Abstract
This is a challenging and invigorating report. Challenging in that it presents modeling techniques that are novel to the design profession (backward propagation modeling) and invigorating in that it points to a potential tool that could help analyze the patient perceived assessment of healing environments.
The authors are careful to clarify that the interpretation of healing environments is based on patient surveys, with no actual physiological or outcome measures used to assess healing. This raises obvious unanswered questions, such as the impact of room characteristics on infection rates, pain medication, and so forth.
The authors also note the limited sample size in their experimental research. The use of multiple regression as a cross-check on the modeling technique was impressive.
The initial introduction frames the issue in the context of focusing on an administrator’s budget decision about the high theme design items. In fact, many of the significant items would not present binary cost choice—for example, the ability to control lighting would not appear to be a major capital cost variable.
Identifying the room height as a major significant physical characteristic of the patient room is curious by American standards and certainly counterintuitive. “The larger and especially the higher the room is, the better.” One has to wonder if there isn’t some other room characteristic that is significantly correlated with ceiling height to produce this finding.
It would have been helpful if a more detailed description of the rooms in the primary research site was provided. Hospital B accounted for the vast majority of the 359 patient samples. How many rooms are private versus multiple occupancy? Is the respondent’s perception of autonomy and privacy affected by this factor? If ceiling height is identified as a significant factor, what was the range of heights in the sample rooms?
One has to also wonder if cultural factors would change some of the ranking of themes. Does the Netherlands population have the same view of privacy as in the United States, where it is almost a pathological obsession?
The implications for practice cited by the authors include focusing on spatial comfort, safety and security, and autonomy as key design issues. Some of the components included in these categories are not physical design (e.g., the ability to order meals), but it would be helpful if inferences from a larger sample size could start to describe the desirable range of design characteristics. “The results also show that the height of the parapet and the window surface are more important in determining the appreciation of the view than for instance the length or width of the window.” Is a higher or lower parapet better?
One has to wonder if the respondents might be suffering from survey fatigue with the range of questions included in this tool. There was also reference to the difference in responses based on the acuity of the patient and the patient’s age. All of this points to the value of a larger, cross-cultural study to verify this pioneering research approach. It would be valuable to integrate physiological measures into the analysis of perceptions of healing provided by the patients.
The potential to predict patient perceptions during the early design stage is intriguing. As patient rooms in the United States continue to increase in size based on the argument of creating a healing environment, can we determine a cost–benefit relationship to inform the nursing unit design? At a minimum, can we identify a lowest threshold of room characteristics? Could this backward propagation methodology be linked with virtual reality tools to provide predictive measures, as users make real-time changes to virtual images?
This article presents an innovative approach to the continuing debate regarding healing environments. In some ways, it illustrates the gap between design and other disciplines regarding analytical techniques. As our academic institutions continue to develop more diverse specialized tracks, it is important that graduates have the opportunity to combine these statistical capabilities with traditional design skills.