Background/Purpose: Healing Architecture (HA) is a design concept primarily aimed at reducing factors of stress in the physical environment both for the patient and for the medical staff. HA works through modifications of the physical environment and the practical functionality of the room. HA has the long term goal of achieving measurable improvements on economy, ressources, productivity and user/staff satisfaction. The study objective was to examine whether the application of HA principles in an outpatient infusion room for treatment with biologic agents used in treatments of rheumatologic diseases would impact patient experience and ultimately improve patient satisfaction as well as work satisfaction of attending nurses. 

Methods: A water wall making silent bobbles were installed in the infusion room in order to increase the stimulation of the senses and to improve relaxation. Artificial plants were introduced. Decorative art paintings substituted existing disease information related wall posters. The functionality of the room was improved by changing the layout of the seating and arrangement of infusion pumps. New ergonomic chairs were installed and for each chair a small table dedicated to the individual patient was provided. Furthermore, individual reading lamps were mounted for the allowing each patient to individually regulate the light. A high table was positioned in the center of the room with coffee, tea and water. In order to de-hospitalize the room all new furniture were similar in appearance and quality to what would be used at home. A questionnaire was designed to quantify the experience of the attending patients on 16 different parameters before and after application of HA modifications. The questionnaire, administered before and after the HA intervention recorded two sets of scores for each parameter: One set scored the perceived patient experience of each parameter. The other set scored the perceived importance of each parameter. A calculated combination of the two scores provided a composite score of the satisfaction with each parameter experienced (range 0-130). The change in the total composite patient satisfaction score before and after re-modeling of the treatment room was evaluated. In addition to this quantitative research, a total of four patients and nurses underwent a qualitative interview before and after the HA intervention.

Results: 43 patients completed a questionnaire before and after the HA intervention. Mean age was 54 ± 12 years, mean disease duration 13 ± 10 years, mean treatment duration 23 ± 8 months. The total score before and after the intervention was 56.6 ± 16.5 and 71.8 ± 19.2, respectively (p<0.001). Both nurses and patients reported highly positive attitudes regarding the HA modifications.

Conclusion: The study confirmed that the principles of HA significantly can increase patient satisfaction. The quantitative findings were supported by qualitative research, which demonstrated both increased patient satisfaction and increased satisfaction for the attending nurses.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-healing-architecture-in-a-rheumatology-outpatient-clinic/