DEA 3590 Program Document

PROGRAMMING DEA 3590 | Fall 2021 Connie Hui, Caroline Jiang

Heley Yang, Serena Xiao, Nayeon Kwon

Cornell University

|

College of Human Ecology

|

Design and Environmental Analysis

Designer

Programmer

Landscape Architect

Programmer

Programmer

Programmer

Programmer

Table of Content Introduction

1

Mission Statement

2

Executive Summary

4

Programming Approach

5

User Personas

6

Context & Finding

8

History & Background / Social & Political Context / Demographics

9

Interview findings

10

Site Visits & Major Challenges (On-site Observation findings)

12

Summary of Findings

14

Recommendations

15

Adjacency Diagram

16

Challenge 1: Overall

17

Challenge 2: Dermatology

23

Challenge 3: Gastroenterology

26

Challenge 4: Rheumatology

29

Challenge 5: Endocrinology

32

Line-by-line Program

35

References & Appendices

40

Bibliography & References

41

Appendices

42

Interview Script

42

Literacture Review

48

INTRODUCTION This section of the document provides our mission for the project as well as an executive summary of the work we have conducted, followed by what programming approaches we have used to conduct our research and form recommendations for the Cayuga Medical Center.

1

Mission Statement

The mission of this project is to support Cayuga Medical Center in designing a four-department medical space that promotes flexible space, sensory comfort, and effective circulation to increase patient satisfaction and promote staff productivity.

2

The Four Departments

3

Executive Summary i. Purpose

The purpose of our programming document is to create an organized report based on in-depth user research and analysis, addressing the current state of interior orientation at all three existing sites of Cayuga Medical Associates and creating detailed and elaborate design recommendations for 1020 Craft Road, Ithaca.

The target site is planned to be transformed into a large multispecialty clinic accommodating Dermatology, Gastroenterology, Endocrinology, and Rheumatology.

ii. Summary of developments

The overall progression of the programming for the multispecialty clinic is as follows: 1) Developing Interview Questions; 2) Site visit, observations, and group interviews; 3) Literature Review; 4) In-depth interviews with staff and patients; 5) Analysis and Synthesis; 6) Initial development of recommendations, with goal statements, performance requirement (PR) statements, concept diagrams, and adjacency diagrams.

iii. Summary of findings

Our findings throughout the semester can be divided mainly into three themes: 1) Promoting flexible space by providing private, multifunctional working spaces, in addition to co-working spaces to improve productivity and work satisfaction. 2) Providing effective circulation to increase the therapeutic services for all users and to increase staff productivity. 3) Promoting sensory comfort through biophilia to reduce stress and increase patient satisfaction.

4

Programming Approach

We programmed the Cayuga Medical Associates Building through two approaches:

the user profile approach and the behavior circuit approach.

The user profile approach provided detailed information on what each user (patients and staff members) required, accompanied by their desires, helping us - the designers - understand the users better to help design the most optimal space for them. Furthermore, the behavior circuit approach helped us understand the recurring sequences of behaviors for each user profile we identified, providing a more comprehensive understanding of their design requirements.

Combining the two approaches allowed us to have a more comprehensive understanding by understanding both the user and their relationship to their environment.

Programming Approach

Level

User Profile Approach

Behavior Circuit Approach Macro

Micro

1) Identify predominant and

Process

1) Identify user types (staff &

recurring behaviors.

patients).

2) Determine discrete behavioral

2) Construct user profiles.

units in each

3) Generate design

3) Specify a level to support or

recommendations for each.

discourage behavior.

flow.

4) Determine design requirements.

Strengths

1) Use for future jobs and apply to

1) Systematic & Concrete

other areas.

2) Behavioral targeted

2) Help designers understand

3) Yields comprehensive and

users better

detailed programmatic

3) Aims to target user’s

information.

requirements more accurately.

Weaknesses

1) 1)Difficult and time-consuming.

2)Need good archival information for reference.

Overwhelming amount of n

informatio

2) Need more communications.

3) Not focusing on internal or group processes.

Source: Nooshin Ahmadi, DEA 3590 Lecture, 08/26/2021

5

User Personas Selena

Title: Program Manager

Age: 32

Gender: Female

Habits: Needs to go home to her kids after work on time

Goal 1

Goal 2 Wants a Have a private office personalized space where she can with photos and discipline her team members when needed decorations

Goal 3 Wants to boost team productivity while also taking care of the team members

Helen

Title: Registered Nurse

Age: 27

Gender: Female

Habits: Lacks exercise, Likes meeting new people

Goal 1 Want to be able to take short walks around the building or outside during break

Goal 2 Wants less noise when talking to people in the hallway or the reception area

Goal 3 Wants more privacy from patients when working

6

User Personas Connor

Title: Provider

Age: 43

Gender: Male

Habits: Busy lifestyle, drinks at least 2 cups of coffee per day

Goal 1 Having proximity between the office and the exam rooms

Goal 2 Having a bigger office where he doesn’t feel congested with other providers

