HEALING THROUGH ARCHITECTURE

DISSERTATION
Submitted by

JANAKI. S. NAIR
In partial fulfillment for the award of the degree of
BACHELOR OF ARCHITECTURE
MAHATMA GANDHI UNIVERSITY, KERALA
Under the guidance of
AR. DHANUSH VAYALAMBRON

ASIAN SCHOOL OF ARCHITECTURE AND DESIGN INNOVATIONS

SILVERSAND ISLAND, VYTILLA P.O.
ERNAKULAM, KERALA, INDIA 682019

MAY 2019

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 TABLE OF CONTENTS

TABLE OF CONTENTS ...................................................................................... 2

LIST OF FIGURES ............................................................................................... 4

LIST OF TABLES ................................................................................................. 6

DECLARATION.................................................................................................... 7

ACKNOWLEDGEMENT ..................................................................................... 8

ABSTRACT ............................................................................................................ 9

CHAPTER 1:INTRODUCTION ........................................................................ 10

1.1 What is Healing? .......................................................................................... 10

1.2 Healing and architecture .............................................................................. 12

1.3 Background .................................................................................................. 13

1.4 Rationale ...................................................................................................... 14

1.5 Aim .............................................................................................................. 15

1.6 Objective ...................................................................................................... 15

1.7 Methodology ................................................................................................ 15

1.8 Scope ............................................................................................................ 16

1.9 Limitations ................................................................................................... 16

1.10 Structure of the report ................................................................................ 16

CHAPTER 2:LITERATURE REVIEW ........................................................... 18

2.1 Introduction .................................................................................................. 18

2.2 Planning parameters ..................................................................................... 18

2.2.1 Convivial Entrance................................................................................ 18

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 2.2.3 Esteemed environment .......................................................................... 19

2.2.4 Addressing Normalcy ........................................................................... 21

2.2.5 Free and Open Environment ................................................................. 22

2.2.6 Directly Accessible Green .................................................................... 23

2.2.7 Rooms on Patient’s terms ..................................................................... 26

2.2.8 Cleanliness and Sanitation ............................................................... 27

2.2.9 Security and Safety .......................................................................... 28

2.3 Elements in Healing ..................................................................................... 28

2.3.1 Colour ................................................................................................... 28

2.3.2 Water ..................................................................................................... 30

2.3.3 Landscape ............................................................................................. 32

2.3.3.1 Samaritan Regional Medical Centre ......................................... 33

2.3.4 Sun ........................................................................................................ 34

CHAPTER 3:LITERATURE CASE STUDY ................................................... 35

3.1 Paimio Sanatorium ....................................................................................... 35

3.1.1 Introduction ........................................................................................... 35

3.1.2 Fresh air and Sunlight ...................................................................... 38

3.1.3 Indoor and Outdoor spaces ................................................................... 41

3.2 Khoo Thek Puat Hospital ........................................................................ 42

CHAPTER 4:LIVE CASE STUDY.................................................................... 46

4.1 Aster med city .............................................................................................. 46

4.1.1 Introduction ........................................................................................... 46

4.1.2 Architecture of the Hospital .................................................................. 48

4.1.3 Inferences from construction of Aster med city ................................... 51

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CHAPTER 5:ANALYSIS ................................................................................... 58

CHAPTER 6:CONCLUSION............................................................................. 63

REFERENCES ..................................................................................................... 65

LIST OF FIGURES

Figure 1. 1 Figure.4. 1 Optimal healing environment healing spaces in architecture

study the explores the (source : ability of space to enhance healing by Cayesar
Hussain ................................................................................................................... 11
Figure 1. 2 A design theory for reducing aggression by Ulrich (2012) (source:
academia.edu) ........................................................................................................ 12
Figure 2. 1 Muktangan de-addiction center, Pune(source : ability of space to
enhance healing by Cayesar Hussain)………………………………………19

Figure 2. 2 Explains the balance between environment and other criteria in Peter
Zumthor’s design of Therme Vals(source: academia.edu) .................................... 20
Figure 2. 3 Paimio Sanatorium, Alvar Aalto, View of Cafe(source: academia.edu)
................................................................................................................................ 22
Figure 2. 4 Paimio Sanatorium, Alvar Aalto, Exterior View(source: google) ...... 24
Figure 2. 5 Paimio Sanatorium, Alvar Aalto, View of Lounge room with special
furniture(source: google) ....................................................................................... 25
Figure 2. 6 View through a window may help for recovery from surgery ( 1984
study of patients recovering from gall bladder surgery(source: google) ............... 26
Figure 2. 7 Paimio Sanatorium, Alvar Aalto, View of Patient room with the
overlooking windows(source: google) ................................................................... 27
Figure 2. 8 Woodwinds Hospital in Minneapolis, Barcelona, View of Water body
................................................................................................................................ 31
Figure 2. 9 Woodwinds Hospital in Minneapolis, Barcelona, View of Landscape
................................................................................................................................ 31

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Figure 3. 1 Site plan of the completed hospital showing the main building and its
wings, A – D, the Junior Physicians’ and Administrative Director’s terraced house
facing the hospital entrance and workers’ apartment building(source:
academia.edu)…………… 36

Figure 3. 2 The Paimio sanatorium is located 60-degree north Latitude(source:

academia.edu) ........................................................................................................ 37
Figure 3. 3 The corridor of the patients´ wing(source: academia.edu) .................. 39
Figure 3. 4 The top floor balcony and its curved canopy(source: academia.edu) . 40
Figure 3. 5 Main stairs of Paimio Sanatorium(source: academia.edu) .................. 40
Figure 3. 6 Khoo Tteck Puat Hospital, Singapore ................................................. 42
Figure 3. 7 Pathway Through The central courtyard ............................................. 42
Figure 3. 8 External Landscaping done at the hospital ......................................... 43
Figure 3. 9 Orienting our self with the central courtyard ...................................... 44
Figure 3. 10 Basic functions coming on each floor(source: academia.edu) .......... 44
Figure 3. 11 Waiting lounge outside ICU(source: academia.edu) ......................... 45
Figure 3. 12 A slice of greenery on the walls(source: academia.edu) ................... 45
Figure 3. 13 Patient room(source: academia.edu) ................................................. 45
Figure.4. 2 Aster med city……………………………………………………..46

Figure.4. 3 Masterplan showing the waterfrontage(source: Nalapat architects) ... 47

Figure.4. 4 Typical floor concept plan(source: author) ......................................... 48
Figure.4. 5 Basement and Ground floor concept plan(source: author) .................. 48
Figure.4. 6 Typical tower plan(source: author) ..................................................... 49
Figure.4. 7 Lower Ground Floor plan(source: author) .......................................... 50
Figure.4. 8 Ground floor plan(source: author) ....................................................... 50
Figure.4. 9 patient's room(source: author) ............................................................. 51
Figure.4. 10 patients room sofa(source: author) .................................................... 51
Figure.4. 12 view from patients’ room(source: author) ......................................... 52
Figure.4. 11 view from corridor window(source: author) ..................................... 52

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Figure.4. 13 Entrance(source: author) ................................................................... 53
Figure.4. 14 Entrance lobby(source: author) ......................................................... 53
Figure.4. 15 Waiting area at the entrance…………………………………………59
Figure.4. 16 Atrium space…………………………………………………...
54
Figure.4. 17 corridor through care unit(source: author) ........................................ 55
Figure.4. 18 cafe(source: author) ........................................................................... 55
Figure.4. 19 View from windows(source: author)……………………………….55
Figure.4. 20 Pathway(source: author) .................................................................... 56
Figure.4. 21 musical instrument played live at the entrance lobby(source: author)
................................................................................................................................ 56
Figure.4. 22 pathway(source: author) .................................................................... 56
Figure.4. 23 Panoramic view of Aster med city being surrounded by a huge carpet
of greenery(source: author) .................................................................................... 57
Figure.4. 24 lake nearby(source: author) ............................................................... 57
Figure.4. 25 Raised platform outside the med city for water fountain(source: author)
................................................................................................................................ 57

LIST OF TABLES

Table 5. 1 results of exposure to sunlight .............................................................. 58

Table 5. 2 view from window ................................................................................ 59
Table 5. 3 single occupancy versus multi occupancy ward ................................... 59
Table 5. 4 relationship of design factors with health outcomes ............................. 61
Table 5. 5 interview with doctors and staff of a health care center in cochin ....... 62

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 DECLARATION

“I hereby declare that this submission is my own work done as part of 2011 AR 702

DISSERTATION (S7 & S8), M G University B.Arch. Course and that, to the best of

my knowledge and belief, it contains no material previously published or written by

another person nor material which has been accepted for the award of any other

degree or diploma of the university or other institute of higher learning, except

where due acknowledgment has been made in the text.

