Excerpt: Evidence about how architecture affects staff and patients is increasingly influencing the hospital design. Diana Anderson, a qualified architect and hospital doctor and Kirk Hamilton, an architect now working in academia after 30 years of practice, provide an international perspective on the issues involved.

Diana Anderson describes the personal experiences of poor hospital design:

I am a resident physician, and a large part of my hesitation in pursuing advanced clinical training was because of what I considered an intolerable hospital setting. Staff facilities are frequently without windows or art, and I have found myself desperately anticipating the first ray of sunlight after a long shift. Working in environments with constant noise from ventilator and infusion alarms, floor polishers, telephones, pagers, and staff discussions creates an ongoing battle to work effectively, or to hold private, often life changing discussions with patients.

During my initial time working in hospitals I often wondered whether anyone asked the clinicians about their opinions on the design and function of their work environments, and whether it has been recognised that the characteristics of the physical environment can enhance or hinder productivity, and can reduce the stress associated with our work and the condition of our patients. On my obstetrics rotation as a medical student the call rooms were located several floors above the labour and delivery unit, meaning we often missed deliveries, and so we learnt not to use the suite, and we slept in chairs closer to our patients. On patient units that did not provide space for respite, I found myself retreating to the supply rooms to gain composure during overwhelming moments. As a physician, a licensed architect, and a patient, I believe that many planned spaces are ill suited to their actual use.

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