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Impact of the Architectural Design
of Hospital Built Environment on the
Behaviour & Psychology of Cancer
Patients
Dissertation Submitted by Manishankar Datta
Reg No: 070901160
B. Arch IX Semester ‗A‘
Manipal School of Architecture and Planning
Manipal University
November 2011
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CERTIFICATE
We certify that the Dissertation entitled “Impact of the
Architectural Design of Hospital Built Environment on the Behaviour
& Psychology of Cancer Patients”, that is being submitted by
Manishankar Datta (Reg No. 070901160), in the IXth Semester of
B.Architecture undergraduate programme, Manipal School of
Architecture and Planning , Manipal University, Manipal is a record
of bonafide work, to the best of our knowledge.
------------------------------ -----------------------
Dr Nandineni Rama Devi Dr. N. K. Garg
Faculty in charge Director
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Acknowledgements
I would like to thank Dr Nandineni Rama Devi my guide for this dissertation.
I would like to acknowledge the contribution of the following people:
Sanghamitra Roy, Associate Professor, Manipal School of Architecture and
Planning
Deepika Shetty, Associate Professor, Manipal School of Architecture and
Planning
Dr. Gautam Bhattacharya, Oncologist, Cancer Centre Welfare Home and
Research Insitute
Anjan Gupta, Design Principal, Anjan Gupta Architects
Dr. Donald J Fernandes, Professor and Head of Department of Oncology,
Shirdi Sai Baba Cancer Hospital, A constituent of Kasturba Hospital, Manipal
Doctors at Shirdi Sai Baba Cancer Hospital, Manipal
Doctors at Cancer Centre Welfare Home and Research Institute, Kolkata
The Medical Superintendant and Administration of Kasturba Hospital, Manipal
for permission and co-operation in conducting the Case-Study.
Prof (Dr.) Garg Director, MSAP for his support.
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Abstract
The main aim of this research paper is to establish the criteria for designing an
environment targeted at the patient‘s psychology that helps them feel
comfortable and at home while combating a debilitating disease like
Cancer. This study is directed at the contribution of architects in reducing
stress in patients and influences their psychology in a positive way.
Cancer is a dreadful disease that affects millions of people all over the world.
Cancer knows no political, religious, caste, colour, race boundaries. It affects
people from different economic segments and a varied age group. Cancer
patients spend a lot of time at hospitals depending on the severity of their
disease. Cancer treatment affects essentially three groups: The doctors,
patients and their loved ones.
The two pronged study mainly consisted of a Medical Opinion on the topic
and an academic one. There lies a gap between Academic practises and its
direct impact on the patients which they may not be aware of which doctors
can bridge.
The research approaches adopted in this dissertation are Photographs,
observations, interview and questionnaires.
However it must be noted that Human Psychology is a dynamic concept and
has various interpretation. In a public space such as a hospital there are
people from various backgrounds, ethnicity, opinion, mental state etc. that
visit and the design solution should be a neutral one which is prevalently
accepted however certain other inputs may be appreciated by a few while
neutral to others.
This dissertation has been limited to the elements of the built environment.
Design considerations in the basis of space planning have not been
addressed. It is the unquantifiable elements of the built environment that
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have been looked into. Further studies on the effect of the psychology of the
patient on the space planning of the built environment can be looked into.
The research aims at developing a concrete relationship between built-
environment with the reactions of cancer patients. The reduction of stress of
this disease through different architectural treatments and principles is the
main goal. The stress has an impact on the recovery of such patients.
Palliative care is also an important study aspect making it comfortable for
terminal patients in their last days.
The findings from this research provide evidence that there is a clear link
between cancer patient‘s psychology and the built environment. The main
conclusions that I seek to draw from this dissertation is attempt to establish the
elements of the built environment that can influence a cancer patient‘s
psychology and come to a design criteria for such an environment.
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Table of contents
Page no.
List of Tables 7
List of Figures 8
Chapter 1: Introduction 9
Chapter 2: Literature Review 12
Chapter 3: Methodology 27
Chapter 4: Analysis of Data 40
Chapter 5: Conclusions 44
Appendix 47
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List of tables
Page No.
Table 4.1 Comparison of Data Collected 1 40
Table 4.2 Comparison of Data Collected 2 41
Table 4.3 Analysis of Data Collected 1 42
Table 4.4 Analysis of Data Collected 2 43
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List of figures
Page No.
Fig 2.1- Maggie's Centre in Dundee by Frank Gehry 12
Fig 2.2: Pictures from Circle Bath by Foster and Partners 15
Fig 2.3 Maggie Centre Fife designed by Zaha Hadid 16
Fig 2.4 Atrium at a Hospital 16
Fig 2.5.1Social Determinants of Health and Environment Health
Promotion.
26
Fig 3.1 Figure Representing Methodology. 27
Fig 3.2 Figure Representing Method of Data Collection 28
Fig 3.3 Site Plan (Source: CCWHRI, Kolkata) 30
Fig 3.3 Photograph of Landscape Areas at CCHWRI 31
Fig 3.4 A Campus Of Colours Shapes And Forms 31
Fig 3.5 A Campus Of Colours Shapes And Forms Atrium With
Fountain And Dome
32
Fig 3.6 A Atrium 32
Fig 3.7 and 3.9 Diagnostic Areas 33
Fig 3.10 Toy Train Line on Campus 33
Fig 3.11 View of Doctors Room 34
Fig 3.12 View of Waiting Area (From Collections of Author) 34
Fig 3.13 View of Main Atrium 35
Fig 3.14 View of Diagnostic Facilities 35
Fig 3.15 and 3.16 View of Diagnostic Facilities 36
Fig 3.17 View of Waiting Area 36
Fig 3.18 View of recreation at Waiting Area 37
Fig 3.19 and Fig 3.20 View Building and meditation Center 37
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CHAPTER 1: INTRODUCTION
1.1 Background
The World Health Organisation has projected that there could be 50 million
new cancer patients by 2020 (WHO, Cancer Repor-2010). In India there are
25 lakh cancer patients as of 2009 (Financial Express, 2005), the government
hospitals that have cancer treatment facilities tend to pay no attention to the
quality of spaces and the impact it makes to the human psychology.The
funds crunch all over has resulted in a severe ignorance towards the quality
of life of cancer patients. Children who are afflicted by this disease are
perhaps those who attract the maximum sympathy from all over.
Palliative care1 is an important aspect that a lot of cancer care facilities do
not pay much attention to. It is important for us to address patients who have
been diagnosed as terminal and make their environment comfortable for
them to spend their last days. Malignant tumours resulted in 56 million deaths
in the year 2000. Thus, there is strong statistic pointing out the need for
Palliative care facilities. Studies have shown, 58% of terminally ill cancer
patients wish to be euthanized. This is perhaps a result of lack of care facilities
of such patients.