Place: Signature:

Date: Name:

PRN:

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 ACKNOWLEDGEMENT

The writing of this dissertation has been the most noteworthy part of my academic
works, but the insight of this research could not have been possible without the
support, patience and guidance of the several people. On the occasion of submitting
the dissertation on “Healing through Architecture”, I take my opportunity to owe
my inmost and genuine gratitude whom I am indebted to. Professor Ar. Dhanush
Vayalambron, ASADI, who by his able guidance, inspired me to a great extent in
successful completion of this research. Professor Ar. Fathim Rashna, Vice
Principal, ASADI for availing me all the facilities to completion of my dissertation.
I also thank my friends Jhanvi and Aamir for providing me resources and facilities
to complete my work on time. I would like to thank my father Satheesan S, my
mother Sudha S Nair and my brother Goutham S Nair, for their love, support and
for inspiring and encouraging me to go for this topic and assisting me at various
stages of my dissertation. Last but not the least; I would also like to thank the God
Almighty for his strength, opportunities and blessings.

JANAKI S NAIR

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 ABSTRACT

“We shape our buildings, later on they shape us”. This is how Wintson Churchill
expressed the effect of architecture and our environment. The intent of this
dissertation is to explore how architecture can inform healing or provide spaces and
events where healing can take place. We as human beings have an inner connection
with our environment by physical, mental, emotional and spiritual means.
Healing cannot be understood in isolation from the factors that operate in the
dynamic life of an individual. These include the self, the family, the community,
the environmental context within which life is carried forth, and the world of spirit
or essence. Furthermore, the arts and art therapy have, over the years, been used to
heal different aliments such as cancer, mental illness, aids, addiction and the elderly
have been successful in doing so as it heals across all ages and race. The question I
pose is can architecture do the same? In our built environment we often interact
with the buildings themselves without knowing the fact of relationship between
building and surroundings. Can we create those interactions by evidence-based
design methods?
Hospitals are one of the important spaces where this concept has to be implemented.
This research commences with defining, what does heal mean? I am also framing
out significant parameters that guide the design of healing spaces. To support my
parameters, I am also citing the works live case studies and literature case studies.
This dissertation summarizes the principals of life enhancing role of architecture
and planning in the healing process. This study includes the innovative solution for
healing environment inside and outside the hospital building through site planning,
building planning, interior of the room, views, social spaces such as waiting areas,
atrium, corridors, food court, healing gardens, etc.

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 CHAPTER 1

INTRODUCTION

Numerous studies show evidence of the body’s ability to “self-heal” when put into
positive healing environments. This healing is enabled by the ability of the body to
‘tap into our internal pharmacies’ by activating the body’s powerful neurochemicals
such as endorphins. Spaces are good mediums for affecting emotions. In places
where intense emotions run high, materials, sounds, smells, light, and colour have
an enormous influence on how people perceive themselves and cope with their
situations. In hospital healing spaces, the patient’s experience is often undervalued,
overlooked by the functions and operations of the medical treatments and busy
schedules.

Healthcare buildings are to be designed as living spaces for patients rather than
warehouses for the sick. It has to be remembered that a hospital is not a factory in
which the assembly lines dictates all aspects of design but is a community in which
the patient is fundamental to the successful working of the whole. Needs and
expectations of the patients have to be visualized, analyzed and fulfilled. The
hospital building should provide the patients a sense of safety, comfort, dignity and
repose. It should also provide pleasing spaces for patients, families and visitors as
well as imbibe the cultural concerns of the community.

1.1 What is Healing?

The terms curing and healing are often used interchangeably but have distinct
definitions. The term curing refers to the relief of the symptoms of a disease or
condition. The term healing refers to the alleviation of a person’s distress or
anguish. In order to fully take advantage of the body’s healing potential,
environments hold the ability to stimulate the senses and become active healers
themselves. This helps minimize negative effects of stress on the body, guiding a

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positive physical and psychological response to environments in ways that
maximize the effectiveness of crucial medical treatments and procedures. In order
to take advantage of the body’s healing pharmacies, environments must prevent the
body from weakening due to stress.

Stress is the body’s biggest obstacle in healing, and many contemporary hospitals
inflict so much stress on patients that it actually slows down healing, counteracting
the medications and treatments patients receive. The research reviews several
healing spaces, comparing traditional healing spaces with contemporary ones,
analyzing both positive and negative examples in terms of the architecture’s ability
to help augment healing

Figure 1. 1 Figure.4. 1 Optimal healing environment healing spaces in architecture

study the explores the ability of space to enhance healing by Cayesar Hussain

Optimum healing environment (OHE) is framed as the “social, psychological, and

behavioral components of healthcare support and stimulate the body’s innate
capacity to heal itself.

In fact, healing is not a process of curing or fixing, but rather a return to balance
between all of these component Health, therefore, is understood as the presence of
this balance; illness is its lack. Far from being inert containers, spaces can be
understood to be fully participant in the healing experience. It Is possible to

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conceive and create structures that heal. Although materials, structure, and
equipment are part of this endeavor, equal footing can be granted to the land,
the natural world, the community, our ancestors, and the spirit in all of this.
Working with the totality of these forces can result unconscious co-creation of
spaces that are not only useful, but which are vibrant and alive, and therefore
capable of their own contributions.

1.2 Healing and architecture

Architecture takes a holographic approach by looking at the effectiveness of art to

promote healing. It is a therapeutic experience aimed at connecting with the inner-
self to bring about change in a person’s lived experience. The question that needs
to be asked is that, can our environments heal or can it make us sick? I would like
to explore the architecture which can be used as a tool for healing. Healing in
psychology, medicine and even nature involves a process where the patient or the
recipient receives a physically external antidote in order to help them heal. It is then
up to the patient to take the inward step of acceptance and observation in order to
progress the healing.

Figure 1. 2 A design theory for reducing aggression by Ulrich (2012)

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Healing environment for a healthcare center describes a physical environment that
supports patients and families through the stresses that develop as a result of
illnesses .the physical healthcare environment that is the psychologically
appropriate can make a difference in patients recovery the physical aspects like day
lighting, window design ,thermal condition etc. should be designed without
compromising the functions of the hospital.

1.3 Background

Hospitals first appeared at the start of the Christian era to shelter sick or weary
travelers and persons too poor or ill to be treated at home, yet their dirty, crowded
and dark environment were anything but hospitable. The change from this to the
present-day hospitals has been metamorphic. Many healthcare facilities inflict high
levels of stress on patients, visitors, and staff members.

The term hospital derives from the Latin word “hospitalis”, which relates to guests
and their treatment. (Bartlett, 2007). The word reflects the early use of these
institutions not merely as places of healing but as havens for the poor or for weary
travelers. Hospitals first appeared in Greece as “Aesculapius”, named after the
Greek god of medicine, Aesculapius. For many centuries they developed in
association with religious institutions, such as the Hindu hospitals opened in Sri
Lanka in the 5th century bc and the monastery-based European hospitals of the
Middle Ages (5th century to 15th century). The Hôtel Dieu in Paris, a monastic
hospital founded in A.D. 660, is still in operation today. (Bartlett, 2007) The first
hospital established in the United States was Pennsylvania Hospital in Philadelphia,
which was chartered in 1751 with the support of Benjamin Franklin. Although other
U.S. hospitals were created in the 1700s, most people were treated for their illnesses
by neighbors and friends in their homes well into the 1800s. Hospitals changed
radically after the Civil War—in the early years of the war no hospitals were
available to treat the thousands of soldiers who were wounded or became ill, but by
the war’s end in 1865, 200 hospitals with more than 137,000 beds had opened in
the northern states. In addition to the military hospitals that emerged during the

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Civil War, many voluntary and public hospitals appeared in the 1850s. 3
Throughout the 1850s and 1860s it was far more dangerous to receive care in a
hospital than at home because of poor sanitation. As many as 25 percent of patients
died after surgery because hospitals of that era were overcrowded, poorly ventilated,
and inadequately cleaned. The introduction of antiseptic techniques by British
surgeon Joseph Lister in 1865 marked a turning point in the safety of
hospitalization. Patient care also improved as a result of the formal training of
nurses at the first nursing schools, which were founded independently .The
development of X rays and the clinical laboratory in the 1890s further improved the
quality of care available to patients and prompted the opening of many new
hospitals, including religious hospitals and hospitals that specialized in the
treatment of women or children. The number of for-profit hospitals owned by
doctors also increased between 1890 and 1920.

