and, in turn, will weaken resistance to disease and perpetuate anxiety
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CONCLUSION

The ability of architecture to heal the mental and physical illness with the different
planning parameters and the elements that can enhance healing has been explored.
Without compromising on the need, the ability of all patients to be outdoors in a good
environment is, in my view, the absolutely greatest strength in the design of this caring
environment.
The spontaneous process of making architecture, it’s almost as if we formulate our own
“abstract” ideas of what we envisage a space to be, through special images from
memory we assemble architecture to be a part of the real world. It not only seems that
art is inherent in all of us, it is also possible that architecture is inherent in all of us. From
the development of the first human shelter, humans have always connected the craft of
making to a significant act of personal growth and of being in tune with ourselves and
the world around us, which is essentially an act of healing and therapy. As an act of
healing it is symbolic of our perseverance as a species to live a fulfilled existence. In
exploring art as healing, architecture as an art and lastly, architecture as a healing
space, I can deduce that the common bond between them is that art does have healing
qualities and it can be said that such healing qualities provide therapeutic harmony in all
of us. I believe its effects may be limitless in measuring the benefits to the Self. The
journey of healing through art seems to be a process of retrospection, Self growth and
Self discovery. This investigation has brought about key design objectives that may be
crucial in space making concepts for my architectural intervention.
The purpose of creating a green oasis which patients can retreat to unescort by staff, in
my opinion, has to be achieved. Even in a number of problems where the outdoor
environments are concerned, everyone agrees that the existence of the gardens and
light courts is something absolutely positive and something that is very good for the
patients. It is also clear that being allowed out in the gardens is perceived as conferring
an opportunity of greater sovereignty. In this way I think the aim of increasing normalcy
has been achieved.
Patients often experience different needs from time to time, and so the architect should
consciously design the place or the environment so as to facilitate the process which
recovery.
In the design process, the architects should consciously reduce the institutional
ambience and achieve normalization for the patients. As I see it, there is scope for the
patients to use different parts of the environment, both indoors and outdoors depending
on the stage of the recovery process they have come to. Outdoor spaces are always
with lusting green and the sound of water to heal their agitation. Indoor is more towards
the sunlight that enhance the healing and the ventilation to give the patient high level of
conformability. With the aid of my detail study and the precedents I have drafted four
connections that has to be consciously addressed while designing.

The connection to Self: Healing begins when one is in a space of retrospection. The
space however is one that must be comfortable and a reflection of oneself.
 52

The connection with the City: The city environment is harsh and busy and tends not
to offer many places or spaces of retrospection and contemplation. The site should be a
part of the city but detached from the fast pace. The end-user should be able to arrive
conveniently with public transport to the site to allow a large catchment of people
seeking a place for healing. The site should also be in a place that is not difficult to
navigate and find.

The connection to Nature: Human beings cannot live without natural surroundings.
The symbiotic relationship that exists between the two is one that has to be nurtured. A
physical and visual link with nature has positive beneficial qualities that help in healing
and health in general.

The connection with Light: Natural sunlight kills harmful bacteria and cleans air. Apart
from these obvious natural benefits of sunlight, natural light - when controlled - gives a
space character that is sensual so giving a space an emotive quality which can be felt
by the end-user. Light is also a symbol of growth and life as it benefits the natural world
in that way.
This study on ‘Healing spaces in architecture’ is an endeavour of understanding the
conceptual way to achieve healing. Since it is vast field of study with the number of
ongoing researches, this has profuse scope for further investigation.
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CASE STUDY

FORTIS HOSPITAL, GURGAON, INDIA

5.1.1 INTRODUCTION

5.1.2 REASON OF THIS CASE STUDY

5.1.3 SALUTOGENIC DESIGN METHOD AND EVALUATION

A. Mapping out in relation to Antonovsky`s sense of coherence factor

B. Evaluation model in relation guidelines set through study of Edward T. hall

and Gehl theory.

5.1.4 CONCLUSION

INTRODUCTION
Location : sector 44, Gurgaon

Site area : 43,303 sq. m.

Built – up area : 65,961 sq.m.