1.2 Definition of Terms
The term built environment refers to the structures, and infrastructure, that are
made by man. This can include everything from simple housing to entire
cities, and even man-made outdoor environments. The Macmillan Dictionary
defines built environment as ―all the structures people have built when
considered as separate from the natural environment‖ The United States
1 Palliative care is defined as the care given to those patients that have been
declared as terminally ill and cannot be cured. Palliative care seeks to medicate
through pain killers and make the last few days for these patients as comfortable as
possible.
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Bureau of Reclamation further goes on to define Built Environment as Human-
modified environment, e.g. buildings, roads, and cities.
Cancer Patient is termed as a person suffering from some form of cancer.
Cancer Patients can be of two types- terminal and non-terminal. Cancer
Patients are categorized in stages in terms of the progression of cancer in
their system.
Patient Psychology is the study of the mind and mental processes, especially
in relation to behaviour and study of the soul. The Latin word psychologia was
first used by the Croatian humanist and Latinist Marko Marulić in his book,
Psichiologia de rationeanimaehumanae in the late 15th century or early 16th
century.
The term positive way implies to the betterment of an individual from both the
person‘s perspective and also others.
1.3 Aim
Designing an environment targeted at the patient‘s psychology that helps
them feel comfortable and at home while combating this debilitating
disease. This research is directed at the contribution of architects in reducing
stress in patients and influence their psychology in a positive way.
1.4 Research Question and Statement
The main question put forth by this research paper is:
„How can architects treat the built environment to affect the
psychology and behaviour of Cancer patients in a positive
way?
The research statement reads:
„The architectural design of a built space and its various aspects
of that design can have a positive impact on the psychology
and behaviour of cancer patients.‟
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1.5 Objectives
The objectives is mainly to establish the following:
To explore the different aspects of the built environment.
To study the impact of these aspects on patient psychology.
To determine the indicators of positive impact on patient psychology
with respect to the design of the built environment.
To study the behaviour of cancer patients in hospitals.
To investigate the architectural factors affecting behaviour of cancer
patients in hospitals.
To find and analyse the relationship between the architectural design
of the hospitals and the psychology and behaviour of the cancer
patients.
The next chapter will cover the existing research and information
regarding the topic of my dissertation. I shall be reviewing excerpts from
various literary sources from journals, books and articles to derive
relationships in regard to the objectives of the dissertation.
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CHAPTER 2: LITERATURE REVIEW
2.1 Maggie's Centres: can architecture cure cancer?
Maggie‘s Co-founder Charles Jencks2 believes Cancer care doesn't have to
mean grim hospital wards he further adds that uplifting buildings benefit both
body and soul. However may feel that it is an Architectural Placebo.
Fig 2.1- Maggie's Centre in Dundee by Frank Gehry, an example of making an impact
through expressive architecture. Breaking the monotony of a cancer patients life through
dynamic architecture. Photograph: Murdo Macleod
Here Jencks does not claim that architecture could replace chemotherapy,
but argues that can make a difference to cancer patients.
All six existing buildings have a lengthening list of high-profile designers:
Richard Rogers, Frank Gehry, Zaha Hadid, Rem Koolhaas. But Jencks has
come has come under fire from both the scientific community, who question
2 Charles Alexander Jencks (born 21 June 1939) is an American architectural theorist,
landscape architect and designer. In the mid-sixties Jencks moved to Scotland where he lived with his late wife Maggie Keswick Jencks. His late wife, Maggie Keswick Jencks, was the founder of Maggie's cancer caring centres, for which Jencks has designed gardens, and the author of a book on Chinese Gardens.
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the validity of his claims (or media distortions of them); and the design
community, who wonder if Maggie's Centres aren't injecting more
architecture into small healthcare facilities than they strictly need.
“Jencks is not advocating some deterministic equation
between architecture and health – as if the sight of a well-
detailed staircase could somehow zap away a malignant
tumour – but he does believes in what he calls an
"architectural placebo effect". "A placebo is a phoney cure
that works," he explains. "This is very hard for the medical
profession to get their teeth around because they hate
placebos but scientifically, placebos work in about 30% of
cases that are psychogenic diseases. You have to believe in
a placebo or it won't work, but if it works it's obviously
working in some indirect way, through feedback in the
immune system, let us say, or in the willpower of the patient
to take a more strenuous exercise in their own therapy.”
Jencks goes on to say "You can imagine all sorts of ways in which architecture
adds to the placebo effect," he continues, "and in that sense it's impossible to
measure. Here's a funny insight: in a way, the carers are more important than
the patients. Because if the carers are cared for, they turn up, they enjoy it
and you create this virtuous circle, this mood in a Maggie's Centre which is
quite amazing. So architecture helps do that because it looks after the carers.
There's a lot of people who would quite rightly attack that notion, and I don't
want to claim that we can yet prove it, but we hope to."
In his book The Architecture of Hope, Jencks presents his case and asks the
reader the question ―So is there an architecture that helps you live?‖
Jencks argues it is not to be found in the modern hospital. He describes the
space in which Maggie herself received her weekly chemotherapy as a form
of "architectural aversion therapy" – a windowless neon-lit corridor of
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Edinburgh's Western General Hospital. Many of us are familiar with similar
spaces. In the industrial age, the design of healthcare buildings has been
dictated by the demands of hygiene and efficiency: hard, sterile surfaces;
bright, white spaces; long corridors; artificial ventilation systems. The template
has been updated a little in the PFI age with atrium lobbies and toothpaste-
coloured cladding, but these places are still overwhelmingly alienating.
Dutch academic Cor Wagenaar, believed that modernism created a rupture
in the long, intimate relationship between architecture and health. That history
stretches back to ancient Greece, where temple complexes such as
Epidauros were about healing the spirit as well as the body, and even
Stonehenge, which recent findings suggest may have been a hospital. Its
modern roots lie in the Enlightenment, when it was first proposed that good
design of the built environment could do more for public health than the
medical profession could. In a way, Maggie's Centres reconnect with this
"secret tradition", says Jencks. Yes, we need medical environments to cure us,
but we also need to feel like people again, rather than patients. He is not
alone in this.
The Circle group's recent hospital in Bath, designed by Foster and Partners,
which feels more like a boutique hotel. They, too, are recruiting architects
such as Richard Rogers and Michael Hopkins to rethink hospital design on a
more human scale. Or there's the AHMM's bright, fresh Kentish Town Health
Centre, also nominated for last year's Stirling prize, or Gareth Hoskins's civic-
minded health centre designs. Things are changing.
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Fig 2.2: Pictures from Circle
Bath by Foster and Partners
where the changing times
of hospital architecture has
shown down. They too
have started recruiting
established architects to
give a new colour and
landscape to hospital
architecture.(Source:
Architect‟s Website)
There's no great architectural secret at work in the design of Maggie's
Centres. They are defined by inarguably positive qualities: light, space,
openness, intimacy, views, connectedness to nature – the opposite of a
standard-issue hospital environment. They are domestic in scale, centred
around the kitchen, a place where you can make yourself a cup of tea and
have an informal conversation. In Jencks's words, they are buildings that hug
you, but don't pat you on the head. It's not just about giving people
architecture, he argues – it's also providing information, relief; psychological,
emotional and even financial support – all of which contribute to the urge to
go on living. Nor is there any set of instructions for architects as to how to
achieve these goals. Frank Gehry's building, for example, combines a crinkly-
roofed fairytale aesthetic with a serene view over Dundee on one side and a
garden maze on the other. Zaha Hadid's outlet in Fife has been compared to
a Stealth bomber – sharp and black on the outside, but mercifully calm and
light inside. More recently, Richard Rogers's London Maggie's Centre shut out
the city behind rhubarb-pink walls and opened up an oasis of intimate,
domestic-scaled spaces, all capped by a protective roof.
