Good design in health infrastructure

Research shows good design makes positive contributions to a patient's wellbeing and recovery, visitor experiences, staff effectiveness and the operation of healthcare facilities (6).

Features include access to natural light, fresh air and views to nature; leading to quiet, privacy and control over one's environment; clear wayfinding and a sense of place.

Integrating art and nature can also reduce stress, alter moods and have a positive physiological impact on staff and consumers.

Good design also has positive impacts on health professionals.

Prof Bernhardt cites research that showed prior to the redesign of the Royal Children’s Hospital, every staff member was being stopped an average of five times a day to help patients and family members find their way around the hospital.

‘So if you get that redesign part right, all of a sudden that’s gone, because people know their way around.’

Explore the Royal Children’s Hospital expansion project, which has been highly commended in the 2023 Partnerships Awards.

In the late 1970s medical sociologist and researcher Aaron Antonovsky set out to measure how an individual views life and maintains their health in specific environments through a sense of optimism and control.

His research (1) into the causes of health and wellbeing resulted in a cohesive model he called ‘salutogenesis’, derived from the Latin salus (meaning health) and the Greek genesis (meaning origin).

The model measures an individual’s health and wellbeing based on three elements:

• comprehensibility – a person’s sense of order, clarity and structure
• manageability – an individual’s sense of control over their situation and surroundings
• meaningfulness – incorporation of factors that bring meaning to an individual’s life such as family, friends, art and music, recreation and spirituality.

Antonovsky summarised the impact of salutogenesis as ‘a measurable aspect of design that can help people operate at peak performance and help them to maintain physical and mental wellbeing. It is the ultimate investment in people in an architectural sense.’

Based on a set of principles developed by Stephen Kellert (2), biophilic design connects the design of the built environment with our affinity with nature.

Researcher Roger Ulrich famously wrote in his 1984 paper ‘View Through A Window May Influence Recovery from Surgery’ (3) that something as simple as a view out to nature could aid healing.

The practice of biophilic design includes applying a range of design strategies to allow a direct and indirect experience of nature in the built environment.

It originates ‘in the recognition of how much human physical and mental wellbeing still relies on the quality of our species’ connections to the natural world of which we remain a part.’ (4)

Co‑design is the process of bringing designers and users together to share ideas, learnings and approaches based on the understanding that people with lived experience and industry professionals have equal value and decision‑making is shared.

Through co-design, project teams can achieve a fuller understanding of a situation, leading to a clearer problem definition and outcomes where multiple perspectives are built into design decisions.

Healthcare facilities developed using a co-design process are more likely to be fit for purpose and support the health and wellbeing of diverse communities with different functional and cultural needs.

In Victoria, co‑design is now mandated for mental health service and facility design. The expectation is that people with lived experience will be involved in the decisions that impact them (5).

Prof Bernhardt says the measurement and evaluation of design and its benefits are a critical next step for architects, health services and planners in the health sector.

‘If we have a brief – and functional briefs that really get to the core of what you’re trying to change – then it seems absolutely imperative to me that you have to check and know whether you met that brief.

‘There is a role for consumers, clients, architects and staff to contribute to the measurement of good design,’ says Prof Bernhardt.

Asked about what is found to be effective, Prof Bernhardt says: ‘It’s got spaces that make you want to explore. Access to positive and stimulating environments… an environment that gave you choice to be physically active, socially active, cognitively active.’

Prof Bernhardt is Co-head of The Florey’s Stroke research group. She is keenly involved in researching how treatments and hospital environments can help people recover well after a stroke. Much of the research takes place within the Neuroscience Optimised Virtual Environments Living Lab (NOVELL), a virtual health facility where various environmental conditions can be tested.

After beginning her professional life as a physiotherapist Prof Bernhardt became interested in how built environments impact treatment and recovery.

Stefano Scalzo is the Executive General Manager of Infrastructure Planning at the Victorian Department of Health where he oversees the Service and Capital planning for Victoria's health infrastructure. He leads a team of experts providing authoritative advice on the conceptualisation and development phases of capital projects up to and including Strategic Business Case phase.

Stefano is committed to design-led innovation in the provision of health service delivery.