FAR : 1.52

Principal Architect : Ar. Rajinder kumar,

 54

Rajinder Kumar Associates, New Delhi

 Fortis Memorial Research Institute, Gurgaon (FMRI) is a flagship hospital of the Fortis
Healthcare Limited.
 FMRI is a multi super-speciality, hospital.
 FMRI is a set on an 11 –acre campus.
 It has 430 functional beds, with a further planned increase in beds to 1000.
 FMRI is accessible easily by road, It can also be reached using Delhi Metro, as the hospital is
located opposite to the HUDA city metro station
DEPARTMENTS -

 Minimal Access, Bariatric & GI Surgery

 Plastic Surgery
 Ophthalmology
 Pulmonology
 Plastic Surgery
 Dental Sciences
 Internal Medicine
 Cosmetic & Plastic Surgery
 Invasive Cardiology
 Paediatrics
 Minimal Assess Surgery (Gynae)
 C-DOC
 Neonatology
 Liver Transplant, GI & Hepato Pancreato Biliary Surgery
 Mental Health & Behavioural Science
 Radiation Oncology
 Radiology
 Rheumatology
 ENT
 Gastroenterology & Hepatobiliary Sciences

LOCATION :-
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NIEGHBORHOOD CONTEXT :-
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REASON OF THIS STUDY

There are tremendous reason for choosing this hospital , main aim to create an
environment which should not give a sense of boring hospital. The design philosophy
behind this hospital to provide the health and well being of the people they serve through
integrated, innovative, and compassionate care, also creates spaces that allow for privacy,
rejuvenation, choice, humanistic scale, feel and experience, communication, and
collaboration. The Hospital should incorporate new trends like wellness, technology and
creates a Gen Next Medical Center which sets new standards for healthcare focusing on
healing & nurturing robust health. At the south corner is a quiet & sun-filled healing garden
for patient, recuperation & areas of respite for staff and families. All major areas in the
hospital will have natural light for healthy and sustainable environment.

The architecture of this hospital considered the healing source, although factors like
daylight, room atmosphere, sound, music, art and optional privacy, altogether are believed
to assist in creating carefully designed environments that affects and supports the
psychological and physical healing of the patients.

With acceptance of the architectural influence on human healing aspects, it is even more
obvious that healing architecture should be incorporated in the planning of future
hospitals.

SALUTOGENIC DESIGN METHOD AND EVALUATION

A. Mapping out in relation to Antonovsky`s sense of coherence factor

Based on research done by Alan Dilani on theory of Salutogenic by Antonovsky , he

created a list of design qualities which enhance the sense of coherence . In case of Fortis
Hospital there are some design qualities which enhances coherence factor of the building.

Although , in hospital some patients are in stress , anxiety , fear , loneliness , insecurity ,
frustration and generally longer hospitalization due to the unsuited facilities but in case of
Fortis Hospital there are no such situation which demoralize the patient. The design of this
hospital suggest that we not only design for stress reduction , but focus on salutary rather
than risk factors. There are several design features which shift the pathogenic approach to
Salutogenic approach manifests in the built environment. According to Antonovsky the
 65

strength of one’s sense of coherence is determined by three key factors:

comprehensibility, manageability and meaningfulness.

COMPREHENSIBILITY - It means when faced with stressful situation or challenge , a

person will have the ability to seek meaning in it, and will do his or her best to overcome it.
There are some design characteristics which help in enhancing the sense of coherence
among the patient , staff and visitors , discussed below;-

1. WAY FINDING
 Modular planning of clinical floors to optimizes flexibility and improves way finding.
 Clear organization and simple circulation system within medical areas eases patient
and staff use.
 Flexible floor plates provide shared practice space, systems, and amenities for various
clinical modules and sub-specialties.
 Ward layouts in older hospitals generally provide long corridors organized around a
central nursing station, where medication and charts are located. Research has shown
that nurses spend much of their time walking up and down halls increasing fatigue and
stress and sharply cutting the time available for observing patients and delivering direct
care.
 Common console for cathlabs, MRI, X-RAY, AND ICT decreases the circulation pattern
proves efficient for patient and staff.
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SIMPLE CIRCULATION SYSTEM DIRECTION SIGAGE BOARDS EASE PATIENT

USE.

ESCELATORS FOR EASE AND FAST MOVEMENT FOR BOTH VISITORS AND STAFF.
 67

2. PERCEPTION
The experience already starts when guest or patient enters the lobby area , where an
welcoming fountain sculpture and reception welcomes the visitor with a holistic experience.

In a beautiful designed combination between the functional space and interior decoration ,
the holistic experience make you feel forget where you really are. When focusing on the
lowest levels of Maslow’s pyramid of needs, the physical and psychological, respectively,
the high-end hospital like Fortis is primarily addressing the self-fulfillment needs of
the visitors, and Fortis is accordingly providing a holistic experience, where design and
atmosphere is united in a multiple sensory expression.

