'Healing architecture': A study of daylight in public hospital designs in Malaysia

Abstract

In the hospital building, where patients seek medical treatment and hospital staff provide continuous support, creating a healing environment is an imperative. However, it appears that the ultimate aim to create a healing environment is not given due attention by healthcare designers. Patients’ negative experiences of the existing physical environment of a hospital building describing as depressing, confusing, dull, little natural light, stressful, noisy causing sleep deprivation, anxiety, isolation and physical restraint were noted in many studies of the built environment. Most of these criticisms are also experienced by the patients in the case studies of hospital buildings in Malaysia, particularly on thermal (too warm) and visual (glare) discomfort. Therefore, the term ‘Healing Architecture’ is adopted to invoke a sense of a continuous process; creating an environment physically healthy and psychologically appropriate for patients’ well-being. A majority of the literature on the healing environment has reached a consensus that the physical aspects of built environment could contribute indirectly to the health outcomes of patients and staff in a hospital building. These include shorter length of stay, reduced stress and increased patients’ satisfaction. Among the physical aspects, daylighting is considered one of the most influential factors to achieve visual comfort contributing to a healing environment. The thesis aims to explore daylighting performance of a four-bed ward by means of a parametric study of design variables in order to achieve the visual as well as thermal comfort in creating a healing environment. Conflicting issues of ‘physical to physical’ (e.g. daylight vs. solar heat gain) and ‘physical to psychological’ (e.g. daylight vs. undesirable glare) are analysed. With the theme of daylight and health, previous studies related to the factors of the physical environments in hospital buildings that influence health outcomes are reviewed. The physical factors affecting daylighting to achieve visual comfort are also analysed. Reviews of the project briefs of the completed public hospital buildings in Malaysia are also conducted and seven hospitals are selected as the case studies to investigate daylighting conditions of the existing four-bed ward environment. Triangulation by means of analyses through questionnaire, measurement and computer simulation is the method adopted for the investigation. Available simulation programs are reviewed for suitability and compatibility of the study. The simulation software (validated) used for the study is Integrated Environmental Solutions – Virtual Environment (IES–VE). Based on the qualitative and quantitative analyses, it can be concluded that visual comfort in the existing four-bed ward environments of public hospital buildings in Malaysia is not achieved. Factors contributing to the failure are that the conflicting priorities (i.e. ‘physical vs. physical’ and ‘physical vs. psychological’) were not analysed by healthcare designers when designing a window (size and position), there is clear evidence of glare and daylighting design failed to meet the daylight factor (DF) requirement of 1% at the (innermost) bed-head. The finding is that a healing environment in the four-bed ward is not achieved. The results of the analysis also confirmed that the key physical factors affecting daylighting in the hospital ward are orientation, window design (size and position), external shading device, glass transmittance and indoor surface reflectances. Parametric studies of daylighting design variables on the ‘base case’ unit are formulated in order to find the remedy as well as to arrive at design guidelines. The Subang TRY weather data set is used and examined and found the two worst conditions days of the year: the hottest (day 60) and the cloudy (day 299). Evaluation criteria for measuring thermal as well as visual comfort are established to critically analyse the consequences of the variants in the permutations. A total of 186 simulations are run to appraise the comfort condition of the computer model of the four-bed ward environment. The simulation of daylighting conditions in a four-bed ward environment would take into consideration the magnitude of solar heat gain of one exposed wall (opaque wall and glass window) for the two selected worst days of the year and the ‘best’ orientation (other enclosing elements are taken as adiabatic). The results of the parametric study are analysed by adopting the process of elimination for the selection of variants. The variants of design variables that satisfy the evaluation criteria for comfort criteria set in the study are identified. Design recommendations are made and guidelines on how best to achieve visual comfort through daylighting design strategies in the hospital ward environment in the future are established. The findings arrive at two crucial conclusions in creating a healing environment. Firstly, visual comfort can be achieved through appropriate daylighting design.The second is that in order to achieve visual comfort in the four-bed ward environment there is a need to find a balance between the acceptable magnitude of solar heat gain and satisfying the requirement of daylighting (i.e. the acceptable limit of glare not exceeding a luminance ratio of 10 and 1% DF).

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