COVID-19 and the Need for More Accessible and Designed Hospital Outdoor Spaces in Developing Countries

Developing Resilient Community Spaces in Healthcare Facilities: An Exploratory Study of a Public Health Crisis

OBJECTIVES

This exploratory study aimed to investigate the impact of the COVID-19 pandemic on the design of healthcare facilities, particularly those featuring communal spaces. It sought to identify strategies that were implemented, learned, or recognized when adapting to the limitations imposed by protective measures during the pandemic.

BACKGROUND

Third places are social gathering places outside of home and work. Over time, these community-centric places evolved from free-standing getaways to more integrated niches in diverse contexts including healthcare. Their numerous advantages for users include enhancing community bonds and collaboration among healthcare workers. The onset of the COVID-19 pandemic resulted in a need to rethink the design of such spaces to make them more adaptable and resilient.

METHODS

An exploratory qualitative study was conducted through in-depth semi-structured interviews with sixteen practitioners involved in healthcare architecture and design projects during the pandemic. Data were analyzed using a thematic analysis approach.

RESULTS

Findings indicate that the design of shared spaces in healthcare facilities for pandemic-like situations requires a special focus on modifiability and multifunctionality, achievable through strategies such as the use of movable, unconnected, and rearrangeable furniture or partitions that could swiftly change the function of a space. Other strategies include the capacity for compartmentalization of spaces, fostering indoor-outdoor connections, integrating advanced technology, and implementing effective infection control measures. Detailed emergent themes and examples of experienced constraints are discussed.

CONCLUSIONS

Insights gained from our findings can be applied to new and ongoing healthcare design projects to ensure resiliency during normal and pandemic conditions.

Hospital Outdoor Spaces as Respite Areas for Healthcare Staff During the COVID-19 Pandemic

The COVID-19 pandemic has created considerable implications for healthcare staff around the globe. During the pandemic, the frontline healthcare workers experience intense anxiety, stress, burnout, and psychological breakdown, with severe implications on their mental and physical well-being. In addition to these implications, anxiety and stress can hinder their productivity and ability to perform their duties efficiently. The literature indicates that hospital gardens and contact with nature can help alleviate psychological distress among hospital staff. However, few studies investigated the role of outdoor spaces as areas for respite and work breaks in healthcare facilities during the pandemic. The present opinion paper highlights the challenges of job stress and psychological distress health workers face during the pandemic. This article also underscores the role of hospital outdoor spaces and garden facilities in coping with the challenges. While other measures to reduce stress among hospital staff and ensure their health and safety are important, hospital administrators and relevant government agencies should also emphasize the provision of gardens and open spaces in healthcare facilities. These spaces can act as potential areas for respite for hospital staff to help them cope with the stress and anxiety accumulated through working under crises.

Influence of Hospital Outdoor Rest Space on the Eye Movement Measures and Self-Rating Restoration of Staff

Objective

To investigate the effect of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff.

Background

Relieving the pressure of hospital staff through exposure to hospital outdoor rest space is essential, but there is a scarcity of research on the impact of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff, especially for large Chinese hospitals.

Methods

Cross-analysis was conducted based on the eye movement measures of 76 staff members obtained by eye movement tracking equipment in combination with the self-rating restoration scale and hospital outdoor rest space picture attributes (element proportion and position, brightness and saturation).

Results

The differences in eye movement measures of different staff attributes (occupation, age, and gender) were identified, and the effects of hospital outdoor rest space picture attributes on the eye movement measures and self-rating restoration scale of staff were summarized. A number of proposals were also formulated: hospital outdoor rest space should be set up close to the working area of the group of medical staff; attention should be paid to the actual needs of senior staff members and the work pressure of junior nurses; the exposure to natural environment should be increased and the proportion of hard artificial elements should be reduced; the natural environment should be placed in the visual center; the saturation and brightness of hospital outdoor rest space should be increased; and staff members should have access to the sky environment in a variety of ways.

Conclusion

The present study is an empirical study of evidence-based design on hospital outdoor rest space in China, and the results reveal the effects of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff.

Functional Settings of Hospital Outdoor Spaces and the Perceptions from Public and Hospital Occupant during COVID-19

Hospital outdoor spaces play an important role for the safety and well-being of users (patients, visitors, and staff), particularly during a pandemic. However, the actual needs of these spaces are often overlooked due to the design and management process. This study investigates the perceptions of the public and occupants on the functional settings of outdoor spaces, and provides evidence for building a safe and resilient hospital during (and after) COVID-19. A multi-method approach of web content analysis (WCA) and a web-based survey was employed. Reports were collected from three mainstream websites; keywords were extracted and then categorized, pertaining to the functional settings of outdoor spaces. Three groups of occupants from Southwest Hospital (staff n = 47, patients n = 64, visitors n = 73) participated in the survey to identify their perceptions of these functional settings. Based on the 657 reports and 33 keywords selected, 7 functional settings were identified: health check (HC), quarantine and observation (QO), food and delivery (FD), healing and restoration (HR), waiting and rest (WR), transportation and parking (TP), load and unload (LU). From all users, HC (4.13) was thought to be the most expected function setting while FD (2.61) was the least. Regarding the satisfaction level, most users were satisfied with HC (3.22) while WR (2.16) was the least satisfying. The users also showed significant differences regarding expectation and satisfaction pertaining to their groups. The results indicate that the current outdoor space could not fully meet the needs of users, regarding the emerging functional setting, due to the pandemic. Users showed significant different perceptions on the functional setting due to their roles. The mismatch between the outdoor space and the users’ needs on emerging functional settings resulted in low satisfaction and high expectation in the survey. Environmental interventions with adaptive and flexible strategies should be adapted for these functional settings. The differences of users should be fully recognized by administrators, decision-makers, and designers.