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Fig 2.3 Maggie Centre Fife
designed by Zaha Hadid.
A clear example of
blending the environment
into the architecture of a
hospital, showing a clear
deviation from the
modular drab
architecture of hospitals at
present (Source:
Architect‟s Website)
Thus Maggie’s Centres are clearly an indication of changing times and they
have gone on to inspire others to follow suit. They believe in a strong link
between making people comfortable in a hospital environment which
directly impact on their mental state. It has often been said that the extra mile
can be covered by Architecture, however the basis of treatment remains in
medicine.
2.2 Playing upon patient psychology in hospital environment
Fig2.4 Atrium- Sharp corners or
unfinished ends in a room depict or
even force a visualization of
impending danger. The shapes have
In another article in a healthcare news
daily, Jyothiram Gajendran, who is an
Architec"t at Apna House of Design
Chennai writes “the singularity of a hospital
environment stems from the fact that it
hosts people of various hues and
backgrounds, held together by a single
common misfortune of their ill health. And
this makes the hospital a melting point of a
myriad of emotions, at times very
uncharacteristic of the principal factors.”
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to have easy-rounded corners,
leading into larger areas
The architect goes on to state that the challenge is identified by the needs of
the patient who looks forward to some amount of comfort and familiarity to
lessen his pain and anxiety. The ambience of a hospital plays an important
role in the psychology of a patient. A patient entering the hospital is at first
apprehensive and confused at the best. He would like to be attended to
immediately or to least find his way around without much trouble. The access
has to be wide; the movement has to be logical to avoid crisscrossing; and
the arrangement of various spaces has to be non-interfering with each other.
It provides the comfort of a home-away-from-home. The patient is made to
feel that he is in a well-cared-for place and is primarily diverted from the
anguish of pain, helplessness and an anxiety over a host of issues. It is
necessary to not have intimidating structures like complex machinery or
convoluted steel structures etc in the direct and open contact of patients.
Also the spaces itself is filled with lot of greens, a symbolism for life and
energy, as a replacement to cold concrete which becomes impersonal and
distant. It is for this reason that landscaping becomes an important feature in
hospital architecture. People entering the hospital, are affected by the
innocuous things and every detail assumes a larger meaning.
The shapes they encounter in any room they enter play hard on their
subconscious. Sharp corners or unfinished ends depict or even force a
visualization of impending danger. Seen along with the layout that is not
chaotic, the shapes have to have easy-rounded corners and leading into
larger areas or spaces. However, care is taken that the spaces are not too
large and devoid of proper sound absorption materials as any sort of echo
would create hallucinations very easily in an already disturbed mind. Also
very large spaces with little objects filled in and with very high ceilings are
imposing and make a very disturbing atmosphere. A patient feels more
comfortable in cosy and snug environs. Colours could be classified into cool,
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warm and neutral shades. A hospital would be effective with cool colours
with soft hues like blue, grey etc. However most of the hospitals is painted
white, as it is a neutral colour. Also white will make a small room airy and
seem bigger. As bigger rooms are a strict no-no, even smaller rooms create a
claustrophobic feeling. Hospitals should be well ventilated so that all the bad
odours are lifted away and a draft of fresh air hangs loose.
Good cross ventilation, apart from its known uses for hygiene,
also acts on the moods of the patients. A small dark room with
little or no ventilation and painted in dark, warm, colours will
increase the ambient temperature and would lead to
hypertension of the patients who are vulnerable to such attacks
on mildest of provocation.
The most unassuming feature of the design of a hospital is the materials and
its finishes. Generally materials that are easy to maintain, non-reflective,
smooth but not shiny and with good grip and non-slippery are preferred.
Apart from the fact that these are functional necessities, they also provide
patients with a feeling of comfort and warmth.
It is generally recognised that half the battle against the disease is won by the
patients’ mind. It, therefore becomes very much imperative that the patients
are goaded into a feeling of well-being and provided with a comfort of
being in expert care. This is partly taken care by the human elements in a
hospital, but various aspects of architecture are effectively used to alleviate
the pain of the truant mind after when the pain of the disease could be
tackled with the cold precision of a doctor‘s skill. The psychology of the sick
and their near ones are well documented and are routinely non-complex. An
architect thus uses this knowledge to provide the doctors with an atmosphere
that is most conducive to an effective treatment. An intelligent juxtaposition
of design features from an astonishingly wide selection makes a hospital
aesthetic and functional both in literal and in a sublime manner.
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This article ties together various aspects of Hospital architecture including
space planning, volumes, colours, odours, finishes and others and establishes
a direct link between these factors and impact on patient psychology.
2.3 Therapeutic Environments
An article in Therapeutic Environments Forum, AIA Academy of Architecture
for Health, Ron Smith (AIA, ACHA, Senior Associate, HOK ) and Nicholas
Watkins, (Ph.D., Director of Research and Innovation, HOK) writes some
interesting insights into therapeutic environments.
This article states that “Healthcare facilities are designed not only to support
and facilitate state-of-the-art medicine and technology, patient safety, and
quality patient care, but to also embrace the patient, family, and caregivers
in a psycho-socially supportive therapeutic environment. The characteristics
of the physical environment in which a patient receives care affects patient
outcomes, patient satisfaction, patient safety, staff efficiency, staff
satisfaction, and organizational outcomes. The effects can be positive or
negative. No environment is neutral.”
A healthcare environment is therapeutic when it does all of the following:
Supports clinical excellence in the treatment of the physical body
Supports the psycho-social and spiritual needs of the patient, family,
and staff
Produces measurable positive effects on patients' clinical outcomes
and staff effectiveness
Therapeutic Environment theory stems from the fields of environmental
psychology (the psycho-social effects of environment),
psychoneuroimmunology (the effects of environment on the immune system),
and neuroscience (how the brain perceives architecture). Patients in a
healthcare facility are often fearful and uncertain about their health, their
safety, and their isolation from normal social relationships. The large, complex
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environment of a typical hospital further contributes to the stressful situation.
Stress can cause a person's immune system to be suppressed, and can
dampen a person's emotional and spiritual resources, impeding recovery and
healing.
Healthcare architects, interior designers, and researchers have identified four
key factors which, if applied in the design of a healthcare environment, can
measurably improve patient outcomes:
Reduce or eliminate environmental stressors
Provide positive distractions
Enable social support
Give a sense of control
Research on completed projects by organizations including the Center for
Health Design, Texas A&M University's Center for Health Systems Design, the
Academy of Neuroscience for Architecture, and by a growing number of
architectural firms and their clients shows measurable benefits to patient
outcomes, safety, and quality of care, from such factors.
