Evidence-based design: A new concept in health care facilities that puts the focus on patients

Patient environment is important
Patient environment is important

A recent article in The New York Times discussed the benefits derived from creating hospital rooms that are more patient friendly.1 When it was time to redesign and expand their hospital in 2003, the management team of the University Medical Center of Princeton at Plainsboro [New Jersey] (UMPCC) did their homework. They studied evidence-based design and new concepts in hospital architecture.2 They surveyed staff and patients. They tested the designs and survey results by creating a simulated patient room in the existing hospital, complete with furniture and medical equipment. Nurses and doctors provided input from the actual room, discussing the placement of everything from handrails along the wall to locating the scrub sink in view of the patient.


At the completion of that phase, the room was ready for use. Over the next few months, patients who had undergone orthopedic surgery did their postoperative recuperation in the model room. The patients liked having amenities such as a desk and individual temperature controls they could operate, and their guests appreciated having a family zone with two chairs and a sofa bed. The testers found the room to be quiet and enjoyed its view of the outdoors. Compared with patients in the old hospital rooms, those in the model room perceived their nursing care and food to be better, even though these were identical in both rooms. The newly designed room demonstrated its clinical advantage when the patients who stayed in it required 30% less analgesic medication than those in the old rooms.1-3

After almost 10 years and $523 million, the new 636,000-square-foot hospital opened in 2012, and all 221 patient rooms were versions of the model room. The management team had obviously done their homework well. The same-handed (not mirror image) design encourages privacy and quiet. The single-bed rooms and emphasis on hygiene ensure that incidences of patient falls and infections remain dramatically lower in the new building, and the patient satisfaction rating is almost 100%. 1,3 


Part of the reason patients at UMPCC required less pain medication may have been the positive effect of sunlight coming through large windows. A prospective study of 89 surgical patients supports this theory.4 The investigators wrote, “Our aim was to evaluate whether the amount of sunlight in a hospital room modifies a patient's psychosocial health, the quantity of analgesic medication used, and the pain medication cost.”4

The investigators placed patients in rooms on one of two sides of the hospital according to the amount of light that filtered into the rooms. Rooms on the “bright side” of the building had an average of 46% higher-intensity light than those on the “dim side.” Patients in the brighter rooms, which received a higher intensity of sunlight, reported having less stress and less pain and required 22% less pain medication per hour than those patients in rooms on the dim side of the hospital.4

In a paper exploring the influence of environmental stimuli on pain, Malenbaum and colleagues noted that patients with pain are rarely in an interesting or relaxing environment. “The typical treatment room is painted white, lacking decoration, sparsely furnished, and windowless. Patient's auditory stimuli may range from the noise generated by overhead lighting to urgent, loud paging requests to sounds of other patients suffering.”5 However, as many studies demonstrate, if patients are given an environment designed to reduce their stress and pain, and it usually does. The authors suggest that changes can be effected without expensive redesign. For example, put patients who are experiencing the most pain in those rooms with the most windows and the nicest views. The authors note that both natural and artificial light, as well as views of unspectacular nature, has positive effects on pain and mood.5


Evidence-based design is defined as “the deliberate attempt to base health care building design decisions on best available evidence,” explained Roger S. Ulrich, PhD, the leading proponent of the concept.6 Ulrich is professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Gothenburg, Sweden, and adjunct professor of architecture at Aalborg University in Denmark. He is internationally the most frequently cited researcher of evidence-based health care design, and his design principles have contributed to more than 1,200 buildings that heal, including the University Medical Center of Princeton at Plainsboro.6

Ulrich founded the Center for Health Design to educate and certify health and design professionals in the principles of evidence-based design. As part of that, the Pebble Project, a unique and dynamic collaborative that intends to create a ripple effect in the health care community, offers education, membership, and recognition for creators of innovative healing environments.6

The online version of this article includes a link to an interactive view of a patient room at University Medical Center of Princeton at Plainsboro.

Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey. 


1. Kimmelman M. In redesigned room, hospital patients may feel better already. The New York Times. August 21, 2014. http://nyti.ms/1tmIpkQ. Accessed September 12, 2014.

2. Rabner BS. How to help hospitals achieve their mission through good design. HERD. 2012;5(3):7-11.

3. University Medical Center of Princeton at Plainsboro. http://www.princetonhcs.org/phcs-home/what-we-do/university-medical-center-of-princeton-at-plainsboro.aspx. Accessed September 12, 2014.

4. Walch JM, Rabin BS, Day R, et al. The effect of sunlight on postoperative analgesic medication use: a prospective study of patients undergoing spinal surgery. Psychosom Med. 2005;67(1):156-163.

5. Malenbaum S, Keefe FJ, Williams AC, et al. Pain in its environmental context: implications for designing environments to enhance pain control. Pain. 2008;134(3):241-244.

6. Pebble Project. https://www.healthdesign.org/pebble. Accessed September 12, 2014.



[web editor: please include the following in the online version of this article. Thank you.]

Click here for a link to the University Medical Center of Princeton at Plainsboro interactive view of a patient room.



[Art: If you want to use any of the images from the facility's web site on their new rooms, the main number is 609-853-7000. I couldn't find a number for their PR office.]


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