Goal 3 Wants natural light in the office

Carolyn

Title: Patient

Age: 36

Gender: Female

Habits: Feels uncomfortable in the dark, fears new places

Goal 1

Goal 2 Finding a comfortable Having a choice of healthcare space where actions (sense of control) within her she feels welcomed

experience

Goal 3 Having access to a bright space, hopefully lit with natural light

7

CONTEXT & FINDINGS This section includes information about the research we did about the history and background of the Cayuga Medical Center, as well as its social and political context and demographics of the users. It also involves interview findings from the users, site visit information with the on-site observations and the major challenges we faced, followed by a summary of our overall findings.

8

History & Background Cayuga Medical Associates (CMA), a multispecialty physician group affiliated with Cayuga Health System (CHS), was founded in 2006. CMA has over 400 employees, approximately 150 providers, and 250 staff. CMA supports over 150,000 patient visits per year across 23 specialties, 22 locations, and 3 counties.

As CHS works to achieve its multispecialty vision, it is in the process of developing and renovating several locations. This project focuses on the downtown location (1020 Craft Road), which needs to be redesigned to support new specialties and spaces: Gastroenterology, Endocrinology, and Rheumatology.

CMA and CHS shared mission and vision statements

Mission Statement

CHS will remain the region’s leading healthcare system and most trusted driver of integrated health services, together with valued partners. We empower our people and employ our capabilities to improve the well-being of the communities we serve equitably. CMA will deliver the highest quality health care, in partnership with Cayuga Medical Center, one person at a time.

Vision Statement

To be an essential organization that inclusively and cooperatively drives superior health outcomes and demonstrable community benefit.

CMA Cornerstone values

Patient-Centered Excellence: We will provide exceptional and compassionate care, one patient at a time.

Safety: We will maintain a safe, clean, and welcoming environment.

Professionalism: We will act in a professional and positive manner.

Teamwork: We will work together as a cohesive team.

Respect: We will maintain a respectful and peaceful atmosphere.

Social & Political Context / Demographics

Population: 30,014

Males: 15,037 (50.1%) Females: 14977 (49.9%)

Persons 65 years and over: 1950 (6.5%)

With a disability, over 65 years: 1710 (5.7%)

Persons without health insurance, under age 65 years: 1110 (3.7%)

Median Household Income: $34,424

9

Interview Findings

Interviewees

Endocrinology

Kayla (PM)

Tammy (Registered Nurse/Medical Assistant)

Rheumatology

Krystyna (Medical Assistant)

Zsofia (Nurse Practitioner)

Jennifer (Arthritis Patient)

Gastroenterology

Wendy (Nurse)

Daphine (PM)

Sarah (PSR)

(Doctor)

Dermatology

Kim (Front Desk)

Lindasue (PM)

Saralyn & Ashley (Nurse)

Steven (Doctor)

Lack of Space

- Managers’ lack of privacy disrupts

- Managers need to have separate offices

meetings and reduces their abilities to

- Need Multi-functionality spaces for more

work effectively.

effective workflow (i.e., exam rooms shared

- Currently, some rooms are not used

between departments, conference rooms that

effectively due to their lack of flexibility

can also be used during breaks/nurse visits)

- Lack of private rooms for telehealth

- Need a separate space to have zoom

makes it difficult to communicate with

meetings due to the current Covid restrictions

patients

2. Furniture, Fixture, & Equipment

- Managers’ lack of privacy disrupts

- Waiting area should be open and large enough

meetings and reduces their abilities to

to put varied sizes of seating 6 feet apart.

work effectively.

- Exam rooms should have windows at a height

- Currently, some rooms are not used

that ensures privacy.

effectively due to their lack of flexibility

- Doctors need individual spaces for telehealth.

- Lack of private rooms for telehealth

- Patients want well-lit, open space, and

makes it difficult to communicate with

preferably access to nature in the waiting area

patients

and along general circulation paths.

10

Interview Findings 3. Adjacency

- The current breakroom is located near exams. As a result, staff cannot relax and enjoy their break

- The current layout lacks direct and easy access in-between departments, which can disrupt their workflow

- Patients don’t have a place to talk to doctors outside exam rooms, so they talk loudly in the corridor about sensitive personal health information.

-Staff break rooms should be separated from the major working areas with open nurse stations to promote staff connections

- It is critical to have easy access to patients for a more effective workflow

- The general area (waiting room/reception/ circulation) should provide some separated seating for informal patient-doctor interaction.

11

Site Visit & Major Challenges Department: General

Almost all of the departments we visited have insufficient space to maintain the general workflow.

Department: General

Staff from every department also stressed the importance of acoustical privacy in the reception area, which is missing in the picture in the left.