Most certainly. In the recent past, healthcare architects and hospital planners have
focused on the issue of universal access and the implications of that on utilisation
and hence, building size. But researches have shown that healing can be brought.

1.4 Rationale

Healing architecture starts with a focus on improving the patient experience and
outcome. In order to bring healing architecture to life in healthcare facilities, it’s
important to adopt a holistic planning approach that includes input and feedback
from the end users in addition to the design, construction and operations teams.
Healthcare facilities are designed to enhance a hospital staff’s ability to provide
high-quality care and efficiency. Yet the power of the architecture itself to impact
a patient’s recovery time and the overall effectiveness of a facility tends to be
overlooked.
An environment that embodies living structure allows us to live life fully. If we can
design our healthcare architecture on principles the outcomes for patients, their
quality of experience and the satisfaction and effectiveness staff are all likely to
improve significantly. The goal of all healing environments is to engage patients in
the process of self-healing and recovery. As a result, these spaces are designed to

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be nurturing and therapeutic to reduce patient and family stress. Recent studies have
shown that living in cities can emphasize or trigger the appearance of health issues
such as anxiety disorder, diabetes, cardiovascular and immune diseases, etc. By
connecting architecture with users’ experiences, medical sciences, art, design and
new technologies, the project aims to develop several models of healing urban
environments that could be tested and implemented in cities. Those small indoor
and outdoor spaces will integrate design and new technologies to stimulate user’s
senses and help them improving their physiological and mental health. Used
occasionally or on a daily basis, those space will help users reconnecting with their
body, get more physically active, focused, relaxed, preventing health problems.

1.5 Aim

The aim of the study is to discover the architectural means to create the healthy
atmosphere and how architects can design spaces capable of bringing happiness and
speed healing especially in case of hospitals.

1.6 Objective

• Research to promote the creation of healing environment through

architecture.
• Exploration of factors that lay positive impact on health outcomes.
• Review of the buildings with healing environment
• Evaluation to enhance smooth and efficient running of healthcare facilities
by provision of recommendation on creating comfortable health care
environment.
• Review to make an assessment of the physical form of the health care
building and its response to enhance patients’ expectations.

1.7 Methodology

• Literature study on reviews based on similar topic to analyses the bag round
or history of the topic.

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 • Literature Case studies on buildings which have applied the concept of
healing through architecture.
• Understanding the present condition of hospitals.
• Live case studies on buildings which have applied this concept.
• Interviews with people(architects) doing or promoting the concept of
healing through architecture.
• Surveys and studies on how this concept have brought in a change.
• Finally, a systematic analysis should be made on the how hospitals or other
public space can be created using this concept.

1.8 Scope

• By connecting architecture with users’ experiences, medical sciences, art,

design and new technologies, the project aims to develop several models of
healing urban environments that could be tested and implemented in cities.
Those small indoor and outdoor spaces will integrate design and new
technologies to stimulate user’s senses and help them improving their
physiological and mental health.
• Here I mainly wish to limit the study on how the topic of healing through
architecture can be brought in to designing hospitals or better spaces for the
patient.

1.9 Limitations

• Research is limited to healing through architectural spaces and environment

there is no provision of healing through medication.
• It deals with only healing and positive impacts on human psychology and
hence is limited.

1.10 Structure of the report

• This report is presented in six chapters followed by references.

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• The first chapter presents the introduction of the dissertation, background,
rationale, aim, objective, methodology, scope and limitations of the study
are explained.
• Literature reviews is explained in the second chapter.
• Third chapter explains about the literature case study.
• The fourth chapter details about the live case study along with its analysis.
• Analysis of the study through researches and questionnaire is explained in
the fifth chapter.
• And the sixth chapter conclusion of the study is given.

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 CHAPTER 2

LITERATURE REVIEW

2.1 Introduction

Numerous studies show evidence of the body’s ability to “self-heal” when put into
positive healing environments. This healing is enabled by the ability of the body to
‘tap into our internal pharmacies’ by activating the body’s powerful neurochemicals
such as endorphins. The terms curing and healing are often used interchangeably
but have distinct definitions. The term curing refers to the relief of the symptoms
of a disease or condition. The term healing refers to the alleviation of a person’s
distress or anguish. In order to fully take advantage of the body’s healing potential,
environments hold the ability to stimulate the senses and become active healers
themselves. This helps minimize negative effects of stress on the body, guiding a
positive physical and psychological response to environments in ways that
maximize the effectiveness of crucial medical treatments and procedures. In order
to take advantage of the body’s healing pharmacies, environments must prevent the
body from weakening due to stress.

2.2 Planning parameters

2.2.1 Convivial Entrance

First impressions matter a great deal. The first encounter deeply tinges our further
experience and thus means a very great deal. Almost instantaneously we create for
ourselves an image, not just of the building but of all its activities. Indeed, Stefan
Lundin in his book
The entrance situation has been a neglected point in the design of healing spaces.
Descriptions from the world of psychiatry testify to obscure, shabby entrances next

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to loading bays and waste bin rooms. This haste effect of degrading the patient,
making him / her feel unworthy of neatness and a decent reception, but the basic
intent to make it as simple as possible forth patient to seek care.
• Also housed kitchen and other services at the rear side of the site to allow
service access, without any chaos in the main entrance. From this precedent,
the coherence between the entrance and the good first impression
misinterpreted.
• A good first impression.
• A welcoming entrance.
• An entrance for everyone.
• A special entrance for emergency cases.
• Ensuring entrance areas are designed to accommodate patients with slower
adaptation rates to dark and light; marking glass walls and doors to make
their presence obvious

Figure 2. 1 Muktangan de-addiction center, Pune

In Architect Sirish Beri’s Muktangan de-addiction center, Pune, he disposed
transparent entrance to have controlled flow of traffic and the easy supervision. The
recessed entrance with the integrated landscape and the flight of steps give the sense
of welcoming entrance

2.2.3 Esteemed environment

Frequently, a mentally ill person has a feeling of elimination combined with a

negative self-image. The patient’s self-esteem can be boosted by offering them

19
dignified environment Care must be made evident in details both large and small
when designing the premises. It is occasionally argued that many sick persons come
from squalid backgrounds should not be offered anything that seems exaggeratedly
posh, something which, not being significant of the patients’ everyday
surroundings, may feel strange and uncomfortable.
A balance must be maintained between the materials and the environment to
emphasis the relationship with the nature, while de-emphasizing the sense of sight
in favor of the other senses. This way of balancing environment and material to
revitalize mental illness is defined as dignified environment. Hospital patients are
often fearful and confused and these feelings may impede recovery. Every effort
should be made to make the hospital stay as unthreatening, comfortable, and stress-
free as possible. The interior designer plays a major role in this effort to create a
therapeutic environment. A hospital's interior design should be based on a
comprehensive understanding of the facility's mission and its patient profile. The
characteristics of the patient profile will determine the degree to which the interior
design should address aging, loss of visual acuity, other physical and mental
disabilities, and abusiveness.
• a dignified environment.
• carefully designed spaces and attention to details.
• people behavioral pattern.

Figure 2. 2 Explains the balance between environment and other criteria in Peter
Zumthor’s design of Therme Vals

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 • cozy accommodation.
• Watch out for day-to-day dilapidation.
• Using familiar and culturally relevant materials wherever consistent with
sanitation and other functional needs.

