'Simple interventions have an effect on patients' feelings of stress'

In 2021, the study The influence of design principles on patients started. The research was partly funded by the Deltapremie, a prize won by Professor of Facility Management, Mark Mobach. It was awarded to Mobach in 2019 to stimulate research into healthy buildings. There are more and more single rooms in hospitals. Architects, designers and hospitals use different design principles for the interior. However, decisions are usually made based on intuition and experiences. For this research, the design principles Feng Shui, the Golden Ratio and Evidence-Based Design were investigated and compared to an existing single room in the University Medical Centre Groningen (UMCG). It has never been studied what these, in the case of Feng Shui and the Golden Ratio, age-old principles do to the stress levels and health of patients.

3D simulation

Zijlstra mainly conducts research in hospitals. Doing physical research in such an environment is sometimes difficult, because for randomised experiments you need many different patients and for that reason also many available hospital rooms. "This is why we created a lifelike 3D simulation of the existing single room at the UMCG for this study," says Zijlstra. "Together with measurement agency Geomaat, the existing room was mapped out in detail and the correct dimensions were determined. Subsequently, 3D artist Bart van der Zwaag recreated the room in a digital environment. Lifelike 3D situations of the three design principles were also created, in collaboration with top experts, Master Dr. Sabine Kullak from the International Feng Shui Association (Singapore) and London-based Ab Rogers Design.

The characteristics of the three design principles have been applied to the existing room. Via the Dutch Patient Federation, an extensive test panel has been compiled and has been randomly assigned to one of the four designs. "The members of the panel were shown a two-minute video and photos and a description of all the facilities in the room. The panellists then filled out an online questionnaire about how they experienced the room. By comparing the results of different design principles and the current hospital room, it can be determined in which room patients experience less stress than in the existing single room at the UMCG," explains Zijlstra. "With our research, we have been able to determine that rooms that are designed according to the principles of Feng Shui and Evidence-Based Design reduce stress in patients. In the room where we applied the Golden Ratio, there was no effect. Patients in this room did not experience less stress compared to the existing room in the UMCG."

Positive energy flows

What do the design principles mean in concrete terms for the design of a single room? Zijlstra: "Points of attention for Feng Shui in hospitals are, for example, the use of earthy colours, natural materials and round shapes so that positive energy can flow well through a room. Negative energy flows are avoided. In practical terms this means that, for example, no clock is placed directly in front of a patient, because it can cause negative energy. The Golden Ratio is more of a mathematical design principle. With this design principle, all rectangular planes in a room must comply with a certain ratio. When this is the case, a room looks more attractive, or so the thinking goes. The design principle Evidence-Based Design uses existing scientific research. For example, previous research has already shown that a view of nature is important for patients. More daylight in the room also helps in the recovery process. The positioning of a bed, with a view of greenery and the door to the hallway, is important as well. We applied the most distinctive features of the different design principles to the 3D environments.'" 

Immediate effect

The researchers measured the greatest effect in the design principle of Evidence-Based Design. Zijlstra: "We have measured an immediate effect there. This means that the design of a room had a direct effect on lowering a patient's stress level. Such was the case with Evidence-Based Design. But sometimes the impact of a hospital room is more complex and the effect can be explained by a psychological mechanism. The design primarily does something with the patient's experience. We have been able to establish this with Feng Shui. Patients indicated that they found that the room looked comfortable and promoted social support. This ensured that patients experienced less stress. Compared to the existing room, we have adapted the colours and the shapes and the materials of the table and chair. We also placed the seating area for family and friends in a different position, in the corner of the room instead of behind the bed. Patients found the space more pleasant due to the different design and therefore experienced less stress. So with fairly simple interventions, you can reduce the feelings of stress in patients."

Added value

The added value of this research is that designers, architects, policymakers and hospitals can make choices as to what a single room should look like based on the results. “The uniqueness of this project is that the age-old principles have now actually been investigated. Thus making clear what works and what doesn't “, Zijlstra adds. The UMCG is currently working hard to apply the results to the new designs of the rooms. "They certainly have the intention to design rooms based on the environmental characteristics of Evidence-Based Design and Feng Shui," Zijlstra says. “Jan Bouwhuis, Director of Construction & Facilities, says he is very happy with the results of the study. Especially since they can now base their choices on scientific evidence. The research fits in perfectly with current events, because they are now working on a major renovation."

Follow-up research

Zijlstra and the Facility Management research group would like to follow up on the research. "We have now investigated which design principles have a stress-reducing effect, but we would like to know, for example, whether the principles also directly contribute to a faster recovery rate of patients. Moreover, we did not measure any effect for the Golden Ratio design principle for this study. For the design of this room, we adjusted the proportions according to the prevailing Golden Ratio principles but the rest of the interior of the room has remained the same. By applying the principles, an emphasis can be placed on the unattractive interior features in the room. If you combine the Golden Ratio with the principles of Evidence-Based Design or Feng Shui, you may be able to achieve an effect. This will require additional research," concludes Zijlstra.