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The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity

Roger Ulrich, Ph.D., Xiaobo Quan, Center for Health Systems and Design, College of Architecture, Texas A&M University
Craig Zimring, Ph.D., Anjali Joseph, Ruchi Choudhary, College of Architecture, Georgia Institute of Technology
The Center for Health Design, September 2004
Funded by the Robert Wood Johnson Foundation

Download PDF of 69-page report.

Download PDF of 100-page research abstracts table.  Supplement to 69-page report.

NEW! Download PDF of the Scorecard for Evidence Based Design Research.  A five-star rating system of the quantity/quality of the available research in the four different topic areas discussed in the report.

Summary

A visit to a U.S. hospital is dangerous and stressful for patients, families and staff members. Medical errors and hospital-acquired infections are among the leading causes of death in the United States, each killing more Americans than AIDS, breast cancer, or automobile accidents (Institute of Medicine, 2000; 2001). According to the Institute of Medicine in its landmark Quality Chasm report: "The frustration levels of both patients and clinicians have probably never been higher.

Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits" (IOM, 2001). Problems with U.S. health care not only influence patients; they impact staff. Registered nurses have a turnover rate averaging 20 percent.

At the same time, the United States is facing one of the largest hospital building booms in US history. As a result of a confluence of the need to replace aging 1970s hospitals, population shifts in the United States, the graying of the baby boom generation, and the introduction of new technologies, the United States will spend more than $16 billion for hospital construction in 2004, and this will rise to more than $20 billion per year by the end of the decade. These hospitals will remain in place for decades.

This once-in-lifetime construction program provides an opportunity to rethink hospital design, and especially to consider how improved hospital design can help reduce staff stress and fatigue and increase effectiveness in delivering care, improve patient safety, reduce patient and family stress and improve outcomes and improve overall healthcare quality.

Just as medicine has increasingly moved toward "evidence-based medicine," where clinical choices are informed by research, healthcare design is increasingly guided by rigorous research linking the physical environment of hospitals to patients and staff outcomes and is moving toward "evidence-based design". This report assesses the state of the science that links characteristics of the physical setting to patient and staff outcomes:

• What can research tell us about "good" and "bad" hospital design?
• Is there compelling scientifically credible evidence that design genuinely impacts staff and clinical outcomes?
• Can improved design make hospitals less risky and stressful for patients, their families, and for staff?

In this project, research teams from Texas A&M University and Georgia Tech combed through several thousand scientific articles and identified more than 600 studies - most in top peer-reviewed journals - that establish how hospital design can impact clinical outcomes. The team found scientific studies that document the impact of a range of design characteristics, such as single-rooms versus multi-bed rooms, reduced noise, improved lighting, better ventilation, better ergonomic designs, supportive workplaces and improved layout that can help reduce errors, reduce stress, improve sleep, reduce pain and drugs, and improve other outcomes.

The team discovered that, not only is there a very large body of evidence to guide hospital design, but a very strong one. A growing scientific literature is confirming that the conventional ways that hospitals are designed contributes to stress and danger, or more positively, that this level of risk and stress is unnecessary: improved physical settings can be an important tool in making hospitals safer, more healing, and better places to work.

A complete listing of references is also included.

Download PDF of 69-page report.

Download PDF of 100-page abstracts table.  Supplement to 69-page report. Posted May 2005.