The application of these factors has been focused on the patient and
patient's family. However, there are also recognized potential benefits for
staff and caregivers in terms of satisfaction, effectiveness, and staff retention,
from environmental factors such as:
Noise reduction
Same-handed patient rooms
Access to daylight
Appropriate lighting
Providing 'off-stage' areas for respite
Proximity to other staff
Appropriate use of technology
Decentralized observation, supplies, and charting
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The benefits staff receive from these environmental factors may impact the
quality of care patients experience.
In general, Therapeutic Environments have been proven to be cost-effective
by improving patient outcomes, reducing length of stay, and by enhancing
staff satisfaction, recruitment, and retention of staff.
2.4 Colour In Healthcare Environments
In a study published in a healthcare magazine, an attempt was made to
establish relationships between Colour and various aspects of Healthcare
Environment. The purpose of this study was to review the literature on colour in
healthcare environments in order to separate among common myths and
realities in the research and application of colour in healthcare design.
Colour is a fundamental element of environmental design. It is linked to
psychological, physiological, and social reactions of human beings, as well
as aesthetic and technical aspects of human-made environments. Choosing
a colour palette for a specific setting may depend on several factors
including geographical location, characteristics of potential users (dominant
culture, age, etc.), type of activities that may be performed in this particular
environment, the nature and character of the light sources, and the size and
shape of the space.
The evidence-based knowledge, however, for making informed decisions
regarding colour application has been fragmented, sporadic, conflicting,
anecdotal, and loosely tested. Many healthcare providers, designers and
practitioners in the field have questioned the connections between colour
and behaviour of people, suspected the value of colour as a
psychotherapeutic aid, and searched for empirical reasoning for the various
colour guidelines in healthcare settings.
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The results of the critical review of the pertinent literature produced no
reliable explanatory theories that may help to predict how colour influences
people in healthcare settings.
Regrettably, much of the knowledge about the use of colour in healthcare
environments comes from guidelines that are based on highly biased
observations and pseudo-scientific assertions. It is this unsubstantiated
literature that serves colour consultants to capriciously set trends for the
healthcare market.
1. There are no direct linkages between particular colours and health
outcomes of people. No sufficient evidence exists in the literature to the
causal relationship between settings painted in particular colours and
patients‘ healthcare outcomes.
2. Specifying particular colours for healthcare environments in order to
influence emotional states, or mental and behavioural activities is simply
unsubstantiated by proven results.
3. There are demonstrable perceptual impressions of colour applications
that can affect the experience and performance of people in particular
environments. There are indications in the research literature that certain
colours may evoke senses of spaciousness or confinement in particular
settings. However, the perception of spaciousness is attributed to the
brightness or darkness of colour and less by its hue. The sense of spaciousness
is highly influenced by contrast effects particularly brightness distinctions
between objects and their background.
4. While studies have shown that colour-mood association exists, there is
no evidence to suggest a one-to-one relationship between a given colour
and a given emotion. In spite of contradictory evidence, most people
continue to associate red tones, for example, with stimulating activities, and
blue tones with passivity and tranquillity. Clearly, colours do not contain
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inherent emotional triggers. Emotional responses to colours are caused by
culturally learned associations and by the physiological and psychological
makeup of people.
5. The popular press and the design community have promoted the
oversimplification of the psychological responses to color. Many authors of
color guidelines tend to make sweeping statements that are supported by
myths or personal beliefs. Likewise, most color guidelines for healthcare
design are nothing more than affective value judgments whose direct
applicability to the architecture and interior design of healthcare settings
seems oddly inconclusive and nonspecific. The attempt to formulate universal
guidelines for appropriate colours in healthcare settings is ill advised. The
plurality, or the presence of multiple user groups and subcultures, and the
complexity of the issues of meaning and communication in the environment
make efforts to prescribe universal guidelines a futile endeavour. Consider, as
an example, the issue of weak communication in the context of colour
specification in present healthcare settings: designers may attempt to endow
the settings with cues that the users may not notice. If the users notice the
cues, they may not understand their meaning, and even if they both notice
and understand the cues they may refuse to conform as predicted.
6. The study of colour in healthcare settings is challenging because it
occurs in the context of meaningful settings and situations. When people are
exposed to a colour in a certain setting, their judgment is a result of a
reciprocal process that involves several levels of experience. Thus, if the
healthcare setting is too noisy, or too cold, or the place is cluttered with an
array of medical equipment and bad odours, the aesthetic experience of an
individual‟s response to its colour will be affected, regardless of its “objective”
meaning. In addition, the response is influenced by the person‘s role in the
settings (whether he or she is a patient, a staff member or a visitor to the
facility). Furthermore, a large host of internal forces are involved in the act of
reaching aesthetic conclusions. Among them are the person‘s physical
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condition (whether he or she feels sick or suffers from pain, how tired he or she
is, whether he or she lays in bed or works out as part of their physiotherapy,
etc.) as well as the person‘s psychological state (whether he or she is aware
of his or her surroundings or he or she is under the influence of drugs, or
anxious about medical procedures, or suffers from dementia, etc.).
The suggestions of the Article were the following:
“In conclusion, we want to reiterate that currently the use of color in
healthcare settings is not based on a significant evidence-based body of
knowledge. Second, we suggest that the attempt to formulate universal
guidelines for appropriate colors in healthcare settings is ineffectual. The
multiple user groups and subcultures, and the complexity of the issues of
meaning and communication in the healthcare environment make the
efforts to prescribe universal guidelines an unproductive undertaking. Our
efforts need to concentrate on the particular through the formulation of
explanatory theories and empirical studies with the aim to give attention to
specific and concrete problems rather than abstract and universal
questions.”
Clearly, the research of color in healthcare environments is an important
endeavor. Yet, the subject matter is complex and multifaceted. Furthermore,
mastering this knowledge for the application of research findings in
healthcare settings requires caution and sensitive creativity is paramount.
The relation of colour to well-being is distorted. However departing from
traditional customary hospitals colours, so as to speak, helps the patients who
have over time have attributed the overall climate of a hospital to those
colours. A deviation from the standard colour scheme keeps the patient open
to a new experience at this hospital. However its strong planning principles
and understanding of interrelation of spaces that can help break the overall
perception of a patient’s hospital experience.
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2.5 A Conceptual Framework For Understanding The Connections Between
The Built Environment And Health
None of the natural environment per se remains in cities, since even the parks
and waterways have been created—or at least significantly modified—by
people, and are therefore part of the built environment.
Nonetheless, the natural environment is essential to all life, including urban
dwellers. Thus, while we consider the natural environment to be a
fundamental determinant of health and well-being (see Figure2.5.1), in the
context of our joint urban planning and public health framework it is
background, while the built environment is foreground.
