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Benjamin & Marian Schuster Heart Hospital, Kettering, OH

September 2015
EDAC Advocate Firm Project
Jain Malkin Inc.


Firm's role on the project:  Planning, Programming, Architecture, Design, Interiors 

EBD Goal

To change a patient’s hospital experience through specific environmental design features aimed at reducing stress.


The concept of EBD was new to many of the hospital staff, but they put aside their individual preferences for the good of the patient in order to reach their goals. Hospital leadership believed an EBD approach would facilitate positive outcomes in a patient’s physical, emotional, and spiritual health and saw a benefit to the staff in the reduction of stress and fatigue. Prior to beginning design work, a literature review was conducted using numerous sources. The research platform was derived from the neurosciences, environmental psychology, psych neuroimmunology and well-established EBD best practices.


Research found staff often associate higher noise levels with higher levels of stress and work interference (Bayo, Garcia, & Garcia, 1995; Norbeck, 1985). A hybrid layout, using decentralized charting stations outside patient rooms, and nursing “pods,” along with a central nurse station provided quiet areas for individual work, yet maintained spaces for group interaction and mentoring. Nurses are afforded a glimpse of views to the outside through windows at each charting station. Patient sleep and staff accuracy were also improved through use of high-NRC-rated ceiling tiles.
Staff fatigue was considered when designing nursing units. Two studies showed that time saved from walking was translated into patient-care activities and interaction with family members (Trites et al., 1970). Regularly spaced supply closets reduced walking resulting in a decrease in fatigue and an increase in overall job satisfaction.
Stress can directly and adversely affect other outcomes. Unhealthy effects of stress are related to detrimental psychological, physiological, neuroendocrine, and behavioral changes associated with stress (Gatchel, Baum & Krantz, 1989; Ulrich, 1991). Positive imagery expressed in representational art and specific design features carried into patient care areas reduced stress levels for patients, families and staff. “Art has the ability to touch us deeply, and profoundly, in our most vulnerable moments” (Kathy Hathorn, 2008). Prominent feature walls in transitional corridors between lobbies and nursing units combined with auditory sounds of nature put visitors in a relaxed state of mind before encountering patients and staff.
The pre-design research and resulting design decisions had a positive effect on satisfaction surveys. Ratings from both patients and staff resulted in significant increases when pre-and post-occupancy data were compared.