2.2.4 Addressing Normalcy

Normalcy should be the main objective if the architecture is aimed for healing. This
attempt should permeate the whole of the design process, from overarching zoning
to the tiniest detail. It is the normal the healthy side of the patients which has to be
encouraged and supported. Maintenance of these everyday routines is most
important to persons who will be staying for a long time and who have got over the
most acute stages of illness but, for some reason, are still being detained. If
institutionalization is what we seek to avoid, then normalcy is what we have to look
for.
That the expression conveyed by the building must in fact be that of the institution
society’s expression of its exercise of authority .Moreover , Christopher Alexander
in his book, A pattern language expressed the explicit recognition of the life cycle
as the basis for every individual life will do a great deal to help people's health in
the community life cycle; this pattern describes the more specific institutions which
help people to care for themselves and their health. More than 90 per cent of the
people walking about in an ordinary neighborhood are unhealthy, judged by simple
biological criteria. In this he criticize the healthcare that tends to create sickness
rather than haling that. A system of space that is capable of keeping people healthy,
in both mind and body, must put its emphasis on health, not sickness. So it must be
physically decentralized, to encourage people in daily practices that lead to health,
otherwise this ill health cannot be cured by hospitals or medicine.

• Aim for normalcy

• avoid making it like an institution
• characterize everyday occupations.

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2.2.5 Free and Open Environment

The desire for a care unit which will be experienced as open is coupled with the
need for a care unit which will be closed and locked. The desire to give the patient
an identity of his / her own and the ability to choose, for example, between seclusion
and sociability, is coupled with the staff’s need to know the patient’s position.
Mental care has elements of coercion unavoidably so. The patients often spend time
in a locked care unit and temporary coercive measures occur in the form of
isolation, medication and shackle restraint. the safety of citizens requires certain
patients to be kept under lock and key and escapes to be prevented, because certain
patients can turn violent
Alvar Aalto in his design of Paimio Sanatorium, concentrated more on creating
social environment with the view of seclusion by proposing each wing oriented in
the direction optimally required by its function. At the same time, rooms with the
same requirements were grouped together in their own wings. Separating functions
was also favorable from the point of view of seclusion. The aim of getting natural
light into the rooms from favorable direction was also achieved. A single building,
on the other hand, offered other advantages compared to a design solution where
each function has its own completely separate building: in the former, efficiency
and internal connections were improved

Figure 2. 3 Paimio Sanatorium, Alvar Aalto, View of Cafe

22
 • a free and open atmosphere.
• avoidance of associations with power and coercion.
• Overview.
• address every separate facility.
• beware of acoustic requirements.
• admitting ample natural light wherever feasible and using colour-corrected
lighting in interior spaces which closely approximates natural daylight.
• use large expanses of glazing and curtains adjacent to areas frequented

2.2.6 Directly Accessible Green

Nature has a rehabilitating effect on all of us, included the people with mental
illness. This insight appears to have grown of late, among other things because
rehabilitation in a natural setting has proved highly successful in connection with
fatigue depressions. A patio multiplies opportunities of movement. The uneasy
“wanderer” can move more freely so as to experience greater personal liberty and
so as to cause less irritation to others by his / her constant to-and-fro. The possibility
of moving about, feeling space and breathing one’s fill of fresh air or having
a smoke alleviates the sense of confinement and increases the possibility of physical
activity.
Windows which can be opened give us birdsong and natural fresh air. The question
is how far these arguments can be taken. Through the polished stone of the floor,
through the oiled planks of the oak flooring, through the stained veneered paneling
of the walls, through the birch of the handrails through the inherent sensuality of
material can be brought.
Alvar Aalto’s Paimio Sanatorium, brings out the idea of rehabilitation by accessing
the green, framing views with well-lit and ventilated spaces. The main building has
been organized into five independent entities: the main entrance, the patients’
rooms, the communal rooms, the operating theatre, and the kitchen/ maintenance.
Each activity has its own wing, with each oriented in a direction most favorable to
the activity in question.

23
 Figure 2. 4 Paimio Sanatorium, Alvar Aalto, Exterior View

Aalto also designed for the hospital grounds to the south of the patients’ wing a
serpentine path linking a series of water fountains, where patients could take walks.
Some of the water fountains have been preserved as flowerbeds. The path network
itself is presently overgrown. The path and pond basin system were a
unique composition which both spatially and visually linked the patient sun balcony
wing and the adjacent exterior space. Furthermore, it had an essential role in
rehabilitating the patients.
The horizontal strip windows of the north-west façade facing the entrance
forecourt reveal the side corridors behind them. Even though the external facades
are white, due to the different colouring of the corridor walls on each storey of the
north-west facade, when the internal lights are on at night time the windows
• access to a garden within the care unit.
• a view of natural surroundings and landscape.
• windows that can be opened.
• use of natural materials.
• Providing views of the outdoors from every patient bed, and elsewhere
wherever possible; photo murals of nature scenes are helpful where
outdoor views are not available.

2.2.7 Scheduling Vistas

The areas should not be so small that people “trip over each other”. Narrow
passages and corridors can be a problem. One must be able to step aside if one wants

24
to. Dead ends should if possible be avoided. A second rat run is always welcome.
The care unit without corridors is a dream. During the implementation of
a construction project there often comes a phase when construction costs are
penetrated. It can also be tempting to reduce corridor widths, so as to be spared
economizing on what one feels are real functional spaces elsewhere. corridors in
the Paimio sanatorium have rooms on onside only and glazing overlooking
landscapes on the other side. This of course leads to lower area efficiency, as has
been remarked on and queried by persons outside the project. But openness and
vistas are space demanding, and make the room spacious.
• territory is space-demanding.
• offer a rat run, avoid dead ends.
• beware of narrow corridors.
• aim for a care unit without corridors.
• Ensuring grades are flat enough to allow easy movement and sidewalks
and corridors are wide enough for two wheelchairs to pass easily.
• Outpatients visiting diagnostic and treatment areas should not travel
through inpatient functional areas nor encounter severely ill inpatients.
• Typical outpatient routes should be simple and clearly defined.
• Outflow of trash, recyclables, and soiled materials should be separated
from movement of food and clean supplies, and both should be separated
from routes of patients and visitors

Figure 2. 5 Paimio Sanatorium, Alvar Aalto, View of Lounge room with special
furniture

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2.2.7 Rooms on Patient’s terms

The room in which a patient lives is their first real abode in their encounter within-
patient care, a place which should as far as possible be governed by the patient’s
preferences. At the same time, this is the place where the patient is most left to his
/ her own devices, even though suicidal patients are never left unsupervised. The
need for preventing self-destructive behavior is also at its greatest here, at the same
time as demands for a cost environment free from associations with force and power
are more important than elsewhere. The room should be designed and furnished so
as to be suitable for more than just rest and sleep. Perhaps with a writing space, an
armchair, and space for a few people to sit round a table. The bed should be
positioned so that the patient can look out of the window, even if this means the
staff not being able to see the patient’s face directly when he / she enters the room.
The size of the room should be limited. Installing an extra bed should not be easy.
Control of lighting and heating, for example, must be possible by simple means, so
as not to cause irritation this is important to be more discreetly designed, this will
reduce the risk of reactions from people in psychotic or manic states. Possibilities
of controlling one’s own Surrounding also include the possibility of opening one’s
own window, but openable windows are beset with great complications regarding
the smuggling in of drugs and blunt instruments. Black-out arrangements and sun
screens are also a problem.

Figure 2. 6 View through a window may help for recovery from surgery ( 1984
study of patients recovering from gall bladder surgery

26
 • patient’s preferences must be paramount in his / her own room,
• rooms and cupboards must be lockable,
• take a close look at safety aspects of the patient’s room, from
• the viewpoint of both patient and staff,
• plan for more activities than just lying in bed,
• take the view into account and try to use windows that can be opened,
• support the patient’s need for control of his or her immediate surrounding.

In Alvar Aalto’s Paimio Sanatorium, rooms are designed based on the type of
user who is using the space. The intricate detail of the room interiors and the
products used give them the coziness but at the same time to avoid vandalism.
The glazed surface on the south side of the room brings in the diffused light to
give those patients the enough radiation required for healing.

Figure 2. 7 Paimio Sanatorium, Alvar Aalto, View of Patient room with the
overlooking windows

2.2.8 Cleanliness and Sanitation

Hospitals must be easy to clean and easy to maintain. This is facilitated by

Appropriate, durable finishes for each functional space

• Careful detailing of such features as doorframes, casework, and finish

transitions to avoid dirt-catching and hard-to-clean crevices and joints
• Adequate and appropriately located housekeeping spaces

27
 • Special materials, finishes, and details for spaces which are to be kept sterile,
such as integral cove base. The new antimicrobial surfaces might be
considered for appropriate locations.
• Incorporating practices that stress indoor environmental quality (IEQ)

2.2.9 Security and Safety

• In addition to the general safety concerns of all buildings, hospitals have

several particular security concerns:
• Protection of hospital property and assets, including drugs
• Protection of patients, including incapacitated patients, and staff
• Safe control of violent or unstable patients
• Vulnerability to damage from terrorism because of proximity to high
vulnerability targets, or because they may be highly visible public buildings
with an important role in the public health system.