Mary Northridge recently collaborated with Amy Schulz, a University of
Michigan sociologist, to delineate the various mechanisms and pathways
through which social, political, and economic processes interface with the
physical configurations of cities to affect the health and well-being of urban
populations.
The conceptual model we jointly devised is presented in Figure 1. Figure 1 was
adapted from a conceptual model for understanding racial disparities in
health that was developed by Dr. Schulz and her colleagues at the University
of Michigan, and draws upon a joint urban planning and public health
framework for use in health impact assessment that our group at Columbia
University previously introduced.
The model posits that three domains—the natural environment (including
topography, climate, and water supply), macrosocial factors (including
historical conditions, political and economic orders, and human rights
doctrines), and inequalities (including those related to the distribution of
wealth, employment
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Figure
2.5.1Social
Determinants
of Health and
Environment
Health
Promotion. Aj
Schutz and ME
Northridge(20
03)
Thus using the various literatures available in relation to the dissertation, the
various factors of design, the stressors in healthcare environment have been
established. We have also managed to establish the best practices in those
factors. The next section will cover the methodology in which I wish to go
about my dissertation including mode of data collection, method of analysis
and drawing inferences.
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CHAPTER 3: METHODOLOGY
After collecting the background on the dissertation like the factors involved in
the topic it gave a guideline in which further studies could be conducted.
Also helped frame the methodology to be followed. This chapter establishes
the method of data collection. It establishes various stages of this dissertation
and the methodology followed to come to the final conclusion.
3.1 Figure Representing Methodology. A clear understand of the various stages of
dissertation can be established from this chart and the organization structure.
Formulation of Research Question
Literature Review
Formulation of Questionaire and documentation
techniques
Case Study 1 Case Study 2
Categorization of data collected in similar format as
Case Studies
Tabulation and analysis of data
collected
Interpretation and conclusion
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3.1 Tools of Data Collection
There were various ways in which the data was collected. The data itself can
be categorized into primary data, secondary data and data collected from
literature review. The chart below shows the various categorizations of data
collected.
Figure 3.2 Figure Representing Method of Data Collection
Data Collection
Primary Data
Observation Questionaire
Doctors/Nurses
Patients
Relatives
Experts
Behavioural Survey
Mapping of Circulation
Visual Analysis
Secondary Data
Internet based data collection
Literature Review
Journals
Articles
Books
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3.1.1 Interview Schedule
The various forms of data collection were included in this dissertation. The
questionnaires mostly comprised of Likert‘s Scale3 type questions which allow
maximum data collection with least effort.
The questions were aimed at deriving a link between the patients feeling
better in regard to the architectural features present at the hospitals. Also
open ended questions were included when questionnaires were filled by
relatives and architects so that more input could be obtained.
The questionnaire target group were four- Doctors, Patients, Relatives and
Architects. This allowed for a wholesome view from all the important user
groups of a hospital and the Architects who designed them.
For further information see Appendix.
3 A Likert scale is a psychometric scale commonly involved in research that employs
questionnaires. The scale is named after its inventor, psychologist Rensis Likert.
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3.2 Case Studies
The case studies mainly encompassed two major hospitals. The 250 bedded
Cancer Care Welfare Home and Research, Kolkata and the 300 bedded
Shirdi Sai Baba Cancer Hospital, Manipal. After establishing the criteria of
observation based on the literature study, a careful analysis was made of
these existing hospitals.
3.2.1 Cancer Care Welfare Home and Research Institute
CASE STUDY I: CANCER CENTRE WELFARE HOME AND RESEARCH INSTITUTE (CCWH&RI)
LOCATION: THAKURPUKUR, KOLKATA, WEST BENGAL
NO. PICTURE OBSERVATION
1. SITE PLAN
Fig 3.3 Site Plan (Source: CCWHRI, Kolkata)
The sprawling
campus features
a lot of
architectural
elements.
Spread of 15
acres the entire
campus has a
toy train track, a
series of ponds,
lots of
landscaping and
also and
amphitheatre.
The campus has
all the modern
technologies in
cancer care.
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2. AN INTERACTIVE CAMPUS FROM END TO END
Fig 3.4 Photograph of Landscape Areas
Upon entering
one cannot
ignore the
campus
screaming out to
the soul. The lush
green spaces
and the geese
present on the
campus do not
give you an
option but to
interact with the
open spaces.
3.
Fig 3.5 A CAMPUS OF COLOURS SHAPES AND FORMS
Architect Anjan
Gupta explains
that this campus
features the use
of a variety of
colours and
shapes and
forms that help
the penetrate
into the patients
psychology and
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4.
Fig 3.6 A CAMPUS OF COLOURS SHAPES AND FORMS
ATRIUM WITH FOUNTAIN AND DOME
Fig 3.7 A Atrium
The three floor
high fountain
penetrates the
atrium spaces of
the child care
centre, making
in a de-stressing
element for the
inhabitants of
the building. The
fountain is
capped by the
giant dome that
sprinkles light into
the atrium and
helps keep the
patients
attached to
natural light
even in their
ultra-clean
artificial world of
their wards.
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DIAGNOSTIC AREAS
Fig 3.8 and 3.9 Diagnostic Areas
Here an
architect cannot
help but block
out natural light
due to radiation
and other
climatic controls,
however by the
use of artificial
lighting in an
intelligent way
along with music
we are able to
de-stress a
patient and
make them feel
comfortable.
Fig 3.10 Toy Train Line on Campus
The toy train
dedicated to
the children
ensures that in-
spite of staying in
a hospital
environment
they do not miss
out on their
childhood and
they are able to
relate to the
hospital in a nice
manner and do
not dread or
regret the days
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they spend their.
3.2.2 Shirdi Sai Baba Cancer Hospital, Manipal
CASE STUDY II : SHRIDI SAI BABA CANCER HOSPITAL AND RESEARCH INSTITUTE
LOCATION: MANIPAL, KARNATAKA
NO. PICTURE OBSERVATION
1. SITE PLAN
Fig 3.11 View of Doctors Room
The doctors rooms
here are definitely
well planned for the
amount of natural
light entering,
however the vista is
nothing to write
home about.
Perhaps better
campus planning
would have
prevented this.
2.
Fig 3.12 View of Waiting Area
The Waiting facility
at diagnostic areas
and the doctors
rooms lack natural
light. The white
fluorescent tube
lighting gives a very
cold feeling to the
area.
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3.
Fig 3.13 View of Main Atrium
The main atrium has
enough space and
light, however again
the white light gives
it a cold feel.
4.
Fig 3.14 View of Diagnostic Facilities
The Diagnostic
Facilities are
comfortable and
well lit. however
there is a clear
absence of
entertainment and
mood lighting.
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Fig 3.15 and 3.16 View of Diagnostic Facilities
The areas leading to
diagnostic areas
have presence of
intimidating medical
equipment that can
demoralise a
patient.
Fig 3.17 View of Waiting Area(Source: Author)
The waiting areas in
the campus have
lack of natural light.
They are spacious
but lit poorly or by
cold lights. The
sources of
recreation in the
campus is few and
far between.
