7th UK CARE Annual General Meeting UK Chinese Association of Resources and Environment Greenwich, 15 September 2007 Sustainable and Therapeutic Environment Design for Hospital Architecture in China Chao Jun 1, Liu Deming 2 1 School of Architecture, Harbin Institute of Technology, China; chaojun@hit.edu.cn 2 School of Architecture, Harbin Institute of Technology, China; liudeming@hit.edu.cn ABSTRACT With the improvement of medical science and technology, the healthcare requirements in modern society push the hospital architecture into a bloom era at a tremendous speed. A large amount of modern General hospitals have been set up in the cities of China. However, the operation of hospital buildings need large energy consumption and produce a large mount of dangers wastes which may cause great influences on the ecological environment. How to establish an efficient way to keep the hospital buildings sustainable and economical became a broad concern for the architects and healthcare providers. This paper introduces Sustainable and therapeutic environment theory and brings forth organic hospital by the principles of design by nature. Some recommended models of hospital were also introduced and analysed in order to make architects grasp the main point and make practical use in hospital architectural design. KEYWORDS hospital architecture; sustainable; therapeutic environment; nature THE THEORY BACKGROUND OF SUSTAINABLE AND THERAPEUTIC ENVIRONMENTS The Sustainable has generated an avalanche of literature in the past fifteen years. The realisation of sustainable buildings is promoted all over the world according to the issues of the World Health Organisation. Many contributions on sustainable development however, are rather vague and less well focused. Sustainable building does not just mean to reduce the energy consumption of buildings but also keep the buildings better to health of the earth and well-being of mankind themselves. For the hospital, human s healing and recovering congregation places, the sustainable building focus on three aspects: flexible use of buildings, less negative influence on the city ecological system and the improvement of occupants health condition in the hospitals. The realisation of sustainable hospitals should be also supported and promoted. Therapeutic Environment theory stems from the fields of environmental psychology (the psycho-social effects of environment), psychoneuroimmunology (the effects of environment on the immune system), and neuroscience (how the brain perceives architecture). Patients in a hospital are often fearful and uncertain about their health, their safety, and their isolation from normal social relationships. The large, complex environment of a typical hospital further contributes to the stressful situation. Stress can cause a person's immune system to be suppressed, and can dampen a person's emotional and spiritual resources, impeding recovery and healing. Sustainable design focuses on dealing with the physical environment of buildings and adopts vernacular or high technology in practical design, and on the other side, therapeutic environment give more priority to psychological and social factors in architectural design. The integration of principles of sustainable and therapeutic environment can make an effective way to heal our environment and also bring benefit for us. THE HEALING AFFECTS OF HOSPITAL ENVIRONMENTS 1
Sustainable and Therapeutic Environment Design for Hospital Architecture in China In the scope of healthcare architecture, there are more concerns on the potential healing properties of hospital environment, and these healing properties have inspired a whole new design approach that is generally referred to as Evidence Based Design. Evidence Based Design (EBD) had a huge impact on the thinking of hospital architects and facility planners and hospital managers. A research team leaded by Ulrich found rigorous studies that link the physical environment to patient and staff outcomes in four areas: 1. Reduce staff stress and fatigue and increase effectiveness in delivering care 2. Improve patient safety 3. Reduce stress and improve outcomes 4. Improve overall healthcare quality [1] Lawson Brawn and his associates also carried out a research on the hospital healthcare environment and its effects on patient health outcome. Besides detailed investigates of the evidence for healing environment, this research also brings forward design principle and the cost of facilities were tested in order to give the evidence of economic value in healing environment design [2]. The healing affects on hospital architecture is also well know in china and its principle has been adopted in hospital design intentionally or unconsciously by Chinese architects. But it is far from forming a systematic theory in architectural markets. It is essential to broadcast and introduce the idea of healing environment to architects. SUSTAINABLE ARCHITECTURAL ENVIRONMENTAL FOR HOSPITAL DESIGN Flexible use of buildings Unlike the Western world, typical general hospital in china often scaled up to 800-1000 beds. With so large scale, they often occupied the most density and complicated urban area. It is very difficult to find a place to accomplish the development and renovation of hospital. But for hospital, it is inevitable to expand or