BERKELEY, Calif. — For many young patients, harsh lights, bare walls, and windows facing parking lots or brick buildings make already painful hospital visits more unpleasant, stoking fear and uncertainty instead of hope. Often, those patients say, it makes recovery harder.
Their perspectives — historically overlooked in hospital design — are at the heart of a budding movement to make architecture more inclusive for the people who actually spend time there. Hospital groups like UCSF Benioff Children’s and Boston Children’s are exploring ways to fold young patients’ feedback into hospital design, like the color of walls and the placement of windows, art, and couches.
The field of “neuroarchitecture” isn’t new. But these days, health systems and their architects are increasingly realizing that building and room design impacts well-being, said Haripriya Sathyanarayanan, a Berkeley Architecture and Building Science Ph.D. candidate leading a research project using virtual reality to gauge how comfortable pediatric patients are in hospital rooms.
“It’s not just about making things look pretty,” she said. “We can create environments that alleviate stress and anxiety, making [patients’] hospital stays a little less daunting and a lot more comforting.”
There’s a business case, too. As they compete for patients, health systems are eager to improve satisfaction scores, which can indicate quality of care, she said. And satisfied patients could cost less to care for and have better health outcomes if they’re more likely to stick to their treatment plans, she said.
The project could inform UCSF Benioff Children’s plans for a new inpatient wing, said UCSF pediatric neurosurgeon Kurtis Auguste, who helps recruit patients for Sathyanarayanan’s study. Auguste, who frequently uses virtual reality to explain surgeries and scans to his own patients, said the technology can give health systems a creative way to get feedback from young patients. “What do you care about? What matters to you most in this space? …What makes you happy, what makes you sad?” he said.
Tucked in the basement of a gray brutalist campus building, Berkeley’s “extended reality” or XR lab is stocked with virtual reality headsets and also houses a pristine white hospital bed. The study has recruited roughly 30 children who were previously hospitalized to explore mocked up hospital rooms in virtual reality.
Participants use handheld controllers to flip through virtual hospital rooms, using a button to toggle between viewpoints from the bed or beside it. By tilting their heads, they can get a 360 degree view. In one room, a window faces into the hallway — a feature some like and others find invasive. Some rooms have different sized windows facing the sky; some have warm colored paintings hanging on different walls.
“Our focus is really on the patient point of view in our setup here,” she said.
It’s a slightly higher-tech version of a similar undertaking at Boston Children’s Hospital, where architects designing a new building made a cardboard model of an exam room that children with developmental diagnoses, their parents, and staff could walk into. Their feedback was sometimes surprising: a bright, cheerful color palette was actually too intense, risking overstimulation. Lightweight, smooth chairs without sharp corners meant children wouldn’t get hurt, but they were also easier to pick up and throw, so staff suggested weighing them down with sand.
To reassure children afraid of tests like EEGs, the hospital set up a simulation room where they can practice, or even play with certain devices before the real measurement later, Spence added.
In addition to easing stress, inclusive design makes care more efficient: A quiet waiting room for kids who find the usual one too overwhelming means they’re more likely to come to their appointments; making scans less frightening means kids won’t want to avoid them.
“And everything you’d do for a kid with disabilities works for everybody else too,” she said. “Not having sharp corners in exam rooms is good for every child.”
Inclusive design also lets former patients help future ones, said Ariela Rubens, a high school student who is part of the Berkeley study.
“I find it really exciting to know that future kids will have more pleasant, and happy, and healing rooms, and to help their process,” said Rubens, who was hospitalized several times in recent years for chronic pancreatitis.
As the research continues, there’s still no formal plan to incorporate the kids’ input into hospital designs, and getting architects and developers on board could be an uphill battle as they canvas other stakeholders, like clinicians.
But Auguste said the study team is collecting data on participant responses to bring to those meetings for consideration.
Immersing patients in virtual reality lets researchers track biological responses like eye movements and heart rate spikes that are, at least in theory, similar to what they’d experience in real life. Sathyanarayanan said that data could be a better reflection of patients’ feelings than surveys, in which they may feel pressure to answer a certain way.
There’s open discussion about which metrics are most useful; there aren’t standards for how to measure emotions like comfort and awe, Sathyanarayanan said. For her study, sensors in the headsets track participants’ eye movements, facial expressions like smiles and frowns, and heart rate spikes and drops. Looking at the window, for instance, showed marked decreases in wearers’ heart rates.
“Seeing the outside world is really nice, because a lot of times we’re not allowed to leave our room or if we can it’s just to our floor,” said Rubens, who joined the study at her parents’ suggestion. “It’s really nice just to see the sky sometimes. It’s a really calming factor.”
In the study, she preferred larger windows and rooms with brightly colored art on the walls. Art, she said, “gives you a little moment to look at other scenery and another area and takes your mind off of what’s going on. You can look at the details and figure out the story behind the art.” She especially liked a setup with a “wellness corner” lined with shelves that appeared to separate the room into two areas, offering some variety.
Auguste said the biometric data gives the health system much richer insight into what features matter the most to patients. “We wanted to prioritize having windows, but we weren’t expecting just how much time our kids spend in that part of the 3D space,” he said. “It’s not just about something to look at — there is actually something therapeutic about them being able to look at a window based on their vital signs.”