Experiential (also known as environmental) graphic design, refers to the combination of interior design, architecture, industrial design and graphic design, focusing on the visual characteristics of a particular building. This heavily involves wayfinding, colour and imagery. During this dissertation, I will explore how these features can be improved inside a hospital setting to maximise factors such as well-being, relieve anxiety and reduce confusion to create a holistically calmer user experience with the aim of reducing expenditures and speeding up recovery.
I will start by discussing evidence-based design and its role in graphic design. Through research, we can design hospital buildings that scientifically aid in the healing process, not in relation to medical equipment but in regards to the use of spatial surroundings, colour and artwork as a distraction technique. Nature is a prodigious component, whether it is shown physically or artificially. Its impact on physiological reactions is astounding – the aim is to explore the possibilities of nature intertwined with architecture to best utilise its properties in boosting patient welfare.
Continuing on from this, I will investigate wayfinding, looking at successful real life examples such as the Brunel Building at Southmead’s Hospital, typography in relation to NHS’ brand guidelines, the use of jargon-free language and types of design that aid in patient orientation. Throughout this process, I will always refer back to evidence-based design to ensure that these concepts would work coherently if put into practice.
In the final chapter, I will look at departments as their own entities within hospitals. What specific features do individual wards need while still maintaining consistency throughout the complex as a whole? As it would be unrealistic to examine all areas of a medical facility, I will focus my attention on Accident & Emergency waiting rooms, paediatric wards and dementia friendly departments to show how making minor changes can have a vast impact on patient experiences. I will briefly touch upon Public Service Advertising in relation to hospital health behaviours and the power of visually strong promotional material. By looking at case studies that support these topics, we can begin to analyse positive and negative techniques and what strategies can be easily implemented into hospitals across the country.
The overriding aim of this dissertation is to show the extent to which design can transform the medical industry, allowing art to work in unison with science.
Chapter 1: Evidence-Based Design
Healthcare Design defined the term evidence-based design as “the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.” (2008) This is an appealing notion for hospitals due to their generally limited budgets – they want to ensure that the measures they are adopting are not going to be misspent. Evidence-based design allows for proven theories to be implemented that accurately result in change, disregarding the fear of wasted resources. In fact, many evidence-based design solutions are not excessively expensive. For example, adding artwork to walls would be of monetary value to a hospital institution as it is proven to speed recovery, therefore saving hospital funds as less medication and space is required for each patient. Due to this, the initial expenditure is likely to be regained.
Spatial design is a fundamental aspect of evidence-based design for hospitals. The main basis being that if we look at the architecture and interior design of buildings to see what measures better accommodate staff and patient needs, then in turn, this will have financial and health benefits. One example of this is by looking at ways we can assist staff in having a more streamlined environment, inevitably improving energy-efficiency and use of time. This can be achieved by well-planned ward layouts that reduce staff walking distances by fitting equipment hubs in centralised locations. Almost 28.9% of nurses time is spent walking (Burgio et al. 1990), suggesting that this would be replaced with patient-orientated care and interaction with family members. Secondly, affixing unambiguous wayfinding solutions around the hospital would reduce the need for staff to direct people themselves, allowing them to concentrate on the individuals that really need them – the patients. The additional time that would be gained and the reduction of fatigue by smaller walking distances, would as a result improve the level of care that is able to be provided.
The Effects of Nature
In terms of the aesthetics rather than the practicalities of spatial design, there have been numerous scientific studies that state the importance of having nature intertwined within constructed environments. We know for certain that environments affect people’s well-being, in and out of hospital settings – this can be in the form of stress, anxiety and safety to name a few. The evidence-based research for this can be found in the form of studies such as the likes of Ulrich et al who undertook laboratory and clinical studies to define the impact of nature on physiological reactions (1989). When viewing nature, they found that muscle tension and pulse transit time quickly decreased in conjunction with blood pressure and heart activity.
On the contrary, viewing urban environments that lacked nature can significantly heighten stress (Ulrich et al., 1991). Not only does nature have a positive influence on physiological symptoms of stress, but using nature as a form of distraction can also aid in the reduction of pain. Levels of pain are increased by how much conscious attention you allocate it. By giving patients an alternative subject to focus on, such as a calmative nature scene, as done in one study, it means that less concentration is going towards the pain, consequently reducing the discomfort experienced (McCaul and Malott, 1984).
Further supportive research shows that patient recovery time and level of pain medication requested decreased when their hospital bed was situated next to a window with a nature view of trees as opposed to a brick wall (Ulrich, 1984).
In addition to this, an investigation into the advantages of viewing nature assembled a group of adult patients undergoing a bronchoscopy operation at a teaching hospital in Baltimore. Aside from a control group which had no independent variables, a second group were assigned a ceiling-mounted nature scene mural and a tape of nature sounds to listen to before, during and after the procedure. It was concluded that the participants reported less pain when faced with this nature-based distraction therapy (Diette et al., 2003). This is something that can be easily administered into hospital settings without excessive costs as a way of improving patient mentality. Images that represent nature reduces stress and pain in a closely comparable way to real-life nature views (Ulrich et al. 2004). Therefore, it is less about reimagining hospital architecture in terms of making nature more accessible, as this may not always be plausible, but instead about extending hospital nature art into as many areas as deemed fit.