2.3 Elements in Healing

2.3.1 Colour

the architecture is different: it has an intrinsic value and is strongly creative of

identity is expressive in details, rooms and Extremely beautiful to see and touch;
the intrinsic materiality of the wood and concrete is palpable,
the colours are often bright , applied in several coats and stained over; the surfaces
make a shimmering or patinated impression, the
buildings possess simplicity and austerity, at the same time as great care and
refinement has gone into the detailing
use of daylight is primary, resulting in narrow volumes and well-lit rooms, the
care devoted to lighting is unmistakable: the lighting strengths are low in relation
to present-day medical care; the light is sparing, sometimes verging on darkness,
only warm filament bulbs are used, never fluorescents,

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Colour often has different meanings to different cultures and is an immensely
evocative medium, possessing powers to provoke immediate and marked reactions
in the viewer. There is power in colour. Each colour has ability to affect
architectural planes which allows it the power to accentuate shapes and forms. Also
it can contradict the true form and expression the building wants to be. Colour can
imply proud architecture or display the building as abstract art. With the many
applications of color, it has the power to change our environment to make a
connection with our environment, body, mind, and spirit

While some colours aid the mind others, green for instance, helps to build muscles,
bones and connective tissue. It even has a cooling, soothing and calming effect on
individuals, both physically and mentally. It does so through the sympathetic
nervous system by relieving tension in blood vessels which then lowers blood
pressure. Nonverbal activity is influenced by the color violet and is often associated
with religious and spiritual issues. The different color purple affects the brain and
central nervous system. In doing so it promotes health, creativity, inspiration,
mental balance and also supports both artistry and spirituality lightly.

Roger Ulrich has investigated the effects of visual stimulation and how it impacts
patient recuperation rates and found that patients surrounded in “vibrant”
surroundings recovered three-quarters of a day faster, and needed fewer pain killers,
than those who did not. Additional studies have confirmed that even brief
encounters with nature significantly reduce stress levels—whether or not the nature
interaction is real or simulated.

• Waiting Rooms, Solaria, Recreation Rooms, and Social Support Spaces:

Because these are shorter term stays, these areas have more potential for
color freedom and visual activity than other public and clinical areas.
Visually stimulating, interesting, and textural materials are suggested, along
with richly saturated to vibrant colorations on walls, floors, ceilings, and in
upholsteries. Vibrant options include colors such as marigold, pumpkin,
crimson, turquoise, and grass greens. If these areas are pediatric, a mixture
of clear, vibrant hues balanced with neutrals is recommended.
• Patient Rooms: Because the patient and family spend an extended amount
of time in patient rooms, the overall walls, cabinetry, and ceilings should

29
 remain in soft tints, while accent walls, floors, and countertops can receive
more saturated hues and/or deeper tones. Either warm or cool hues are
acceptable. However, if using warm hues, they should not feel “hot or
aggressive” and cool hues should not feel “too monotone, drab, or cold.” If
the space is too cool and lacking in contrasts, it is believed to cause
depression for many patients and their families.
• Treatment Rooms: Though the visit may be considerably brief, often the
patient and family have tension associated with the administered treatment.
However, it is important that these areas do not feel clinical and drab, but
instead, inviting and safe. Therefore, color is recommended on floors, walls,
and sometimes the ceiling.
• Surgery: To combat glare from high intensity lighting and potential surgeon
“afterimage” (when the eye stares at one color for too long, becomes
fatigued, and begins to see its complement), many surgery rooms use light
to mid shades of green or green-based blues. This is to help reduce
brightness and relieve the stress on surgeons’ eyes that view blood for
extended lengths of time. This is because green, being the complement of
red, helps to negate “afterimage.” Avoid red completely in all surgical
applications.
• X-Ray, Trauma, Physiotherapy Rooms: Patients in these rooms often
experience high stress levels, and may be accompanied by family members
and practitioners. All colors should be soothing, low in contrasts, and
minimal visual stimuli. Soft colors are beneficial, such as topaz, sky, sage,
or coral.

2.3.2 Water

Huelat, writes about the importance of water as, “Water is symbol of the vitality in
life and is a key to the sacredness of a healing architecture. Water can be
metaphorical of peace, tranquility and calm. Conversely, it is also associated with
vitality, fertility, abundance, fluidity and movement.

30
Water opens up the contemplative nature of the soul and helps to elicit memories
and a sense of belonging. Surface water has the ability to enhance both healing and
prosperity, provided it is located on the proper direction in relation to the building
and the site. Geomantic practices the world over (such as fengshui) refer to ideal
locations for water in the landscape.

Surface water can be incorporated into a site in many ways: as a gushing stream in
a fountain it is symbolic of the life force, of surmounting obstacles, and initiating
new life. As as low moving, meandering stream or creek, water is symbolic of the
river of life and our personal life path, and is also symbol of progress and
attainment. As a waterfall, it is symbolic of a leap into the unknown, of courage,
and triumph over fear.

Figure 2. 8 Woodwinds Hospital in Minneapolis, Barcelona, View of Water body

Figure 2. 9 Woodwinds Hospital in Minneapolis, Barcelona, View of Landscape

As a still pond, water is symbolic of contemplation, of the soul’s yearning for truth,

31
renewal and healing. Water that disappears into the earth, a cave, or crevice is
allegoric of the cycles of life and death and can be a reassuring symbol of our ability
to overcome even the direst circumstances.

Adding a bridge over moving water is a powerful symbol of our ability to overcome
obstacles. It also helps to define our journey within the landscape and to create a
sense of natural transition into more pristine environments. Underground water, like
the energy lines, can also be traumatized; geopathic stress often involves
compromised underground water known as dark streams. In such cases it is
necessary to perform earth acupuncture in order to heal the problem.

2.3.3 Landscape

A healing garden is a link to the divine, to the creative force of the Cosmos. A
healing garden needs to work with Nature and its forms: it should discourage
rigidity, conceptual thinking, and preconceived notions of design. It must recognize
the polarities and organic forms present in nature. Consequently, it needs to avoid
straight lines, sheer volumes and planes, and excessive use of symmetry. A healing
garden is a micro cosmos of the larger world: each feature in the garden has the
power to represent a larger feature in the landscape: mountains, rivers, lakes. It is
through this holistic modeling that a healing garden can stimulate the senses,
improve vitality, and promote recuperation from physical, emotional, mental and
spiritual illness. A successful healing garden is a co-creative process in which
humans and Nature are intimately connected through the bonds of reciprocity and
stewardship. A healing garden is a symbol of the possibilities, obstacles, and
hardships that need to be overcome in order to reach higher levels of consciousness
and a sense of our own divinity and interconnectedness with all that is. This
potential allows a successful garden to have a healing role even in those situations
where physical healing is not possible

In all cases, however, there is also the interaction of humans and nature: plants,
wildlife, and the forces of wind, water, light, and color. A healing garden should
afford opportunities to make choices: private areas and public spaces,

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contemplation and people watching, various walking routes, different kinds of
seating, interaction with humans and nature, participation in the garden’s
maintenance. A healing garden should allow its users to experience a sense of
control: users must know it exists, how to gain access to it, they should be able to
use it in ways they prefer. They should enjoy a sense of physical and psychological
security. Design should encourage clarity of layout and movement. The garden
should provide a sense of enclosure and a special entrance to convey a feeling
of structure, permanence and roundedness. It should avoid dead end paths and
complex formations. Design needs to create opportunities for movement
and exercise; this brings physical and emotional benefits and helps to combat
depression. Create paths for walking, make the garden visible from corridors that
can also be used for exercise, place rehabilitation units in view of the garden or
nature, add a walking or jogging route for staff.