renovate. So how to make hospital flexible is the key problem to solve. The Nucleus system may be the best development unit model for large hospital in UK. But in china there is not always enough site for Nucleus model to extend. Renovation will be most manners for flexible use in China. Another way of setting up a brand new branch hospital long distant way even in the suburb is broadly adopted for huge hospitals in large cities today. Ironically, this developing way burdened the traffic in the city, and broke the rules of sustainable design. Renovation only suits for small scale expansion and also influence the normally operation of the hospitals. Actually, the ideal planning model needs to leave some places for the future development. We should make hospital architectures more organic and make it growth like a tree. Heal the environment and heal us Environment and human is an integrative whole body. The world around us is damaged because our activity and desire impel us suck up the nutrition and broke up the balance of the earth. This makes the unhealthy environment that also do harm to us. Sustainable buildings will play an important role in healing the environment, and healing our environment also brings benefit for us. THERAPEUTIC ENVIRONMENT ELEMENTS AND DESIGN The human in the built environment can be regard as a very complex system. If our task is to try to understand the influence the architectural experience on human health or the outcome in a hospital, then we need a system model of the environment. The following diagram gives this model (see Figure1). This model illustrates all kinds of interaction of things that need to be accounted for in trying to understand the influence of the architectural experience on wellness. We need some CARE 2007 Greenwich 2
Sustainable and Therapeutic Environment Design for Hospital Architecture in China significant measurement to sort out what are the major influences and scientific knowledge base to explain, measure, and predict outcomes. To do this as a better underpinning for architectural practice, we need to be able to develop and test models elements of these systems and put them together. Figure 1- Model of the Physical Environmental influence on human DESIGN WITH NATURE FOR THE HOSPITAL THERAPEUTIC ENVIRONMENT Learning from nature is the inherent ability of human. The contemporary architects advocating the Green building is prone to choose vernacular culture and material to form their works. For example, the Kaedi Regional Hospital in Kaedi, designed by Fabrizio Carola, indigenous influences in a series of interconnected domed circular buildings housing patients wards (see Figure 2- Kaedi Hospital, Kaedi, Mauritania Figure 2- Kaedi Hospital, Kaedi, Mauritania )[3]. The buildings were set in a pattern suggestive of anthropomorphism and leaf-like patterns in traditional thatched dwellings. Except for the reason of ecological reason, it does exhibit a natural aesthetic for hospital building. Because human originated and developed in the nature and the esthetics has the inherent connection with the natural elements such as the tree, mountain, river, flower etc. Compared with man-made environment, beautiful natural environment is easier for man to appreciate in common. Weather in the west culture or the east culture, there are aesthetic trends advocate the natural beauty. In china, Tao s attitude to the nature influenced deeply Chinese culture, and its pursuing an aesthetics of peaceful, harmonious, natural way of living is also a brilliant treasure for the modern society. Taoists view life and death as simply different stages, or manifestations, of the Absolute Tao and consequently advocate a life in accord with nature. The serenity of such a life stands in sharp contrast to the life of public service advocated by Confucius. Tao s attitude to the nature is also the base of Chinese traditional medicine. By thousands of years, the ancients found that Tao s CARE 2007 Greenwich 3
Sustainable and Therapeutic Environment Design for Hospital Architecture in China living way is good to human s health, and can even heal some chronic and stubborn diseases. In the west, many researches have been made to testify the therapeutic function of the natural environment can shorten the time in hospital for patients and release their pains. Thus, we can make a conclusion that a natural aesthetic have positive influence on the human health condition. Many people involved in trying to make hospitals a healing place retain the old-aged belief that nature heals. This belief can be seen simply in the daily ritual of bringing flowers to the recovery patient. Investigations of aesthetic and affective responses to outdoor visual environments have shown a strong tendency for American and European groups to prefer natural scenes more than urban views that lack natural elements. Views of vegetation, and especially water, appear to sustain interest and attention more effectively than urban views of equivalent information rate. Because most natural views apparently elicit positive feelings, reduce fear in stressed subjects, hold interest, and may block or reduce stressful thoughts. They might also faster restoration from anxiety or stress. The famous records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences. Twenty-three surgical patients