REFRESHING & CONGENIAL ENVIRONMENT FOR PATIENTS BY CREATING A

MODERN, UP MARKET & PLUSH INTERIORS.
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3. LANDMARK
While entering the central courtyard we see a white sculpture titled Loveable Curious Child
– a baby with a stethoscope plugged into the ground, creates a landmark of the hospital
building. Around this sculpture many people take selfie and sit together, seems to be an
vital part of the hospital social space.

VIEW OF A CENTRAL COURTYARD

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4. PLEASURE
It also accommodate a small cinema name as " FORTIPLEX", for visitors it is a recreational
hall where visitors can watch a cinema for several time, so that they will get some relaxation
and stress free time
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MANAGEABILITY- A person can sense of the situation , problems or challenges that

they face. it also mean making provision for the patients to exercise control over their
environment. Features such as operable windows or access to sporting facilities can make
a significant difference in the level of manageability a patient may feel. “The feeling that a
person is in control of his or her environment and life circumstances is very fortifying… the
feeling that you are totally out of control is absolutely disempowering”

1. AESTHETIC ELEMENTS

2. NATURAL LIGTH

Perception of sunshine contribution

study done for the fortis hospital ( included both patient and staff interviews)
Patient Staff
Survey question
Considered sunlight to be a nuisance 2% 55%
Considered sunlight to be pleasurable 91% 33%
Considered sunlight to be calming 95% 37%
Considered sunlight to be unfavorable 1% 18%
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The study found that these patients subsequently required less narcotic pain medication,
experienced a shorter hospital stay, and had fewer negative evaluative comments in
nurses’ notes.

SECTION SHOWING NATURAL LIGTH PENETRATION IN THE ATRIUM

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All major areas in the hospital will have natural light for healthy and sustainable
environment. Skylight at the roof transmitting natural light into the most common & waiting
areas.

DOUBLE OCCUPANCY ROOM SINGLE OCCUPANCY ROOM

The integration of natural physical environments into treatment for human sufferers has
always proven to be an effective course of action. Elements in nature emulate qualities of
calmness and serenity that are necessary for a healing environment. There are two
benefits of windows: one is daylight and the other is view.
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3. GREEN ENVIRONMENT

VIEW OF THE EXTERIOR LANDSCAPING AT THE ENTRANCE PORCH

Landscaping in order at the entrance give visitor and patient a sense of order, decreases the
stress and anxiety among the patient , ultimately arouses a level of coherence factor among
themselves. it also provide a sense of supportive design for patient as plants represents life ,
growth and hope. they can provide interest and diversion.

MEANINGFULNESS- In the face of a challenge or stressful situation, a person has

adequate their disposal and that they trust , which can help them cope.

1. SOCIAL SUPPORT
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ARRANGEMENT OF FURNITURE IN MAIN ATRIUM SPACE increases the social

support among the visitors as they talk to each other about the disease or experience
without knowing the patient, these kind of seating arrangement make these spaces as
sociopetal.

The fact that it is only space adds a social unifying value, even though it is still possible for
different groups to sit privately at the same sofa at one time. The ground floor is the center for
social interaction, where people arrange meetings or just engage on informal basis.

ARRANGEMENT OF FURNITURE IN
MATERNITY WAITING AREA FOR
MOTHER is designed in such a homely
attmosphere which reduces stress level
among the patient. The detail with the false
cieling and sofa shows the intention making
the waitinf area comfortable , homely space
but the specific choice of curtain make it
seem clinical in some respect.

2. MUSIC AND ART

Studies have shown across a variety of
patient groups that pleasant music,
especially when controllable, often can
reduce anxiety or stress and helps some
patients cope with pain.
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Wallpaper at pediatric centre Wallpaper at oncology department

Patient Based Art Programs include artwork that is selected based on the unique needs of
each patient groups (such as Cancer, Pediatric, Geriatric, Women, Heart, ICU, Rehab and
Psychiatric). Patient Based Art helps to deinstitutionalize the clinical setting while illustrating
a sensitivity to location and patient demographics. Patient based artwork can also aid in way
finding by helping to visually identify areas.
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A successful healthcare art program consists of a coordinated series of visual elements

placed in public and private spaces throughout the facility. The selection of these elements,
as well as their size and placement, is crucial to the success of the program.