2.3.3.1 Samaritan Regional Medical Centre

Good Samaritan Regional Medical Centre, Phoenix, Arizona in 1996 a healing

garden was incorporated into the medical center in Phoenix, Arizona. The garden is
a rooftop courtyard “bounded on three sides by two-story buildings and on the
fourth side by a twelve-story tower, with porthole windows, that looms up in one
corner of the garden.” A water feature is the main focus throughout this garden.
The water feature symbolizes “The Cycle of Life.” The different phases of life from
birth to death are symbolized in various ways by means of quiet pools, as well
as flowing streambeds. Throughout the site waters not only audible and visual
but also touchable throughout the garden. Seating in the garden varies from
movable chairs and tables to a curvilinear seat-wall, allowing for different levels of
comfort and positions in sun and shade. Raised beds contain plants that have low
water and maintenance requirements. Another major element featured in this garden
is art. A tile artist was brought into the project to design colorful tiled columns
that actively engage users of the site. The site is handicap accessible and also has
capacity for walkers, gurneys, and wagons. A small coffee bar is a part of the garden
that provides a social aspect for the garden users. “The garden-courtyard is well
used: by visitors and inpatients who come together to enjoy a coffee or stroll; by

33
visitors waiting for an outpatient who is at an appointment or undergoing a test; by
staff, for breaks, lunch, or small group meetings; by physicians and hospital
chaplains meeting with family members. A fairly large expanse of flat concrete
allows beds to be wheeled out on occasions. Another, less direct form of use, is
visual access. Outpatients attending a cardiac care unit can exercise on the Stay

Seating was varied according to type, material and location in sun or shade. The
garden is open twenty-four hours a day which is great in a hot climate like Arizona
where many garden users may be more inclined to use it when it is cooler at night
and early morning hours. The addition of colorful art engages the garden visitor and
the entry and navigation in the garden are straightforward. Patient rooms include
views down onto the healing garden. One of the best things about this gardens the
fact that it is strongly supported by the hospital administration.

2.3.4 Sun

Sun exposure is one of the key environmental factors that designers can look at in
order to provoke the process of healing and to help relieve symptoms in those who
have already incurred the illness. Sun exposure is one latitude dependent
environmental factor that is inversely related to MS instance and
prevalence according to Dr. Islam of the University of Southern California from the
department of preventative medicine. People have begun to shelter themselves
indoors, due to more indoor activities, indoor building climates, minimizing the key
environmental factor. These shelters cut us off from our nourishment, mainly
sunlight, which may be reason for the spike in diagnosis of illness. Our body relies
on sunlight in order to produce adequate amounts of vitamin D. Vitamin D helps
with our immune system; in fact, it has strong immune regulatory affects. It has also
been shown that periods of low Vitamin D precede occurrences of high lesion
activity whereas periods of high vitamin D precede low lesion activity. The
knowledge that adequate light is needed to help heal weak bodies is no new theory.
Years ago, before antibiotics, the only known “cure” for tuberculosis was to get lots
of rest within an environment containing clean air and plenty of sunshine. Thus the
age of sanatoriums was

34
 CHAPTER 3

LITERATURE CASE STUDY

3.1 Paimio Sanatorium

3.1.1 Introduction

Paimio Sanatorium is a former tuberculosis Sanatorium in Paimio, designed by

Finnish architect Alvar Aalto. Paimio Sanatorium is located at the Paimio town, in
southwest Finland. Paimio Sanatorium is situated in a rural area, surrounded by a
unique, beautiful mountain atmosphere. A natural beauty which includes fields and
scattered dwellings. The current location was considered extremely well suited for
this sanatorium complex’s specific function, a tuberculosis sanatorium with precise
medical requirements. Aalto’s starting point for the design of the sanatorium was to
make the building itself a contributor to the healing process. He liked to call the
building a "medical instrument". during this time period, it was believed that the
best treatment for tuberculosis patients was being around an environment with fresh
air and plenty of sunlight. This idea is part of the foundation of the building design

The central building of the sanatorium is situated at the top level of the site, and is
oriented in a north-west direction (fig.3.1)The layout was organized into five

35
independent entries, which connected with the basic functions such as communal
rooms, kitchen services and technical spaces, patient rooms, and operating theatre
(surgery room). Everyone designed at its own wing and oriented in favorable
direction regarding the light. The various wings placed in a central connection node,
where the most important interior circulation links are located (main staircases and
lift). With an amoeba-shaped canopy, the main entrance porch is also placed at this
central core.

Figure 3. 1 Site plan of the completed hospital showing the main building and its
wings, A – D, the Junior Physicians’ and Administrative Director’s terraced house
facing the hospital entrance and workers’ apartment building

• A wing: patient’s wing and nurses’ apartment.

• B wing: Reception, Operation theatre, Phototherapy treatment, Dining wall,
library
• C wing: staff dormitory, kitchen and laundry
• D wing: district healing plant

36
 • E wing: junior physicians and administrative director’s terrace house
• F wing: workers apartment building

Paimio Sanatorium is asymmetrical in its form, and the orientation of the building
is at an inclined Northwest axis. This inclined Northwest axis means that the
building open up to the morning sun, while facing away from the evening sun. The
building orientation is a result of Aalto's work and his effort to balance the huge
fluctuations between the summer sun and the winter sun.

Figure 3. 2 The Paimio sanatorium is located 60-degree north Latitude

The unsymmetrical building opens towards southeast, utilizing the morning

sunlight, while at the same time shielding the evening sun. also, the asymmetrical
shape protects the building from too early sun and also utilizes the winter sun
throughout the cold, dark, winter period.

37
The balconies joined the A wing at an angle of 20˚, running parallel to the B wing;
namely the A wing and B were at an angle of 20˚to each other. The area of
circulation connecting the A and B wings is at right angles in regarding the A wing,
while the C wing joined the wing B at 45˚ angle. Various functions were entered in
different wings, which was the common practice in tuberculosis sanatoriums.

3.1.2 Fresh air and Sunlight

The exposure to sun and fresh air was originally attached in the natural therapy.
This method remained fundamental for the TB therapy, especially after the
discovery of the bacterium. So, at Paimio special requirements concerning spaces
which affected by light, where it was vital for patients’ treatment and it was essential
to ensure that light can the balconies, the large spaces, the dining area and the
workroom at the B wing confronted directly the south. The premises on the south
were higher than on the north side. This ensured that the sunlight could infiltrated
into the northern corners. The windows of the patients’ rooms faced south-southeast
towards the morning sun. To control the light entering the patients’ rooms, fixed
wooden blinds outside of the windows. The windows on the south facing B wing
facade were equipped with canvas sun awnings. Penetrate sufficiently into the
building.

The front part of the building opens up to the morning daylight, and the back part
away from the late afternoon sun. Thus, the sanatorium is protected from
overheating in the afternoon during the hot summer period. Finally, the northwest
building facade has much more reduced window area, which leaving north facing
balcony without windows. In various ways, the building asymmetrical shape
reflects the openness and sun exposure during the morning sun and the protection
and closeness from the afternoon sunlight. Energy-wise, means that the sanatorium
is warmed by sun in the morning, this time the building is cooler, and
simultaneously is protected by the overheating when is warmer. To conclude. Aalto
seems to orientated the sanatorium according the sun. Moreover, the building shape
in better way. Instead of place the building facade towards sun, as Le Corbusier and

38
many other modernist architects do, Aalto orientates the complex away from
sunlight, not to optimizing the sun, but to balance the sun in relationship to the
seasonal rhythm.

A row along the almost hundred meters long corridor is formed by the patients'
rooms (Figure 3.3). The ward sisters’ studios were located at the western end of the
corridor. These small apartments had their own stairs and lift. Sun balconies of
patients' wing, at the eastern end, formed their own separate units (Figure 3.4).
Moreover, there is a sunbathing area for 120 patients on the sixth floor. The work
chambers, strategically, designed in the middle of the corridor, in order to supervise
easily the traffic along the corridor. Offices are separated by the corridor with glass
walls. The six wards, were almost identical and one above the other, but separate
sections. Then, the lower floors were for the weaker patients Also, users could enter
into the sanatoriums from a waiting room, which connects the A and Bwings. This
route used by patients and the staff.

