Much has been studied about the impacts of the environment on people’s physical and emotional well-being. The way the built spaces interact with us, from the outside as from the inside, also considering the expectations we have, interfere directly with the outcomes of this human-space relation.
In healthcare environments the balance of this connection can be even more important, for this reason, in order to take care of people’s health, first, there is a necessity to look at (and look after) the building itself.
Almost 40 years ago Roger Ulrich’s experiment showed that patients in rooms with a window view of trees (compared to another group of patients with a lookout to a brick wall) 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 (Ulrich 1984, p. 421). It just reinforces how much spaces have effects on people, no matter who they are – users, visitors, permanents, passengers – every time you are at a place you are being affected, even unconsciously, by its elements.
Trying to clarify which are the elements that provoke the most intensive impacts, TUNED has developed an approach methodology to be applied during the project conceptualization process, to give support to the other areas using neuroscience’s concepts, helping with the space organization, the interior quality, the integration of the context and with the biophilia. The objective of the method is to develop an initial phase so, based on its indications, the subsequent design phases should lead to works that bring out emotions and feelings which should be aligned with users’ expectations. In the case of the healthcare buildings, there is a gain because this balance should activate protective factors, strengthening and speeding up the trauma or illness recovery in inpatients, improving services for customers, and reducing costs for the administration.
The methodology was applied in the project proposal for the competition of the new hospital of Padova (Italy), developed in partnership with T.H.E.MA and Farrow Partners Architects. The TUNED method brought to the process some measurable factors that were integrated into the project, a holistic treatment center, integrated into the city and the vegetation of surrounding parks, in order to reach the balance between people and space, expectations and feelings, income and outcome: a place where the health of the mind is intertwined with that of the body.
Also called “design pillars” by the basis function they have in that initial phase of the project, these measurable factors are 12 in total – they work giving guidance during the development of the project itself, but they are not a self-recipe that can be used always equally. All cases, buildings, spaces, and users should be analyzed particularly. Within the pillars are included some known elements such as light, air, natural materials, colors; as also, but not only, integration of the paths and orientation, art therapy, and staff support areas.
In the Hospital of Padova, some factors had a stronger part in the conception of the project. Considering the large range of emotions that can be evoked between inside and outside spaces, and how rooms can embrace scenarios of activation and relaxation, the space was thought to be a responsive environment, to harmonize with users’ expectations in a way to balance the emotions and regulate stress.
Also, as a building for healthcare services, it must promote healthy uses and practices. As several scientific studies show, the movement of the body is fundamental to producing the protein responsible for neurogenesis (the origin and development of new neuronal cells), the BNDF – Brain-Derived Neurotrophic Factor (Di Liegro et al. 2019; Małczyńska et al. 2019). For this reason, the built space should be able to facilitate physical activity and movement through the provision of “attractors”. One example is to place services at different points of the hospital to induce people to move without using elevators or treadmills.
There was also a concern about the built space to guide the users to elaborate allocentric maps, to stimulate the hippocampus (studies show that those who do not develop allocentric mental maps are more predisposed to the development of degenerative diseases), and improve the intuitive wayfinding, through the integration of the different perception scales (from external to internal navigation), the recognition of the departments, the use of colors, and a correct formal and spatial organization.
Besides improving the good outcomes, it’s also possible to reduce the bad ones, like stress and errors through the environment. As has been established, stress has a strong influence on the telomeres, terminal regions of chromosomes, which have the function to protect them from deterioration (Lin et al. 2022). Roger Ulrich’s studies (Ulrich 2008) highlight how the presence of greenery inside hospital environments brings a significant reduction in stress and pain, and a decisive improvement in the scale of sadness, not only in patients but also in staff and family members.
Another important issue is noise – one of the major causes of stress in a hospital setting. Environmental noise affects the sleep of patients, increases their blood pressure, and decreases their immune responses, but also has direct consequences on the attention and accuracy of the healthcare staff. Through the design, some measures (using specific materials, shapes, and devices) can mitigate and recalibrate these parameters to reduce discomfort and errors.
Although the design pillars are proposed by 12 factors nowadays, probably they are not going to be defined like this permanently. Much has been studied over the last decades trying to understand, through the concepts of neuroscience, which way architecture relates to people, in order to design and create better spaces for people. And much still must be studied. This way, with more knowledge, more solid the pillars are going to be to guide the conception of the design to this better architecture centered on people – an architecture where people’s bodies and minds are connected with the environment, where they intercommunicate and seek the same: balance – for the benefit and for the health of everyone.
Di Liegro et al. 2019 – Carlo Maria Di Liegro; Gabriella Schiera; Patrizia Proia; Italia Di Liegro. Physical Activity and Brain Health. Genes 2019, 10, 720;
Lin et al. 2022 – Jue Lina, Elissa Epel. Stress and telomere shortening: Insights from cellular mechanisms. Ageing Res Rev. 2022 Jan; 73:101507. doi: 10.10 16/j.arr.2021.101507. Epub 2021 Nov 1. PMID: 34736994; PMCID: PMC8920518;
Małczyńska et al. 2019 – Paulina Małczyńska, Zofia Piotrowicz, Dorota Drabarek, Józef Langfort, Małgorzata Chalimoniuk, The role of the brain derived neurotrophic factor in neurodegenerative processes an in the neuroregeneration mechanisms induced by increased physical activity. Postepy Biochem 2019;
TUNED 2021 – Healthcare Neuroscience Applied to Architecture, 27.10.2021 – 0000 ES F PR 01 17- TUNED, Lombardini22, Milan 2021;
Ruzzon 2021 – Davide Ruzzon, Emotion drive healing. Speech held by the architect Davide Ruzzon at the European Healthcare Design congress, London 2021;
Ulrich 2008 – Roger S. Ulrich, Biophilic design of healthcare environments. In S. Kellert, J. Heerwagen, & M. Mador (Eds.), Biophilic design for better buildings and communities (pp. 87–106). New York, NY: Wiley;
Ulrich 1984 – Roger S. Ulrich, View through a window may influence recovery from surgery. Science, New Series, Volume 224, Issue 4647,1984 (420–421).
By Clarissa Machado, Architect