Designing hospitals that support patient health

An expert in architectural design and theory, Dr Rebecca McLaughlan’s research shows a fascinating link between the built environment, our experiences of healthcare and a patient’s physical and emotional wellbeing.

Image of Rebecca McLaughlan

We might not always notice its effects, but the built environment can alter our mood and behaviour in subtle but significant ways.

A confined, busy room can heighten an already stressful situation. An echoey open space can intrude on our privacy. Dr Rebecca McLaughlan explains that in healthcare settings such as hospitals, the built environment can have a surprisingly powerful influence on the experiences of a patient, their family and medical team.

“Architects have long understood that the quality of the built environment can have a profound effect on people and their wellbeing. If people feel uncomfortable in an environment, the ramifications of that discomfort may be severe, even if this is difficult to measure.

“For example, imagine having to sit for days in a hospital room you really dislike. Would this make you feel agitated? Would you feel encouraged to sit past visiting hours or would you be in a hurry to get out of there?

“Or imagine trying to process complex information in the middle of a hospital’s circulation space. Would you feel like you could take the time to ask all of the questions that you had?”

As an experienced architect and esteemed researcher, Rebecca is particularly interested in how the built environment impacts people during times of intense vulnerability. This includes mental health, palliative and paediatric patients and their support networks.

“My work seeks to understand how the built environment can better support people through these difficult life experiences.”

Keeping children engaged in care

According to Rebecca, researchers are just beginning to uncover the many ways in which the built environment can impact patient wellbeing.

For example, over the last decade or so, architects have been encouraged to create ‘positive distractions’ within healthcare environments—such as gardens, artworks or aquariums—to distract patients from the stresses associated with their illness.

While the value of a distraction was originally understood by the length of time it could hold a patient’s attention, Rebecca’s recent research has uncovered evidence for engaging people—especially children—in new ways.

“In a study recently conducted at the Melbourne’s Royal Children’s Hospital— undertaken by a team at the University of Melbourne (where I was previously working) in partnership with Lyons Architects – we found that the value of distraction was different for kids.

“By putting features into a hospital that kids wouldn’t expect to find there—such as movie theatres, aquariums and animal enclosures—it didn’t just distract them, it reframed for them the very idea of a hospital.”

Creating interesting spaces within hospitals can have a strategic impact on children’s long-term health by keeping them engaged in care.

“These interesting spaces made kids more willing, even excited, to return for their follow-up appointments.

“Discovering that architectural strategies can shift perceptions so significantly that kids actually want to visit a hospital is meaningful since absenteeism from follow-up appointments can exacerbate the severity and cost of medical treatment.”

Insights from researchers such as Rebecca and her collaborators are contributing to a growing evidence base that can inform the architectural designs of the future. As a result, hospitals are paying increasingly close attention to their built environment as an important factor for patient health and outcomes.

“Our research will provide evidence for those who design and commission hospitals regarding the importance of including unique features when setting construction budgets for new healthcare facilities.”

Architecture with empathy

In 2019, Rebecca brought her valuable research expertise to the University of Newcastle. The Newcastle region, she explains, provides a perfect position from which to connect with hospitals and key health providers along Australia’s east coast.

The University also offered Rebecca a tight-knit research community that could support her most recent research focus: examining the environments in which palliative care is delivered.

“Dying or losing a loved one is one of the most difficult challenges we must face. Yet contemporary architectural responses seldom acknowledge this.

“Palliative care is often delivered within hospital wards of the same, standard design used throughout the hospital. This architecture does nothing to alleviate the stresses of these life experiences and can actually exacerbate it.”

Supported by a Discovery Early Career Researcher Award (DECRA) fellowship from the Australian Research Council, Rebecca’s research project aims to discover how palliative care spaces can be redesigned to better suit the physical and emotional needs of patients and their families. Rebecca says the project is also motivated by personal experience.

“I’ve observed life-altering diagnoses delivered in busy hospital corridors where anyone could overhear them. I’ve found myself having to communicate devastating news over the phone to friends and family members while standing in a corridor wedged between a laundry room and a kitchenette. Architecture can offer so much more than this.

“My DECRA project will find out what patients, their families and medical teams need from their built environment and how the complexities of project procurement (budgets, policy, procedures around project briefing, etc) must be navigated to enable better environments for palliative care to be built.”

Overcoming roadblocks to success

Alongside hospital procurement complexities, one of the biggest challenges in Rebecca’s research is the ability to accurately measure the emotional impact of the built environment.

“We can measure things like the distance a nurse must walk during a day, or how the relationship of one space to another can impact communication between medical teams. But the question of how our built environment makes us feel is much more complex.

“To date, no one has developed a measurement tool sophisticated enough to quantify this with any certainty.

“Subjectivity also makes measurement more complicated. People bring different life experiences, preferences and associations when responding to the built environment. Is one set of design guidelines even capable of responding to people from different cultures, for example?”

Fortunately, Rebecca and her collaborators are committed to uncovering solutions, asking the tough questions and championing the often-misunderstood role of architecture in healthcare.

“Architecture impacts the delivery of medical care in subtle but significant ways and few researchers are asking these types of difficult questions, even though we know they can impact people on a very personal level.

“There will be no easy solutions, but my DECRA project hopes to unravel these complexities a little further, to bring the field closer to a fuller understanding of how design can be used to benefit patients and families.”

The University of Newcastle acknowledges the traditional custodians of the lands within our footprint areas: Awabakal, Darkinjung, Biripai, Worimi, Wonnarua, and Eora Nations. We also pay respect to the wisdom of our Elders past and present.