Figure 3. 3 The corridor of the patients´ wing

39
Figure 3. 4 The top floor balcony and its curved canopy
The architect designed the largest windows at the central stairway, in order the
landings and steps to flood with daylight. As mentioned above, this was not a
coincidence, since both daylight and physical exercise are integral parts of
tuberculosis therapeutic treatment. The steps are low and deep. The yellow staircase
design, so the infirm patients could easily exercise while receiving the morning
sunlight through the northeast – facing windows on the stairs

Figure 3. 5 Main stairs of Paimio Sanatorium

40
The glass usage could cleave the others solid masonry and make buildings to reflect
the surrounding environment, thus create life, openness and light, without borders
between inside and outside. Here, architecture becomes a political issue and the
light the common denominator for a healthier and open society.

3.1.3 Indoor and Outdoor spaces

the relationship between interior and exterior plays a very important, leading role at
Paimio Sanatorium design, as in most of Alvaar Aalto’s architecture. At the main
building, between the wings, architect placed a number of different gardens and
courtyards, which are part of the complex's function. The courtyard entrance
opening at the west of the sanatorium, bordered with trees sides of the main
building. Also, with the terraced houses of the junior physicians, on the western
side. From the patients' rooms and corridors, the library, the dining room and the
stair landings there was a nice view of this central point.

To the south of the patients' wing, in the garden, Aalto designed five circular ponds
which surrounded by sandy paths and flower beds. This bright and protected garden,
which was bordering with the forest, was like the natural environment continuation
and also intended for patients' walk. Patients from their rooms and balconies could
easily gaze the courtyards and gardens. Furthermore, by walking outside, through
the gardens, they could express their existence, their feelings, they could
communicate their health improvement state to others. The entrance yard and
garden were visible to everyone, but also from outside one could see the interior of
the sanatorium. This building with its large windows gave to those who were
outside the building an insight for the life into the sanatorium.

On the top floor he designed a roof terrace that spreads throughout the entire wing
and faces south. The patients rested there lying down. Originally, each floor of the
patient wing had an open, terrace-like dormitory. The patients, whose condition
allowed it, were encouraged to make walking trips into the sanatorium’s
surroundings and along the serpentine path in the south yard. There were several
fountains along the walkway that spread along the length of the yard.

41
3.2 Khoo Thek Puat Hospital

Khoo Teck Puat Hospital is a 660-bed hospital located at Yishun in Singapore. The
main concept of the design was to bring in garden at the Centre of the hospital and
thus drawing it inside.

Figure 3. 6 Khoo Tteck Puat Hospital, Singapore

Figure 3. 7 Pathway Through The central courtyard

• The Khoo Teck Puat Hospital was designed by RMJM to be patient-

friendly.
• The hospital also incorporates environmentally friendly features. The
building uses 30% less energy than other newer hospitals. The main
attraction of the hospital is the presence of a large central courtyard garden
which also introduces light, nature, ventilation into the basement.

42
• "Fins" along the building's walls are designed to channel the prevailing
north-east winds into the building.
• Sunshades over the windows protect patients from the
direct glare of sunlight. The shades also re-direct light towards the ceiling to
enhance the brightness of the wards and save on the use of energy.
Large fans in public areas are powered by solar panels on the roof. The air-
conditioning system draws supply air from its internal courtyards, where the
air is cooler, hence reducing the cooling

Figure 3. 8 External Landscaping done at the hospital

• Integrating architecture and nature

• Building something that would promote health and does not feel look or
smell like hospitals.
• So, the site provided 13.5 h large landscape garden
• Main idea was to bring inside the nature by creating central courtyard also
providing with additional water elements.
• This incorporated introduction of light, nature and ventilation into the
basement making it not feel like a basement.

43
 Figure 3. 9 Orienting our self with the central courtyard
• Central orienting: wherever we go in the hospital we can orient our self with
the help of courtyard at the Centre.
• Nature everywhere
• From rooftop to even the toilets

Figure 3. 10 Basic functions coming on each floor

• Greenery has been introduced up into the walls too

• The patients in the rooms hence shall always have a soothing view from
their bed.
• The picture below shows us the waiting area for the emergency department
in the hospital it has been designed in such a way that it gives a relaxing
mentality for the people waiting outside to know about there dear and near
ones.

44
 Figure 3. 11 Waiting lounge outside ICU

Figure 3. 12 A slice of greenery on the walls

Figure 3. 13 Patient room

45
 CHAPTER 4

LIVE CASE STUDY

4.1 Aster med city

4.1.1 Introduction

A world-class quaternary care Centre with one Multispecialty Hospital and eight
separate Centers of Excellence, Aster med city combines the best of talent and
technology to provide holistic treatment with a multidisciplinary approach.

Set in a soothingly beautiful 40-acre waterfront campus, Aster med city is a 670-
bed quaternary care facility with one Multispecialty Hospital and eight separate
Centers of Excellence in Cardiac Sciences, Neurosciences, Orthopedics &
Rheumatology, Nephrology & Urology, Oncology, Women’s Health, Child &
Adolescent Health and Gastroenterology & Hepatology. The design philosophy of
Aster med city is simple - it’s all for the patient. Spaces that are actually spacious,
rooms and waiting lounges that don’t make one claustrophobic, patient care areas
that assure privacy and easy access to all facilities, an ambience that’s soothing to
the eyes and mind, a place that’s peaceful and positive – everything is designed for
the comfort and convenience of patients.

Figure.4. 1 Aster med city

46
The building of Aster med city is designed keeping in mind a very unique
architectural concept called patient centered design. In the peak hours when the OP
is supposed to be busy, you will not find any crowded corridors in this hospital.
Everything is completely decentralized and that is one important element.
Currently we have focused on the 9 centers of excellence which are mainly geared
up to the most challenging morbidities or disease profiles in our state.

The building was designed by HKS Architects a Delhi based architectural firm
according to them More than a hospital, Aster Med City is an entire urban
development dedicated to healing. The plan, inspired by the nesting behaviors of
the local Brahminy Kite, resembles a family of birds settled along the banks of the
Kochi backwaters. Built on a 38-acre property, the 600,000 square foot, eight-story
medical building is strategically situated to provide optimal views and offer
opportunities for vertical and horizontal expansion. Three inpatient bed towers are
united by a central atrium at the base of the building, which is surrounded by
pedestrian circulation paths that take the healing experience outdoors. In addition
to patient care, Med City also includes a 4-star hotel and serviced apartments, a 500-
seat convention center, retail, staff accommodations and high-end residential units
to create a sustainable and active community for some 10,000 residents. HKS
collaborated on this project with Design Relations in Kochi.

Figure.4. 2 Masterplan showing the waterfrontage

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4.1.2 Architecture of the Hospital

The building consists of three inpatient towers each consisting of eight floors , the
three towers are united by a central atrium at the base of the building .The building
is developed with horizontal expansion than vertical expansion for convenience of
patient commutation The building is surrounded by pedestrian circulation paths that
takes the healing experience outside. An important element to be noted is the way
the have done landscaping for the building. An abstract of what function comes in
each floor is given below. Entrance lobby is a big core which is further divided into
departments.

Figure.4. 3 Typical floor concept plan

Figure.4. 4 Basement and Ground floor concept plan

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 • Lower ground floor: Diagnosis, ed, emergency, stores, pharmacy, kitchen.
cost cutting and hr.
• Ground floor: consultation room, procedure rooms, waiting lounge,
entrance level.
• First floor: theatre related ICU’s
• Second floor: general ward
• Third floor: ICU’s, (private ICU, open ICU, cubicle ICU etc.)
• Fourth floor: patient accommodation rooms
• Fifth floor: patient accommodation rooms
• Sixth floor: patient accommodation rooms

Figure.4. 5 Typical tower plan

Figure.4.3 shows the typical tower plan as you can see both sides of the tower are
covered by patient rooms, after which comes the corridor with a width of 8ft it was
designed in such a way that two beds could pass through the corridor at the same

49
time. The lift lobby and stairs come at that point where one tower connects to the
other tower.

Figure.4. 6 Lower Ground Floor plan

Figure.4.4 shows us the lower ground floor plan, the plan is similar for ground floor
also except for some minute changes caused due the entrances of center of
excellence.

Figure.4. 7 Ground floor plan

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The main entrance lobby comes in the ground floor, the different entrances provided
for different departments can be seen in the above figure.