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Fig 3.18 View of recreation at Waiting Area
Fig 3.19 and Fig 3.20 View Building and meditation
Center
There is a distinct
lack of privacy of
the meditation
room. Meditation
rooms should be
neutral towards
religion as there a
variety of users.
Both these cancer hospitals showed contrast in terms of built environment. The
Cancer hospital in Manipal had great space constraints hence not much attention is
paid to the environment outside. The hospital also lacks funding for interior
environment and the old structure when design, many modern day practises such as
double height atriums were not present. The Cancer Hospital in Kolkata had the
luxury of space, and hence the campus could spread horizontally rather than
vertically making the quality of space both inside and outside quite different and
pleasurable for patients.
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3.2.3 Interview Data of Key Informants
The key informants comprised of various people from different backgrounds.
The Professors and doctors at the Cancer Hospitals were crucial in giving
feedback of architectural elements from the medical perspective. The
relatives of patients were also key in notifying the troubles of a cancer patient
and the relatives. Architects gave insight on modern day practices in hospital
architecture and the various constraints in such an environment.
3.2.3.1.Dr. Piyush Saxena, Professor, Department of Oncology, KMC Manipal.
He was very detailed on the kind of colours that patients are considered
apprehensive due to their relation with treatment, hospital environment and
bodily fluids. He went on to say that Red, Brown, Yellow were colours that
should be avoided. Patients directly respond to friendly relaxed and open
hospital staff. Perhaps a way to passively influence the patients is to keep
those who work at the hospitals happy and their environment open inviting
and stress free. Painting are a good idea as long as they are not too abstract
that patients would find them distracting to look at. Televisions should remain
on mute and hospital environment should be as neutral as possible due to the
wide strata and social standing of people coming to it. Public spaces are for
public! He felt that a clear circulation of patients and flow of patients from
area to area of hospital which is free from confusion helps them stay calm
and collected when in a hospital.
3.2.3.2 Dr. Donald Fernandes, HOD of Oncology KMC, Manipal
He was of the opinion that large landscape areas go a long way to keeping
the patients and the users of the hospital happy. Giving a source of
recreating during procedures and in the waiting hall is critical.
3.2.3.3 Deepika Shetty, Proffessor MSAP
She spoke from experience of getting treatment for a relative and spoke
about the importance of a clear and un-confusing flow of space. She was of
the view that patients must be introduced to large open spaces and
interesting elements only after the process of admitting and other formalities
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are done. Distracting Architectural elements just prior to the admission areas
are perhaps a bad idea as the patients are here at the hospital for a purpose
and do not always enjoy the distractions in the moment of crisis. Further, the
quality of spaces at tertiary waiting areas is often not looked at. Architects
often concentrate on the main waiting halls and neglect other waiting areas
in front of diagnostic facilities or procedure rooms. Perhaps it is there that a lot
of the distractions are required. The organisation of waiting areas like a
railway stations pointing directly a television is perhaps a bad idea as it
discourages conversation. The plight of patients if shared between each
other will perhaps make it easier for them to cope. Hence more open and
interactive waiting spaces may be a better idea.
Thus after speaking to the doctors, relatives and architects the basic design
factors could be reinforced with statements from affected parties. The proof
of these co-relations could now be established through observations at the
hospitals, interviews with the doctors and talking to architects of such
healthcare environments. The next chapter will show the tabulation of the
data collected from various sources and the inference drawn from it.
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CHAPTER 4: ANALYSIS OF THE DATA
4.1 Observations and Inferences
Tab
le 4
.1 C
om
pa
rison
of D
ata
Co
llec
ted
1
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Tab
le 4
,.2 C
om
pa
rison
of D
ata
Co
llec
ted
2
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Tab
le 4
.3 A
na
lysis o
f Da
ta C
olle
cte
d 1
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Tab
le 4
.3 A
na
lysis o
f Da
ta C
olle
cte
d 1
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4.2 Findings
The major factors of built environment in relation to the research question was
identified as landscape, light, acoustics, ventilation, colours, forms , vistas, art
and artefacts and interior open spaces. The psychological factors of patients
which are linked to the topic and in the purview of architecture were
identified as anxiety, stress, discomfort, homeliness and depression.It was
found that landscaped areas had an overall impact on all the psychological
factors and helped alleviate the patient‘s distress.
Light whether artificial or natural had a positive impact on a patient‘s well
being provided it was adequate controlled and positioned. Acoustics is
important in creating a sound buffer for patients and keeping them free from
irritation and mental uneasiness.
Natural ventilation was ideal wherever possible to keep patients connected
to nature and keep establishment costs low and treatment affordable.
Diagnostic areas have to be mechanically ventilated due to unavoidable
reasons should be monitored to keep patients free of discomfort.
Colours give a sense of vibrancy to an area and had a positive impact on
cancer patients if used judiciously and too loud colours were avoided.
Forms gave a sense of variation to the built environment and prevented a
sense of monotony in the patient‘s minds. Vistas help keep patients engaged
while they are in the hospital.
Art and artefacts create very dynamic components in a room and free from
becoming mundane as artwork has various interpretations. Hence replacing
TVs in a congregation area with some nice art work or artefacts have a
positive influence on the people.
Interior open spaces can create interest in a patient‘s mind keeping him
distracted from his health situation and keeping his or her spirits high.
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CHAPTER 5: CONCLUSIONS
Upon conclusion of the data collection, analysis clear relations were
established between the patient psychology and the difference aspects of
the built environment. Though many of these conclusions cannot be
quantified, however many of them can be observed in practise. The direct
link between many of these may not be established, however through
secondary factors such as stress and mental well-being of the patient,
relations can be established.
5.1 Inferences
The predominance of Medicine in cancer treatment is un-doubted. However
the human touch through architecture goes a long way to going that extra
mile in patient care and treatment.
Thus a medical campus with massive buildings and mono-tone interiors can
intimidate patients and cause them to by psychologically depreciated
before even entering a hospital building. Hence it is seen that keeping an
open campus with lots of nature, human scale buildings, interesting
interacting architectural element can help patients feel at home even at a
hospital.
The architectural touch through the built environment has a truly positive
impact on patients. Landscaping, lights, acoustics, ventilation, colours, variety
in form, vistas, art and artefacts and interior open spaces can all contribute
towards impacting the patient‘s psychology in a positive way.
It is however cautioned that one must not go overboard with architectural
elements creating confusion in the organized structure of a hospital. A patient
or relative must have a direct and straightforward circulation; it is only at
waiting areas and other static areas that architects should make the
interventions. Often creating informal spaces in a hospital is obstructing, but
planning those spaces correctly can create the best distraction for patients
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which is each other. The formal arrangement of spaces in a hospital prevents
patients from interacting with each other and cause patients to become
isolated in their own rooms.
5.2 Summary
Also a cautioning design guideline must be to keep the neutrality of the
design interventions. Music, lights and some architectural elements might
have a wide audience with different levels of discomfort or comfort
associated with them. Hence such elements should be programmed in a
neutral way to help keep the hospital environment open to people from
many different background and psychological states.
