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Hospital outdoor spaces: User experience and implications for design

October 2022
The Center For Health Design


Why does this study matter?
The impact of outdoor views and spaces on patient and hospital staff outcomes has been studied, but using outdoor areas for therapy programming  in post-acute and rehabilitation care requires further research to understand how best to help patients return to their preferred activities. Researchers used a pre-occupancy evaluation to collect information from patients, family, and staff involved with rehabilitation activities in the outdoor areas of an existing hospital to inform the design of a new facility.  The purpose of this study was to understand the perspectives of various user groups regarding how outdoor spaces impact patient experiences in a post-acute setting.

How was the study done?
Eligible participants included in-patients with a minimum of a 2-week stay, outpatients with a minimum of three visits, family with a minimum of 3-visits, staff with a minimum of 1-year of employment at the facility and volunteers. Semi-structured interviews with these user groups first addressed topics including outdoor space accessibility, frequency of use, and activities, safety, and social interactions. Participants were asked how both outdoor views and direct access to outdoor spaces impacted their   mood and treatment experiences. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis and qualitative data analysis software. Descriptive analysis was used on demographic data.


So what do we learn from the study?
After completing a total of 74 interviews, researchers identified three overarching themes:
First, outdoor spaces and views benefit patients by helping them focus on life beyond their illness – and were especially important to those not able to access outdoor spaces. The second theme captured design elements including: year-round access or at least year-round visual access to outdoor spaces; variety including: trees, fresh air, birds and wildlife, greenery, flowers, water elements and sunlight; autonomous access including a balance between challenging grades that support therapy and those that create barriers for patients with mobility issues; safety stations and clear signage for trails or paths starting within the facility varied seating options for social interactions and separate spaces for patients/families and staff to avoid awkwardness. Finally, deliberate design of therapeutic outdoor spaces can promote healing and recovery. Both patients and staff mentioned their appreciation of the option to using outdoor spaces for therapy and some recommended including not only spaces for individual activities, but also covered areas and areas for small outdoor classes.


Can we say the results are definitive?
Although the results are not definitive, they can be used to inspire the integration of outdoor spaces in continuing care facilities. There are two primary limitations to be considered. First, this is a single-site study and may not be generalizable to other locations or populations. Secondly, participants who elected to be interviewed may have been more likely to use outdoor spaces and may not represent the full complement of user perspectives.  


What’s the takeaway?
Deliberate design of outdoor spaces and access to these spaces can not only provide positive distraction to patients, but can also be part of an intentionally designed therapy program. According to participants, patients often found the outdoors motivating suggesting outdoor spaces have the potential to support rehabilitation therapy goals. Including a variety of typological features provides a real-world setting for a variety of passive and active activities and leisure with visitors that can improve user experiences and optimize patient outcomes. Conducting a pre-occupancy evaluation or similar type of assessment in such a strategic way, will hopefully result in a new facility that meets the needs of a variety of user groups.


Interested in the topic? Visit The Center for Health Design Knowledge Repository for more.


Summary of:
Tseung, V., Verweel, L., Harvey, M., Pauley, T., & Walker, J. (2022). Hospital outdoor spaces: User experience and implications for design. HERD: Health Environments Research & Design Journal, 15(1), 256–267. https://doi.org/10.1177/19375867211045403



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