How can you use design to promote health? Minou Afzali, Head of Research at the SCDH, says the question needs an interdisciplinary answer.
The Swiss Center for Design and Health (SCDH) is a place for anyone interested in the points where architecture and design interface with health-related questions. «These interfaces don’t only become tangible in built environments,» explains Head of Research Minou Afzali. The environments she refers to include digital spaces, such as a platform that provides oncology nurses with information and a forum for dialogue, or hybrid settings that support us at home, such as telemedicine.
Putting people at the centre
As a doctor of social anthropology, Minou Afzali is interested in how people interact in analogue, digital and hybrid spaces when it comes to their health. And as a design graduate, she knows that everything is designed – not just spaces, but also the interactions and objects that exert an effect within those spaces. These range from plasters for children to anaesthesia tubes, from urologists’ waiting rooms to operating theatres, and from home nursing visits to telemedical consultations. The healthcare system is also designed because politicians want it that way. It also provides the SCDH’s system horizon. Embedded within this are the development of continuing education and cooperation with various real-world and research partners. The SCDH’s activities are divided into three areas: «Visual communication», «Objects and environment» and «Systems and processes». «Our goal is to research and develop design solutions and standards in all these areas that will promote health,» Minou Afzali explains.
In pursuit of this Holy Grail of design methodology, the SCDH’s offerings are people-centric, participatory and iterative. «We put people at the centre of everything we do, factor in all stakeholder perspectives right from the outset, and we know we can find a design solution by a process of constant review.» As a researcher, however, Minou Afzali is particularly interested in the fourth cornerstone of the SCDH – an evidence-based approach.
Does architecture have curative properties?
This is because the question that overarches all these efforts is whether it is possible to relate health with design, and, if so, how. After all, the built environment, the products with which we interact and the services we use impact our well-being as part of our daily experience. But can architecture help? Certainly not on its own, says Minou Afzali, anxious to head off exaggerated claims. «Our health is determined by a large number of other factors.» The part of her that is a scientist is keen to know exactly what quantifiable effect architecture and design have on health. There are already reliable findings relating to this issue. The publication of a study in «Science» in 1984 marked the start of evidence-based design (EBD) as a research discipline. A research team headed by US professor Roger Ulrich evaluated the medical records of 46 patients who had their gallbladders removed at a hospital in suburban Pennsylvania between 1972 and 1981. The 23 patients with a window view of a natural setting spent less time in hospital, received fewer negative evaluative comments in the nurses’ notes, and took fewer potent analgesics than the other half of the group, who were in similar rooms but with windows facing a brick wall.
When it comes to health, the demonstrable stress-reducing effect of being able to relate to the natural environment is just one of many factors. Since then, a range of studies has shown how carefully thought-through and designed spaces, objects and processes can reduce healthcare-associated infections, medical errors, patient falls or staff injuries, patient and staff stress, safety and productivity, as well as improving environmental and financial sustainability. This fund of reliable knowledge provides the foundation for new research and design work, including the work done by the researchers at the SCDH. «We review current research, then work with our research and real-world partners to develop a starting point. If there’s no evidence, we try to find it,» explains Minou Afzali, outlining the approach. «Building on that, we identify potential solutions and sources of optimisation.»
Functional requirements for healthcare spaces have a long history. There is no doubt that a lot of knowledge has gone into directives, standards and specifications. So why is there still a need for fresh evidence? «It’s true that people have been building health-related spaces for hundreds of years,» says Minou Afzali. «But our research and design work relates to specific contexts and varying needs.» Something that could be beneficial to one group of patients might be alarming for another. The evidence can be contradictory, depending on the context. Design is always context-dependent and involves psychological issues of perception. And that takes us to the heart of the matter: How do you set about gathering aesthetic evidence? To answer this question, the SCDH also has a design and architecture team.
Highly interdisciplinary
The SCDH team uses a broad definition of evidence. «Collecting data, observing, designing and testing are all part of evidence-based design,» says Minou Afzali. «And, as in any research activity, we always use the existing knowledge as our starting point.» The SCDH takes an active approach to managing this knowledge by organising symposia on health-related issues and inviting guest researchers or project partners from the higher education institution environment to share and jointly advance their knowledge. «The researchers bring their expertise and use our skills or infrastructure. That way they can obtain specific knowledge for their projects,» Minou Afzali explains. This dialogue is highly interdisciplinary in nature. This is also essential for the enormous research area covered by health. This is because the WHO defines health not merely as the absence of disease or infirmity, but as a state of complete physical, mental and social well-being. It therefore makes sense to combine forces to tackle the huge task of translating this into research.
Evidence-based design (EBD)
The term was first coined in healthcare and began with the publication of Roger S. Ulrich’s study «View Through a Window May Influence Recovery from Surgery» (Science 224(4647):420–1). Since 2007, «Health Environment Research & Design Journal» (HERD) has been publishing articles and research papers on the relationships between health and environmental design. EBD methodology requires design decisions that are based on validated research results. This demands a rules-based approach that follows scientific working principles. A rationale is given for design and construction decisions and the results are reviewed, which in turn leads to fresh evidence. Research in the field shows that the way analogue and digital environments are designed has an impact on system participants’ well-being. As a method, EBD is also discussed in user experience (UX) design. Studies of the efficiency of using digital interfaces are based primarily on findings from usability research conducted since the 1980s.
Minou Afzali is a university-trained product designer who holds a PhD from the Institute for Social Anthropology at the University of Bern and researched and taught at Bern Academy of the Arts as a professor of social design in design and health. Minou Afzali is a mem- ber of the SCDH’s Extended Management and its Head of Research.