The role of physical design and informal communication

of more than 40 Pebble Project partners, such as healthcare organizations and
manufacturers, have participated in research and are demonstrating that evidence-
based facility design can improve the quality of care for patients, attract more patients,
and recruit and retain staff (The Center for Health Design, 2006).
1.2.1 Examples of Patient-Centered Evidence-Based Design
The increasingly competitive nature of healthcare is forcing facilities to pay
closer attention to consumer demands (Annunziato, 2000). As a result, much of
hospital design today has become deinstitutionalized as part of a shift toward patient-
centered design. There is a growing emphasis on creating supportive, aesthetically
pleasing, comfortable healing environments developed with the patient perspective in
mind. This movement toward humanistic design parallels, in time and philosophy, the
Planetree model of patient-centered care. According to Planetree, a not-for-profit
organization whose mission is to improve the patient experience, a patient-centered
approach partners providers with patients and their family members to identify and
satisfy a full range of patient needs and preferences (Planetree, 2008). The experience
of Planetree and other research (Ulrich et al, 2008) indicates that there are a number of
design factors that affect the patient and staff experience and the quality of care.
1.2.1.1 Access to Nature
In a number of studies over the past two decades, researchers have
demonstrated the stress- and pain-relieving effect of nature, real or simulated. In a
landmark study by Ulrich (1984), surgery patients who had a room with a view of a
small group of deciduous trees had shorter hospital stays, fewer negative evaluative
comments by nurses, and requested fewer painkillers than matched patients in rooms
with a view of a brown brick wall. This exploratory study spurred other investigations
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