Lit Review

We know that one facet of green building is to better protect the health and welfare of the inhabitants of the built environment over traditional construction methods, given its concern with unnecessary exposure to chemicals and the improvement of indoor air quality among others. But what effect does knowing that a space was built with these things in mind have in making people feel appreciably better? Is there any way to know that it's the perception of a healthier built environment that's improving people's health over the fact that the built environment is simply healthier? I guess what I'm proposing to examine is a sustainability placebo effect, if you will, if such a thing is even possible.

To that end, I have started to examine some research which indirectly addresses these topics since I have found very little which directly applies:

Adams, A. (2010). Kids in the atrium: Comparing architectural intentions and children’s experiences in a pediatric hospital lobby. Social Science & Medicine, 70(5), 658-667.

This paper addresses research conducted at The Atrium, an eight-story addition to the Hospital for Sick Children in Toronto completed in 1993, through both a review of architectural documentation and interviews with the atrium’s designers as well as evaluations by children who use the space. The authors place The Atrium in the context of late-twentieth century shopping malls and other consumerist spaces and discuss their findings including the social uses of the space, its role in wayfinding and issues of connectivity and distraction. Although sustainability is not directly addressed, The Atrium contains many things – gardens, ample natural light, visual connection to the outdoors – which can be considered sustainable. They ultimately ask if the role of hospital design is to create healing spaces instead of shopping malls and, if so, what implications this has on the current model of hospital design.

Becker, F. (2008). The Ecology of the Patient Visit: Physical attractiveness, waiting times, and perceived quality of care. The Journal of Ambulatory Care Management, 31(2), 128-141.

I have been familiar with this research for several years now, though this is the first time that I have actually read the article. The research, which involved six clinics – three deemed “attractive” and three “unattractive” by non-design research students prior to the study – at the Weill Cornell Medical Center on the Upper East Side of Manhattan, aimed to discover the connections between actual and perceived waiting times to be seen by a caregiver and both the attractiveness of the spaces as well as an overall impression of the quality of care received. Actual times were recorded by observers over a 15-week period and the others were collected through voluntary surveys returned by patients. Researchers found a significant correlation between physical attractiveness and both overall satisfaction and relief of patient anxiety, as well as a noticeable difference in the perceived versus actual wait times where patients overestimated short wait times and underestimated long wait times. It should be noted that one of the attractive clinics was stated to contain “many sustainable finishes and materials,” although this is the only overt reference to sustainability. This model of research seems particularly exciting, and I can envision a similar survey which seeks to correlate a clinic’s sustainability with perceived quality of care.

Caspari, S. (2006). The aesthetic dimension in hospitals: An investigation into strategic plans. International Journal of Nursing Studies, 43(7), 851-859.

This paper concerns an investigation into the strategic plans of Norwegian general hospitals, where the researchers analyzed the documentation provided to them in order to determine to what extent aesthetics played a role in the design of the buildings and how these issues were ultimately prioritized.  The researchers created a matrix of ‘aesthetic categories’ – harmony, food, art, rooms, light, colors, design, sound, nature, aesthetics and quality (aesthetics was given its own category to chart specific mentions of the term) – each with its own subcategories, and noted mentions of each in the strategic plans. They concluded that all categories were significantly underrepresented (“almost absent”), though it should be noted that just because these categories were not overtly mentioned does not mean that they were not considered during the design process. However, this model of research does present a potentially interesting way to investigate mentions of sustainability in strategic planning and to what end such mentions may lead.

Shepley, M. (2009). Eco-effective design and evidence-based design: Perceived synergy and conflict. Health Environments Research and Design Journal, 2(3), 56-70.

While this article should prove to be extremely valuable, the copy which I received via inter-library loan is almost unreadable and I hope to be able to obtain a better copy soon. From what little I’ve been able to read without getting a headache, the authors attempt to address the intersection of eco-effective design and evidence-based design and determine both the amount of overlap (which seems substantial) and its ultimate result (either supportive or in conflict). If I may quote: “Though a number of studies that assess either sustainability in the built environment or the relationship between building design and health outcomes have been completed recently or are currently underway, few if any studies have addressed both EBD and EED in relation to the other.” I hope to be one of the first!

Ulrich, R. S. (2001). Effects of healthcare environmental design on medical outcomes. In A. Dilani (Ed.) Design and Health: Proceedings of the Second International Conference on Health and Design (pp. 49–59). Stockholm, Sweden: Svensk Byggtjanst.

This conference paper by Ulrich is the most thorough of a series of articles and lectures given on a similar topic; namely, a review of the existing research available at the time concerning environmental characteristics which influence health outcomes and an attempt to formulate a broad theory of “supportive healthcare design” which addresses these issues. Ulrich touches on the usual suspects – noise, views to nature, adequate sunlight, room occupancy size, flooring materials, furniture arrangements – in order to demonstrate that there is a growing body of knowledge which can be used to formulate an active method of design which fosters control, promotes social support and provides access to nature. It is interesting that Ulrich never overtly addresses the issue of sustainability, although one could argue that an environmental sensitivity exists in his theorizing.