Distraction theory needs to be implemented with caution however. Using visual arts such as paintings in hospitals is not always positively received. Art that is emotionally challenging, ambitious and provocative can promote stress rather than diminish it. With this in mind, it is important to ensure artworks have soothing connotations, which would then consequently work in creating a more desirable environment (Ulrich and Gilpin 2003 as cited in Ulrich et al. 2004). When considering options for artwork in hospitals, nature imagery is rated as much more preferable to abstract art (Carpman and Grant, 1986).
The impact of nature is closely related to that of natural sunlight. Combining nature murals with sunlight would be the ultimate serene setting in hospitals. This is due to the evidence surrounding the implications of natural sunlight in the advanced recovery of patients. This is particularly apparent in depression cases, for example, patients that were admitted to hospital for severe depression who were assigned to a sunny room as opposed to a room with minimal sunlight were released by an average of 3.67 days earlier (Beauchemin and Hays, 1996). Although this isn’t directly related to graphics, it is a large factor of experiential design and this concept of sunlight in hospitals is predominantly attributed to subsequent case studies when creating a holistic design solution for medical buildings. factor
The Application of Colour
Colour is another element that should be considered in terms of not only its psychological implications, but it’s effect on physiological factors too. When designing a hospital nursery, initial thoughts may turn to the stereotypical pink and blue used to easily identify between genders, however this use of colour would actually hinder nurse’s ability to observe the situation at hand. The skin of infants is highly reflective, thus impacted by surroundings which means designers need to take this into consideration when choosing a colour palette (Frank H. Mahnke, 1996). For example, the aforementioned pink would give the impression of a healthy glow, misleading nurses into thinking the child is in good physical condition and enabling them to accidentally disregard complications such as anaemia and jaundice. On the contrary, tones such as yellow or green may create an image of jaundice where it isn’t. Additionally, a blue wall can reflect a cyanotic discolouration onto babies’ skin which could falsely indicate low oxygen levels in the red blood cells or problems with oxygenation around the body. In order to combat this, shades that have a low light-reflection ratio are best suited to hospital nurseries – neutral, faint and pale colours such as light beige would be best advised (Frank H. Mahnke, 1996).
Other hospital departments also rely on the colour of the surrounding environment to aid in recovery. As an example, in physical therapy, Mahnke is an advocate for aqua due to its ability to reduce muscular tension while also reflecting a glowing complexion (1996). On the reverse of that, if the therapy was specifically for the improvement of muscular movements, yellow would be more appropriate on account of its motoric capabilities. This would be best implemented with murals that show subtle motion (Frank H. Mahnke, 1996). Linking this back to the previous statement, murals of nature such as trees lightly swaying or leaves gently blowing in the wind would be a comprehensive proposal by associating movement with nature.
Colour and design has a wealth of possibilities for improving therapy. When aiding patients in relearning to walk, segmenting flooring into different colours could be a tool that emphasises progress. Mahnke suggests that the first section could be red to connote that the first steps are the most challenging, followed by a gradual transition to orange, yellow and then finishing with green or blue to indicate that the process is at a close, giving a sense of release (1996).
Following on from this interaction between colour and the feeling of release”,
dark, cold colours such as black, blue and green promote lower physical tension (Kurt Goldstein and Otto Rosenthal, 1930). Heinrich Frieling backed this up when he conducted a study at the Institute for Colour Psychology in Germany and concluded that blue-green and orange-red colour pairs are “tension releasing and the gathering of motoric actions.” (Frieling, 1968 cited in Mahnke, 1996) This is ideal for processes such as child birth where Frieling also discovered that blue-green was the preferred colour of choice, cementing the research that these tones would be highly regarded on labour wards as a technique to subtly promote relaxation and ease tension (1968).
This goes to show the importance of colour when designing for specific departments in hospitals and how evidence-based design can increase the practicalities of these design choices depending on the area of care needed.
In conclusion, evidence-based design studies in regards to graphic design has taught us that having art around hospital walls is intrinsic in creating an environment that reduces stress, pain and recovery time, as long as the art itself is of a nature theme. All things that denote a natural environment such as sunlight and sounds can accompany these graphics for a holistic user experience. As expressed by Architect’s Data File: “In the ever advancing field of public healthcare, technological innovation is increasingly matched by efforts to improve patient ‘healing’ and well-being by designing hospital environments with greater access to natural daylight and ventilation, more generous spaces and a less institutional feel.” (2014)
We have also concluded that colour plays an intrinsic role in the hospital environment and should be carefully considered as different departments require unique colour palettes. Specific tones can inherently aid recovery or benefit the process of specific treatments.
When broadening the topic to architecture, there is a wealth of research that shows how buildings can use evidence-based design to better accommodate the needs of hospitals. However, when we are just focusing on graphic design, implementing effective wayfinding into architecture is a key aspect in reducing staff walking distances and increasing patient-care time. The next chapter will look further into wayfinding and how designers can work with researchers and hospitals to optimise navigational experiences.