Two years ago, a coworker and I decided that to provide the most effective design strategies for our healthcare provider clients, we needed to better understand the needs of their clients-the patients who are the actual patrons of the facilities. My colleague, Steve Christoff, AIA, and I knew that positive patient feelings and attitudes contributed to better health and faster recovery rates. We also knew from previous experience and research that, in both acute and ambulatory care environments, patients rank a building’s “conduciveness to well-being” as a top priority, second only to “access to caregivers.” But exactly what design elements are most conducive to better health? What values do patients most closely associate with feeling well? What places most strongly trig-ger positive thoughts of health and well-being?

If we could answer those questions, Steve and I believed that we, along with others at our firm (Hammel, Green and Abrahamson [HGA], Inc.), could more strongly evoke those values and places in our designs. We would be able to create built environments that would contribute to improved patient outcomes and enhanced perceptions of care. Our goal, therefore, was to quantify and translate patients’ perceptions of their well-being into successful healing spaces. We wanted to understand how design affects patients in healthcare environments ranging from hospitals and ambulatory care centers to clinics and facilities for the aged. We wanted to know not only what made them heal, but also what made them feel well.

Applying an analytical approach to a highly subjective topic, we developed the Discovery Design Process. This “visual survey” helps to answer questions such as “What makes you feel well?” and “How do your physical surroundings affect the way you feel?” During the past two years, more than 600 people representing a diverse demographic sample have participated in the Discovery Design Process. Gathering in small groups ranging from first graders to senior citizens, participants were asked a number of questions and instructed to use wooden blocks and colored shapes to illustrate their feelings and thoughts regarding wellness and healthcare facilities. Then they were encouraged to explain their creations.

This has come to be called “The Blocks Game.” It begins with a custom-designed game board (Figure 1) intended to inspire patients toward creative conceptualizing. Each board features a design based on works of famous artists-Mondrian, Rothko, and Kandinsky, for example-and it is anticipated that the patient will gravitate toward the art style that appeals to him or her most. Some, for example, are more attracted to the rigid forms of a Mondrian; others prefer the more free-flowing, urban-oriented Kandinsky. The true value of the Discovery Design Process, however, is in the opinions and insights that patients’ use of the blocks helps to reveal. In other words, how participants arranged the blocks was not nearly as interesting or informative as their stories and explanations regarding this.

Game board for “The Blocks Game.” Patterns representing artworks by Mondrian, Kandinsky, Rothko, and other artists are intended to inspire patients’ conceptualizing

We heard senior citizens reminisce about old family farms. We listened while a young woman described whale watching as a child with her family. We even learned that the number-one value for senior living facilities was “fun!”-not necessarily something we had expected to be a priority.

One participant named John deliberately gestured as he erected a long, tall, metal barrier. Using colored blocks of different sizes and shapes, he composed a rhythmic interplay of positive and negative spaces representing a city. On the other side of the barrier, two simple branches were used to support a translucent, circle-shaped piece of Plexiglas. He called this structure his “forest.” John explained to us that his well-being depended on the balance between the competition and challenge of urban life and the rejuvenation that comes from the privacy and peacefulness of the woods.

Now, two years later, we continue to use the Discovery Design Process. The responses have already begun to form a consistent pattern. Besides “fun,” some of the Top 10 Values associated with wellness include “peace,” “beauty,” and “friendship and human contact.” Some of the Top 10 Places are “nature,” “home,” and “bodies of water.”

These insights have enabled us to translate consistent emotional responses into materials and design guidelines. Although the design and construction of a wellness concept is not as literal as recalling the images we have mentioned, the appropriate implementation of an approach such as this can provide a greater opportunity for an enriched experience.

For example, we translated a tranquil, natural setting into elements of design. Natural gardens, creeks, and open space became “natural” woodwork, water features, and daylight. We re-created the quiet comfort of family experiences using color, subtle patterns, and evocative artwork.

Innovis Health: view downward into the atrium. The “patchwork” effect is carpeting and the lower two floors are terrazzo, reflecting the colors of natural settings in the North Dakota region

Innovis Health: water feature on the atrium floor. The water supply is a gentle “rainfall” from the 2nd and 3rd stories

Innovis Health: Solid wood panels with narrow glass dividers make up the railing for the corridors. All-glass railings were not used to avoid causing feelings of vertigo

Every healthcare facility has a unique mix of patients, community, and mission. Listening and responding to administrators’ and patients’ concerns helps us to express a facility’s meaning in new ways. Values can be translated into powerful places that play up the intrinsic nature of healthcare facilities and make them places for well-being. HD

2003 DuPont Antron Design Award Winner

HGA’s unique design approach garnered the firm a Healthcare Merit Award for Innovis Health in this year’s DuPont Antron® Design Award competition, which honors creative carpet applications. Jurors admired the richly colored atrium carpet pattern that was designed to resemble the local farm-field patchwork, including natural colors found in the region. Several DuPont Antron Design Award judges commented that they “enjoyed the seamlessness of the carpet to other flooring materials” and that “the spiral was clever, innovative with color, texture, and pattern-a fresh approach.”

The DuPont Antron Design Award is an annual competition for professional architects and interior designers in the United States and Canada. Since 1983, the DuPont Antron Design Award has recognized those who are setting new standards of creativity and originality in commercial interior design through the innovative use of carpet. Entries are accepted in the following categories: Large Office, Small Office, Retail/Showroom, Institutional/Public Spaces, Hospitality, and Healthcare. Award prizes include national publicity, cash awards, trophies, and participation in the awards ceremony and press announcement. For more information, phone (800) 458-4329 or visit

Christine Guzzo Vickery, CID, is an interior designer with Hammel, Green and Abrahamson (HGA), Inc., a Minneapolis-based firm specializing in healthcare facilities’ design and engineering.

For more information about the findings of HGA’s healthcare design study, phone (612) 758-4337.

Healthcare Design 2003 May;3(2):24-29