If photographs and slides of nature are viewed positively and reduce stress, it is probable
that artwork that replicates nature would also have this effect. Research on adult patients
suggests that by infusing art into the healthcare setting, patient-focused design may foster
improved moods or reduce stress that would impact the negative thoughts that could impede
the healing process.

ALL PHOTOGRAPHS ARE CLICKED BY DIFFERENT

DOCTORS ACCORDING TO THIER EXPERIENCE AND
ALIGNED IN THE HOSPITAL CORRDIOR.
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3. VIEWS

VIEW OF THE GARDEN AND THE CITY

FROM SINGLE OCCUPANCY SUITE ROOM
IN NORTH DIRECTION.

Views of vegetation, and especially water,

appear to sustain interest and attention more
VIEW OF THE GREEN AREA FROM DOUBLE effectively than urban views of equivalent
OCCUPANCY ROOM IN SOUTH – EAST information rate . Because most natural
views apparently elicit positive feelings,
DIRECTION. reduce fear in stressed subjects, hold
interest, and may block or reduce stressful
thoughts, they might also foster restoration
from anxiety or stress. in comparison with
the wall-view group, the patients with the
tree view had shorter postoperative hospital
stays, had fewer negative evaluative
comments from nurses, took fewer moderate
and strong analgesic doses, and had slightly
lower scores for minor postsurgical
complications . natural scene had
comparatively therapeutic influences, it
should be recognized that the "built’ view in
this study was a comparatively monotonous
one, a largely featureless brick wall.
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B. EVALUATION MODEL IN RELATION GUIDELINES SET THROUGH

STUDY OF EDWARD T. HALL AND GEHL THEORY.

FUNCTIONS
What are the options of residence?

The living area in suit room considered as primary

place for visitors , where visitors always remain
close to the patient. Although looking at the
furniture arrangements in the living room looks
almost like you are in such a homely atmosphere,
which ultimately increases the sense of coherence
among the patient. The lighting in the room sets a
relax mood of patient and visitors both , which
changes the pathogenic place to Salutogenic
place.

seating arrangements in the suite room for visitors.

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What are the optional functions?

You can watch television as entertainment; the primary activity is relaxation on the lounge.
Other than this there are no such optional activities like kitchen counter for self-provide able
snacks in the room.

Does the function in the space

in the social space invite the
participation?

When you arrive in the center

staff is welcoming the guest
accommodatingly and friendly
describing the various possibility
in house. This behavior
enhances the homely
atmosphere, arouses a sense of
coherence among the staff and
visitors. The arrangement of
furniture also allows different
visitors to sit together and talk to seating arrangements in the cafe area for visitors.
each other.

seating arrangements in the central courtyard area for visitors.

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MATERIAL AND TEXTURE

List and short description of used
material,

textures, furniture?

The red color broad strip dominating the

central courtyard is a sound absorbing
material which reduces the bad noise ,
enhances the healing power of hospital.
Furniture are consists of couches and
armchairs in white upholstery with colorful
accessory cushions and small wooden tables
aside.

The red color strip dominating interior of atrium

How is the room characterized by
materials and texture?

In regards to material and textures , the

space is not seems to be very attractive
and luxury, as the travertine stone flooring
and designed false ceiling generally
predominant.

The furniture used in lounge area have

leather covered cushions ,recliners and
general design of these are luxury.

Are the use of materials and textures Recliners in NICU waiting areas

consistent and deliberate?

The furniture in the ward area seem to be

institutional , although it does not define a consistent
design as compared to single occupancy room . The
material in the ward are distinguished from the other
areas of the hospital. There is some lack of luxury in
these common ward as compared to other areas.
Not that much luxury in common ward areas
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DETAILS
Scale and partition of the room?

The main suit room is large in scale

through with specially defined
partition with door accessibility and
the room is experienced
personalized in scale. The living
area in this category divides the
room into two. The patient area is
kept quiet institutional and a living
area is non institutional.

Furniture and distances ? The room is divided in patient and visitors use in presidential suite.

The living area is luxury designed

with a 6 - person dining table and
one armchair with a coffee table.
In scale it is recognizable from
private homes and the multiple
seating options provide alternative
choice . The l-shape sofa is placed
along the perimeter of the room
and is not used during observation.

Other details ? There is one dining table and couch for

seating.
Specific details such as flower pot

at the window bay as well as lamp in

the living area arouses a feeling that

a patient is in his/her home. t is done

to define attractive and welcoming

Small details give a
social space. feeling of home.