Overall we were able to establish links between the positive impacts on
patient psychology with the architectural factors of built environment such as
colour, light, landscape, acoustics, vistas, forms etc. Further studies are
possible on the individual architectural elements and the particular segments
of patient psychology that it affects. Through this paper thanks to
collaboration with doctors, architects, patients and relatives some concrete
links between the unquantifiable elements such as well being, positive impact
on a patient were linked to architectural elements of the built environment.
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CHAPTER 6: BIBLIOGRAPHY
1. Jencks, Charles&Heathcote, Edwin – The Architecture of Hope:
Maggie's Cancer Caring Centres – 2010
2. Mary E. Northridge, Elliott D. Sclar, and Padmini Biswas, December 5
2003, Sorting Out the Connections Between the Built Environment and
Health: A Conceptual Framework for Navigating Pathways and
Planning Healthy Cities, Journal of Urban Health: Bulletin of the New
York Academy of Medicine, volume 80 No. 4
3. Lynn Nesmith,Eleanor – Health Care Architecture: Designs for the
Future-1995
4. Jyothiram Gajendran, Architect, Apna house of Design, Chennai
http://www.expresshealthcaremgmt.com/20020131/architecture.shtml
on August 19, 2011.
5. http://www.who.int/mediacentre/news/releases/2003/pr27/en/ on
August 22, 2011
6. http://www.worldrtd.net/news/most-terminally-ill-cancer-patients-favor-
right-die on August 19, 2011.
7. http://www.financialexpress.com/news/25-lakh-cancer-patients-in-
india/445476/ on August 20,2011
8. http://www.cancercentrecalcutta.org/about-cancer/index.html on
August 19, 2011.
9. http://www.guardian.co.uk/artanddesign/2010/may/06/maggies-
centres-cancer-architecture on August 20, 2011.
10. http://www.wbdg.org/resources/therapeutic.phpon August 19, 2011.
11. http://www.healthcaredesignmagazine.com/article/summary-color-
healthcare-environments-critical-review-research-literature on August
19, 2011.
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APPENDIX
APPENDIX A- QUESTIONNAIRE FOR DOCTORS/NURSES
NAME:
OCCUPATION:
YEARS WORKED:
1: STRONGLY AGREE 2: AGREE 3: NEUTRAL 4: DISAGREE 5: STRONGLY DISAGREE
1. THE FACILITIES HERE IS OF HIGH CLASS:
2. THE INTERIOR ENVIRONMENT OF THE HOSPITAL IS GOOD FOR PATIENTS
3. THE PATIENTS HERE ARE NOT STRESSED DURING THEIR STAY
4. THE FACILITIES HERE ARE OF WORLD CLASS STANDARDS
5. DURING DIAGNOSTIC PROCEDURES MUSIC AND LIGHTS MAKE AN
IMPACT ON REDUCING PATIENT STRESS:
6. THE LANDSCAPE AREAS ARE MAINTAINED WELL
7. GOOD LANDSCAPE FACILITIES HELP PATIENTS REDUCE STRESS
8. THE WINDOWS OF THE HOSPITALS HAVE GOOD VISTAS.
9. THERE ARE SUFFICIENT SPACES FOR PATIENTS TO GO AND UNWIND.
In Your own words:
What do you think improves the mood of patients?
How are the palliative care facilities?
How do you think Architects can contribute to making the patients feel
better?
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APPENDIX B- QUESTIONNAIRE FOR PATIENTS
1: STRONGLY AGREE 2: AGREE 3: NEUTRAL 4: DISAGREE 5: STRONGLY DISAGREE
1. THE FACILITIES HERE IS OF HIGH CLASS:
2. THE INTERIOR ENVIRONMENT OF THE HOSPITAL IS GOOD FOR PATIENTS
3. THE PATIENTS HERE ARE NOT STRESSED DURING THEIR STAY
4. THE FACILITIES HERE ARE OF WORLD CLASS STANDARDS
5. DURING DIAGNOSTIC PROCEDURES MUSIC AND LIGHTS MAKE AN
IMPACT ON REDUCING PATIENT STRESS:
6. THE LANDSCAPE AREAS ARE MAINTAINED WELL
7. GOOD LANDSCAPE FACILITIES HELP PATIENTS REDUCE STRESS
8. THE WINDOWS OF THE HOSPITALS HAVE GOOD VISTAS.
9. THERE ARE SUFFICIENT SPACES FOR PATIENTS TO GO AND UNWIND.
In Your own words:
What do you think improves the mood of patients?
How are the palliative care facilities?
How do you think Architects can contribute to making the patients feel
better?
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX C- QUESTIONNAIRE FOR RELATIVES OF PATIENTS
1: STRONGLY AGREE 2: AGREE 3: NEUTRAL 4: DISAGREE 5: STRONGLY DISAGREE
1. THE FACILITIES HERE IS OF HIGH CLASS:
2. THE INTERIOR ENVIRONMENT OF THE HOSPITAL IS GOOD FOR PATIENTS
3. THE PATIENTS HERE ARE NOT STRESSED DURING THEIR STAY
4. THE FACILITIES HERE ARE OF WORLD CLASS STANDARDS
5. DURING DIAGNOSTIC PROCEDURES MUSIC AND LIGHTS MAKE AN
IMPACT ON REDUCING PATIENT STRESS:
6. THE LANDSCAPE AREAS ARE MAINTAINED WELL
7. GOOD LANDSCAPE FACILITIES HELP PATIENTS REDUCE STRESS
8. THE WINDOWS OF THE HOSPITALS HAVE GOOD VISTAS.
9. THERE ARE SUFFICIENT SPACES FOR PATIENTS TO GO AND UNWIND.
In Your own words:
What do you think improves the mood of patients?
How are the palliative care facilities?
How do you think Architects can contribute to making the patients feel
better?
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
Psychology of Cancer Patients
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX D- QUESTIONNAIRE FOR EXPERTS
1: STRONGLY AGREE 2: AGREE 3: NEUTRAL 4: DISAGREE 5: STRONGLY DISAGREE
1. THE FACILITIES HERE IS OF HIGH CLASS:
2. THE INTERIOR ENVIRONMENT OF THE HOSPITAL IS GOOD FOR PATIENTS
3. THE PATIENTS HERE ARE NOT STRESSED DURING THEIR STAY
4. THE FACILITIES HERE ARE OF WORLD CLASS STANDARDS
5. DURING DIAGNOSTIC PROCEDURES MUSIC AND LIGHTS MAKE AN
IMPACT ON REDUCING PATIENT STRESS:
6. THE LANDSCAPE AREAS ARE MAINTAINED WELL
7. GOOD LANDSCAPE FACILITIES HELP PATIENTS REDUCE STRESS
8. THE WINDOWS OF THE HOSPITALS HAVE GOOD VISTAS.
9. THERE ARE SUFFICIENT SPACES FOR PATIENTS TO GO AND UNWIND.
In Your own words:
What do you think improves the mood of patients?
How are the palliative care facilities?