assigned to rooms with windows looking out on a natural scene had shorter postoperative hospital stays, received fewer negative evaluative comments in nurses' notes, and took fewer potent analgesics than 23 matched patients in similar rooms with windows facing a brick building wall [4]. It is published in Science by RS Ulrich. The author drew a conclusion that hospital design and siting decisions should take into account the quality of patient window views. In China, citizens have accustomed to the high buildings and heavy traffic roads because of the high density population in the cities. Some patients are prone to select streets or plazas as their favorite views. When I do the survey, I found the older and the young are most easy to do this selection. Analyzed this result, I guess the patients of oriental people are more fear of loneliness than the west, so they want to communicate to each other from the view of the window, and the Natural elements for an Asian should include active facilities and lively scenes in the city. Hospital environment is rather opened to the society than closed like a prison. Healing garden Healing gardens are an age-old therapeutic intervention designed for the restoration of the body, mind, and spirit. The traditional healing garden conveys the concept of establishing a transactional connection to nature. Human first cultivated plants in a garden in Persia in 3,000 B.C. The first gardens were magical, religious places. Through the centuries the garden came to symbolize the highest of human aspirations. Restorative gardens are for the healthy as much as the sick, and for all ages. For the healthy, the gardens encourage sociability, promote relaxation and contemplation for the solitary visitor and establish a sense of community for the inhabitants in the hospital. For the sick of body or troubled of spirit, a garden can relax and soothe, as has been proven from authority to the present. Next key problem faced us: how to design a healing garden or make garden a more healing place by arrangement? The efficient way is to imitate nature. However, the scope of this kind of garden is normally limited. It is not easy to mimic nature in a limited garden space. Thereby, some natural elements can be introduced such as water, trees, bridges, lights and other garden furniture. Arranging all these elements by natural will make the garden amazing and release the stress of patients. For example, Huashan hospital in shanghai established a garden by traditional Chinese garden design manner to attract patients and make life more vibrant (see Fig 3). Water scene can be make patients more peaceful, so make use of water in the hospital design if possible. The cons of water consists its potential dangerous for brooding eggs of mosquitoes. However, fishes in the water will reduce the mount of the mosquito eggs greatly. Healing garden is different from other green spaces. CARE 2007 Greenwich 4
Sustainable and Therapeutic Environment Design for Hospital Architecture in China Figure 3- the Healing Garden of Huashan Hospital The space between the buildings For most hospitals, it is difficult to find a whole large garden space in the hospital site. The space between the buildings becomes more prominent for the hospital environment. The building shape and its plan will determine these places and these spaces also provide natural light, ventilation and view for the buildings. Preserve some space for building to breathe and form the building like a tree is common cognized idea. The follow example is a competition project I have attended for The South West hospital in China. We conceived it with preservation of several open yards so as to make the building contact nature and got better ventilation. Besides, Hospital Street has been introduced in the plan, that forms the axis of the building and in the mean time give a good view for the patients (see Fig 4). Figure 4- the Plan of South West hospital Master plan is very important for a large scale hospital to arrange healing gardens. Systematic design and make use of the roof garden can also make the environment amazing see Fig 5. Figure 5- the garden of Shu Guang Hospital, China CARE 2007 Greenwich 5
Sustainable and Therapeutic Environment Design for Hospital Architecture in China CONCLUSIONS Human is created by nature, and the connection to the nature is inherent under the human s body as to their spirit. In health care building design, the connection can also affect medical outcome and well-being of the people, in order to make environment more healing, it is necessary to learn from nature and to design with nature. Acknowledgement Thanks for Professor Jian Kang and PhD students of Sheffiled University, Hui Xie, Bo Wang, who had help me to prepare the paper and attend the conference. Thank for Professor Bryan Lawson, Judith, they inspired me and give my valuable ideas. References 1 Roger Ulrich.,Xiaobo Quan. The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity.2004,3. 2 Lawson B.R.,M. Phiri. The Architectural Healthcare Environment and its Effects on Patient Health Outcomes. London: The Stationery Office,2003,19-20. 3 Http://Archnet.Org/Library/Files/One-File.Tcl?File_Id=461. 4 Rs. Ulrich. View through a window may influence recovery from surgery.[j]. Science. 1984, 224:420-421. CARE 2007 Greenwich 6