Journal of General Internal Medicine

, Volume 34, Issue 2, pp 312–316 | Cite as

Bricks and Morals—Hospital Buildings, Do No Harm

  • Diana C. AndersonEmail author


The volume and rigor of evidence-based design have increasingly grown over the last three decades since the field’s inception, supporting research-based designs to improve patient outcomes. This movement of using evidence from engineering and the hard sciences is not necessarily new, but design-based health research launched with the demonstration that post-operative patients with window views towards nature versus a brick wall yielded shorter lengths of hospital stay and less analgesia use, promoting subsequent investigations and guideline development. Architects continue to base healthcare design decisions on credible research, with a recent shift in physician involvement in the design process by introducing clinicians to design-thinking methodologies. In parallel, architects are becoming familiar with research-based practice, allowing for further rigor and clinical partnership. This cross-pollination of fields could benefit from further discussion surrounding the ethics of hospital architecture as applied to current building codes and guidelines. Historical precedents where the building was used as a form of treatment can inform future concepts of ethical design practice when applied to current population health challenges, such as design for dementia care. While architecture itself does not necessarily provide a cure, good design can act as a preventative tool and enhance overall quality of care.


Healthcare design Evidence-based design Architecture Ethics Hospital 


Compliance with Ethical Standards

Conflict of Interest

The author declares that she does not have a conflict of interest.


  1. 1.
    Ulrich RS. View through a window may influence recovery from surgery. Science. 1984;224(4647):420–1.CrossRefGoogle Scholar
  2. 2.
    Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61–125.CrossRefGoogle Scholar
  3. 3.
    Berry LL, Hamilton DK. How to build a better, safer, more welcoming hospital. The Conversation.2018.Google Scholar
  4. 4.
    American Institute of Architects. American Institute of Architects' 2017 Code of Ethics and Professional Conduct. 2017.Google Scholar
  5. 5.
    Clinicians for Design. Clinicians for Design - Vision and Mission. 2017.
  6. 6.
    Berry LL, Parker D, Coile RC, Jr., Hamilton DK, O'Neill DD, Sadler BL. The business case for better buildings. Front Health Serv Manage. 2004;21(1):3–24.Google Scholar
  7. 7.
    Sadler BL, Berry LL, Guenther R, Hamilton DK, Hessler FA, Merritt C., et al. Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities. The Hastings Centre Report. 2012;42(1):13–23.CrossRefGoogle Scholar
  8. 8.
    Currie JM. The fourth factor: A historical perspective of architecture and medicine. Washington, DC: The American Institute of Architects Academy of Architecture for Health; 2007.Google Scholar
  9. 9.
    Anderson D. Humanizing the hospital: design lessons from a Finnish sanatorium. CMAJ. 2010;182(11):E535–7. doi: CrossRefGoogle Scholar
  10. 10.
    The Academy of Neuroscience for Architecture. The Academy of Neuroscience for Architecture - History. 2018.
  11. 11.
    Wiener J. Dementia-friendly architecture: Reducing Spatial Disorientation in Dementia Care Homes. UK Research and Innovation; 2018.Google Scholar
  12. 12.
    O'Malley M, Innes A, Wiener JM. Decreasing spatial disorientation in care-home settings: How psychology can guide the development of dementia friendly design guidelines. Dementia (London). 2017;16(3):315–28. doi: CrossRefGoogle Scholar
  13. 13.
    Montague J. How design is helping people with dementia find their way around. The Guardien. 2018.Google Scholar
  14. 14.
    National Diasbility Authority. Centre for Excellence in Universal Design. 2014. 2018.
  15. 15.
    Facilities Guidelines Institute. Guidelines for Design and Construction of Hospitals and Outpatient Facilities 2010. Chicago, IL: American Society of Healthcare Engineering of the American Hospital Association; 2010.Google Scholar
  16. 16.
    McCabe C, Roche D, Hegarty F, McCann S. 'Open Window’: a randomized trial of the effect of new media art using a virtual window on quality of life in patients' experiencing stem cell transplantation. Psychooncology. 2013;22(2):330–7. doi: Google Scholar
  17. 17.
    Vincent JL, Slutsky AS, Gattinoni L. Intensive care medicine in 2050: the future of ICU treatments. Intensive Care Med. 2017;43(9):1401–2. doi: CrossRefGoogle Scholar
  18. 18.
    Hamilton DK. Too Sick for the Window and the View? HERD. 2016;9(2):156–60. doi: CrossRefGoogle Scholar
  19. 19.
    West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516–29. doi: CrossRefGoogle Scholar
  20. 20.
    Parks T. Physicians take to “reset room” to battle burnout. American Medical Association (AMA) Wire.2016.Google Scholar
  21. 21.
    Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action. Crit Care Med. 2016;44(7):1414–21. doi: CrossRefGoogle Scholar
  22. 22.
    Gunderman R. What Happened to the Doctors’ Lounge? The Atlantic - Health. Nov 5, 2013.Google Scholar
  23. 23.
    Jen L. Genetic complement. Canadian Architect. 2006:28–33.Google Scholar
  24. 24.
    Weidenbener L. Doctors use VR to try to reduce ICU delirium. Indianapolis Business Journal. 2018;39(14):8–9.Google Scholar
  25. 25.
    Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118(3):219–23.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  1. 1.American College of Healthcare ArchitectsFellow, Harvard Medical School Center for BioethicsBostonUSA

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