How do you think Architects can contribute to making the patients feel
better?
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
Psychology of Cancer Patients
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX E- QUESTIONAIRE FILLED BY SANGAMITRA ROY
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
Psychology of Cancer Patients
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX F- QUESTIONAIRE FILLED BY DEEPIKA SHETTY
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
Psychology of Cancer Patients
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX G- QUESTIONAIRE FILLED BY DR. SHARMA, SSCH,KMC, MANIPAL
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
Psychology of Cancer Patients
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX H QUESTIONAIRE FILLED BY DR. PIYUSH SAXENA, SSCH, KMC, MANIPAL
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
Psychology of Cancer Patients
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX I- QUESTIONAIRE FILLED BY ANJAN GUPTA,AGA
Scale to be followed: 1: STRONGLY AGREE 2: AGREE 3: NEUTRAL 4: DISAGREE
5: STRONGLY DISAGREE
1. DURING DIAGNOSTIC PROCEDURES MUSIC AND LIGHTS MAKE AN IMPACT ON
REDUCING PATIENT STRESS: 1
2. THE LANDSCAPE AREAS ARE MAINTAINED WELL 2
3. GOOD LANDSCAPE FACILITIES HELP PATIENTS REDUCE STRESS 2
4. A GOOD VISTA FROM A WINDOW GOES A LONG WAY TO HELPING DE-STRESS.
1
5. A PATIENT MUST BE DE-STRESSED BEFORE ENTERING A HOSPITAL BUILDING TO
HELP HIM OR HER BE MORE CO-OPERATIVE. 3
6. THERE MUST BE SUFFICIENT SPACES FOR PATIENTS TO GO AND UNWIND. 1
In Your own words:
What do you think improves the mood of patients?
The spatial quality, natural light, tranquilty, soothing music, pictures/painings of
natural scenery, human touch of Doctors, nurses and paramedics are of prime
importance to improve the mood of patients.
What are the architectural inputs possible on palliative care facilities?
Creating space of openness with privacy to be with their near and dear ones
alongwith views outside the windows to connect to the serene nature and thus
almighty in their last days of life.
How do you think Architects can contribute to making the patients feel better?
The architecture should be friendly at the same time reassuring in terms of creating
an image of latest technology for to boost their self confidence and mental well
being.
In your opinion, what are the ways in which a patient can de-stresses before entering
a hospital?
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
This depends on the accompanying relatives or friends how they try to distress before
entering a hospital
Inside a hospital what are the elements that can reduce anxiety?
The overall ambience that blends architecture with surrounding serene nature
seamlessly. Also the proper organization of different spaces so that the patients can
go through a systematic way to their final destination without any confusion and
wasting anytime.
Patients and/or Doctors prefer Artificial Light or Natural Light?
Natural light is always preferred to artificial light in general. However, artificial lights
are required for clinical examination and other medical procedures.
Patients and/or Doctors prefer Natural Ventilation or HVAC?
Natural ventilation is always preferred to mechanical HVAC system. However,
considering the climatic condition of the region a proper HVAC system should be
there to provide human comfort controlling the temperature and the humidity.
Special ares like ICCU,ITU, BMT and the likes, a controlled HVAC is a must for the
prevention of any cross infections.
What elements can help the relatives or the patients?
Built form and open space should be blended well along with rational architectural
planning.
All the spaces inside and outside the building should be functional, soothing visually
to alleviate the agonies of the patients and their relatives. There should be spaces for
different kind of activities including recreational, library, cafeteria and other waiting
and sitting spaces with good natural landscaping, indirect lighting, artwork, fountain
and play areas for the child patients.
An auditorium plays a vital role in a hospital not only for scientific seminars and
conferences but also for the cultural/entertainment programs for the inpatients and
their relatives to take care of their psychological aspects especially when they are
suffering from the dreadful disease called ‗Cancer‘.
Impact of the Architectural Design of Hospital Built Environment on the Behaviour &
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
APPENDIX J- QUESTIONAIRE FILLED BY DR. BHATTACHARYA, CCWHRI, KOLKATA
NAME: Dr GAUTAM BHATTACHARJEE M.D.
OCCUPATION: Radiation Oncologist
YEARS WORKED: 30 years
Scale to be followed: 1: STRONGLY AGREE 2: AGREE 3: NEUTRAL 4: DISAGREE 5:
STRONGLY DISAGREE
Questions
1. THE FACILITIES HERE IS OF HIGH CLASS: 2
2. THE INTERIOR ENVIRONMENT OF THE HOSPITAL IS GOOD FOR PATIENTS 1
3. THE PATIENTS HERE ARE NOT STRESSED DURING THEIR STAY 2
4. THE FACILITIES HERE ARE OF WORLD CLASS STANDARDS 3
5. DURING DIAGNOSTIC PROCEDURES MUSIC AND LIGHTS MAKE AN IMPACT ON
REDUCING PATIENT STRESS: 1
6. THE LANDSCAPE AREAS ARE MAINTAINED WELL 2
7. GOOD LANDSCAPE FACILITIES HELP PATIENTS REDUCE STRESS 1
8. THE WINDOWS OF THE HOSPITALS HAVE GOOD VISTAS.1
9. THERE ARE SUFFICIENT SPACES FOR PATIENTS TO GO AND UNWIND.1
10. A PATIENT WOULD BE EASIER TO HANDLE IF THAT PERSON IS DE-STRESSED
BEFORE ENTERING THE HOSPITAL. 1
11. COLOURS HELP DE-STRESS 1
12. ARCHITECTURE ELEMENTS SUCH AS FOUNTAINS, SCULPTURES, LIGHTING,
MATERIALS ETC HELP IN RE-DUCING STRESS 1
In Your own words:
What do you think improves the mood of patients?
I feel good lighting with lot of colours and good aroma improves the mood to a
large extent.
How are the palliative care facilities?
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DISSERTATION ARC-411 | MSAP MANIPAL | MANISHANKAR DATTA | B.ARCH SEMESTER IX ‗A‘
They are reasonably good covering all issues of Palliative Care but we still need more
professional counsellors
How do you think Architects can contribute to making the patients feel better?
By good lanscaping , allowing more air and light to enter the rooms and spaces with
lots of bright colours and preferably soft music like the Buddhist Chants etc :-
Any other notable facility visited by you, and your observations:
Thakurpukur Cancer Hospital takes into consideration the patients needs to de-stress
and feel comfortable with oneself. It tries to augment the environment with good
lighting and colours which makes it bright and cheerful. Most of the patients coming
to this hospital are advanced cases which means they have limited liofe-span and
hence often anxious and depressed. Good environment tries to take away their
depression and elevate thie moods.
Being a Doctor and a user group of a Hospital what elements in a Hospital helps you
de-stress?
Lots of open space to walk around - the rooms are bright and well-lit and the water-
bodies makes us feel optimistic and healthy.
Which would you prefer-Artificial Light or Natural Light? Natural Ventilation or
Artificial?
Would surely favour natural light and natural ventilation if feasible.