4.1.3 Inferences from construction of Aster med city

Hospital patients are often fearful and confused and these feelings may impede
recovery. Here every effort has been put forward to make the hospital stay as
unthreatening, comfortable, and stress-free as possible. The interior designer has
played a major role in this effort to create a therapeutic environment with the use of
different materials, textures, colours etc. Some major points which shows relation
with factors affecting healing through architecture has been jotted down from the
study and are given below

• There is use generic room sizes and plans as much as possible, rather than
highly specific ones

Figure.4. 8 patient's room

Figure.4. 9 patients room sofa

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• They have used the concept of easy visual supervision of patients by limited
staff by bringing the patient service rooms and other facilities in the central
portion between two rows consisting of patient rooms.

• We will not find any crowded corridors in this hospital as efficient use of
space by locating support spaces so that they may be shared by adjacent
functional.

• Admitting ample natural light wherever feasible .Providing views of the

outdoors from every patient bed, and elsewhere wherever possible; photo of
nature scenes are present where outdoor views are not available

•
Figure.4. 11 view from patients’ Figure.4. 10 view from corridor window
room

• They have Designed a "way-finding" process into every project. Patients,

visitors, and staff all can easily know where they are, what their destination
is, and how to get there and return. A patient's sense of competence is
encouraged by making spaces easy to find, identify, and use without asking
for help. Building elements, colour, texture, and pattern should all give cues,
as well as artwork and signage.

• Adequate and appropriately located housekeeping spaces The hospital has

been designed wheelchair friendly.

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• They have ensured that grades are flat enough to allow easy movement and
sidewalks and corridors are wide (8ft) enough for two beds to pass easily

• entrance area is designed to accommodate patients with slower adaptation

rates to dark and light; marking glass walls and doors to make their presence
obvious

• The Outpatients visiting diagnostic and treatment areas do not travel through
inpatient functional areas nor encounter severely ill inpatients .Typical
outpatient routes are simple and clearly defined .Visitors have a simple and
direct route to each patient nursing unit without penetrating other functional
areas .Separation of patients and visitors from industrial/logistical areas or
floors

Figure.4. 12 Entrance

Figure.4. 13 Entrance lobby

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 • Outflow of trash, recyclables, and soiled materials should be separated from
movement of food and clean supplies, and both should be separated from
routes of patients and visitors

• Adequate number of service elevators for deliveries, food and building

maintenance services and patient service has been provided and has been
located in the most desirable position.

• Usage of large expanses of glazing and curtains adjacent to areas frequented

by patients

Figure.4. 14 Waiting area at the entrance Figure.4. 15 Atrium space

• a view of natural surroundings and landscape, windows that can be opened

to a beautiful view either of the garden or water front.
• social participation and elective seclusion have been brought in through
spaces like cafes, waiting lounge, gardens, etc.

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 Figure.4. 17 cafe Figure.4. 16 corridor
through care unit
a natural midpoint – the atrium is considered as the heart. care unit has
been broken down into smaller units of 3-5 patient equivalents. a social
space has been provide for each unit, they have facilitated a limited degree
of screening-off

• rooms and cupboards are lockable, they have taken a closer look at safety
aspects of the patient’s room, from the viewpoint of both patient and staff, ·
planned for more activities than just lying in bed, · taken the view into
account and tried to use windows that can be opened, thus supporting the
patient’s need for control of his or her immediate surroundings.

Figure.4. 18 View from windows

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 Figure.4. 19 Pathway

Figure.4. 20 musical instrument played live at the entrance lobby

Figure.4. 21 pathway

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Figure.4. 22 Panoramic view of Aster med city being surrounded by a huge carpet
of greenery

Figure.4. 23 lake nearby

Figure.4. 24 Raised platform outside the med city for water fountain

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 CHAPTER 5

ANALYSIS

The use of theoretical or empirical knowledge obtained from the surveys and
questionnaires by doctors, patients, staff in design consideration to reduce pain ,
stay in hospital and level of medication and stress.

Subsequent conclusions are derived from the survey conducted by BM association

on depression patients, of exposure to sunlight.

Little sunlight Ample sunlight

Control of stress 35% 48%
Sleep performance 75% 80%
Overall performance 49% 56%
Willing to heal 85% 93%
Tolerance of pain 56% 62%
contentedness 68% 74%
Table 5. 1 results of exposure to sunlight

Following are the results of the survey conducted by Ulrich, of view through a
window on recovery days from surgery.

year Number of days in ICU Number of days in ICU

without windows with windows
2000 4.9 3.8
2001 4.7 3.9

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 2003 4.6 4.2
2005 4.9 4.5
Table 5. 2 view from window

Following are the results of the survey conducted by Hamilton on single occupancy
and multi occupancy room

Single occupancy rooms Multioccupancy room

Cost of treatment More Less
Length of stay Shorter Longer
Medication Less More
error/infection rate
Level of medication Lower Higher
Privacy and comfort More Less
Stress level Lower Higher
Interaction with family More Less
and relative
Interaction between Less More
patients
Surveillance of doctors More Less
Sleeping hours More Less
Table 5. 3 single occupancy versus multi occupancy ward

Following are the results of the survey conducted by Ulrich of relationship of design
factors with health outcomes

59
Health Single Day Appropriate Views Family Noise
outcomes bed unit light light from zone in reducing
window patient finishes
room
Reduced **
infections
Reduced * * *
medical
errors
Reduced * * *
patients fall
Reduced pain * * ** *

Improved * * * *
patient sleep
Reduced * * * ** * **
patient stress
Reduced ** ** * *
depression
Reduced * * *
length of stay
Improved ** * *
privacy
Improved ** * *
interaction
with family
Improved * *
social
support

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 Increased ** * * * * *
patient
satisfaction
Decreased * * * * *
staff stress
Increased * * *
staff
effectiveness
Increased * * * * *
satisfaction

Table 5. 4 relationship of design factors with health outcomes

Following are the answers of the questionnaire conducted by me, on few doctors
and staff of a health care center in cochin.

Q. How the stress of patients could be reduced?

A.by diverting their mind to beautiful views or art displays and engaging them in
different activities
Which types of materials and textures should be used?
A.it should make patient feel comfortable and should not look clumsy
Q. on what factors the built environment focus?
A.
• environment should be comfortable.
• Welcoming entrance and waiting areas.
• Calm and peaceful interior spaces

61
 • Social and interactive spaces for patients, their families, and relatives.
• Outdoor spaces like terrace and balconies
• Interrelationship between different internal spaces

Q. requirement of public and private spaces

A.
for privacy –
• Visual and acoustic privacy
• Infection control regimes
For public spaces-
• Good interaction between patient and staff
• Spaces for interaction between families of patient
Q.How to make a patient feel comfortable?
A.
• temperature must be comfortable in all seasons
• By providing privacy and dignity
• Fresh and good air quality.
Q. how daylight and artificial light should be used
A. Daylight – all the spaces should have ample daylight.it should not create
discomfort due to glare
Artificial light- should enhance interior of the building and should not be given much
dependency.
Table 5. 5 interview with doctors and staff of a health care center in cochin

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 CHAPTER 6

CONCLUSION

The ability of architecture to heal the mental and physical illness with the different
planning parameters and the elements that can enhance healing has been explored.
Without compromising on the need, the ability of all patients to be outdoors in a
good environment is, in my view, the absolutely greatest strength in the design of
this caring environment.

• the connection to Self: Healing begins when one is in a space of

retrospection. The space however is one that must be comfortable and a
reflection of oneself.

• The connection with the City: The city environment is harsh and busy and
tends not to offer many places or spaces of retrospection and contemplation.
The site should be a part of the city but detached from the fast pace. The
end-user should be able to arrive conveniently with public transport to the
site to allow a large catchment of people seeking a place for healing. The
site should also be in a place that is not difficult to navigate and find.

• The connection to Nature: Human beings cannot live without natural

surroundings. The symbiotic relationship that exists between the two is one
that has to be nurtured. A physical and visual link with nature has positive
beneficial qualities that help in healing and health in general.

• The connection with Light: Natural sunlight kills harmful bacteria and
cleans air. Apart from these obvious natural benefits of sunlight, natural
light - when controlled - gives a space character that is sensual so giving a
space an emotive quality which can be felt by the end-user. Light is also a
symbol of growth and life as it benefits the natural world in that way. This
study on ‘Healing spaces in architecture’ is an endeavor of understanding

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the conceptual way to achieve healing. Since it is vast field of study with the
number of ongoing researches, this has profuse scope for further
investigation.

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