Department: Dermatology

Many offices are located along the patient’s journey, invading the staff’s privacy and negatively impacting their work satisfaction.

12

Site Visit & Major Challenges Department: Gastroenterology

The storage area is in conflict with the office area; insufficient temperature-controlled storage for samples.

Department: Rheumatology

Insufficient space in exam rooms for operations that require multiple staff (e.g., Joint injection).

Department: Endocrinology

A lot of the exam rooms do not have a window, which causes issues with ventilation and lack of daylight.

13

Summary of Findings Lack of Space

Almost all of our interviewees stressed the need for multi-functional, private spaces, a separate area to have zoom meetings and conduct telehealth, and a space for informal patient-doctor conversations so that they can have a degree of privacy rather than talking in the corridors. Based on the concerns of our interviewees, we propose a co-working, flexible workspace solution. This means that instead of merely designing individual offices for the staff, we will provide co-working offices and private, multifunctional working spaces that people can use when necessary. For instance, three doctors will share an office space, in which they work most of the time. However, when they have telehealth appointments or more individual spaces to work, they can access individual private workspaces for a more private environment. Such a solution is proposed as several studies demonstrate that co-working and flexible workspaces improve productivity and thus result in higher work satisfaction (See References).

Sensory Comfort

Our interview with medical staff members in all four departments has emphasized the importance of access to nature, ventilation, temperature, and diversified facilities. They mentioned that reasonable public/shared spaces are critical to staff productivity and patient satisfaction. The staff want to have accessible exterior space for short breaks and “walkaways,” and patients talked about their needs for natural elements as a “relief.”

Consistent temperature and effective ventilation are required in the entire medical building for health considerations. The elderly and people with disabilities need special accommodation in both waiting and exam spaces. Indoor lighting and wall colors also affect patients’ experience.

Several research studies have proved the statements of our interviewees (See Refereneces).

Effective Circulation

During our site visit, medical staff demonstrated the importance of effective circulation, which is critical for easy access to patients and developing functional and efficient workflows. They expressed their preference for the current double-door system in Rheumatology and Endocrinology exam rooms, which helps staff control patient access to the administrative area and ensures privacy. Patients say they choose medical institutes based on handicapaccessible facilities and want short circulation routes both in the interior and the exterior of the building. The current space layout in many departments fails to ensure privacy and causes inconvenience in patients’ wayfinding and staff workflow. For patients, acoustic barriers can increase a sense of security when sharing personal information. Studies also showed that low wayfinding performance caused by any reason in hospital environments could lower the level of therapeutic services for all users (for more details, see References).

14

RECOMMENDATIONS This section provides the recommendations we are providing the Cayuga Medical Center, with an adjacency diagram to give an overview of the spatial relationships of each departments, as well as recommendations to fix the five challenges (for the Overall departments, Dermatology department, Gastroenterology department, Rheumatology department, and Endocrinology department).

Each of the five challenges have problem statements, goal statements, and performance requirement (PR) statements for further detail in how to handle the challenges. Also, there are concept diagrams for each performance requirements to allow for better understanding. Lastly, a lineby-line diagram is also included.

15

Adjacency Diagram

General Utility Rest

Rooms

Recep

-tion

Staff Spaces Waiting

Room Conference

Room

Nurse

Station

Patient Spaces

Break

Room Phone

Booth

Offices

Rheuma

-tology

Gastroent

-erology Storage

Endocri

-nology

Rheuma

-tology Primary (Immediate) Close (Secondary) Convenient (Tertiary)

16

Challenge 1: Overall Problem Statement 1: There is not enough space to maintain the general workflow.

Goal Statement: The facility would provide flexible spaces to accommodate patient flow, internal management events, and patient-doctor communication.

Performance Requirement Statement 1.1: There should be extra rooms that are multifunctional and can serve as backup exam rooms or rooms for nurse visits.

17

Performance Requirement Statement 1.2: Provide separate space for the staff to have private conversations with patients (i.e., telehealth) that ensures acoustic privacy (no more than 50dB).

18

Performance Requirement Statement 1.3: The waiting room should have seatings in a variety of sizes and arrangements to support different needs and desired sociability of patients (and their company).

19

Problem Statement 2: The reception area lacks acoustical privacy.

Goal Statement: The reception area should provide acoustical and visual privacy for staff (from patients) while maintaining visual accessibility to patient activities.

Performance Requirement Statement 1.4: The check-in and check-out counters should be separated with acoustic panels made of material with an NRC of 0.75 or higher.

20

Performance Requirement Statement 1.5: The reception area should provide space separated with acoustical panels for informal patient-doctor interactions along the way to check-out.

21

Performance Requirement Statement 1.6: The receptionists should maintain visual access to the patients in the waiting room at all times to ensure safety.

22

Challenge 2: Dermatology Problem Statement: Many offices are located along the patient’s journey, invading the staff’s privacy.

Goal Statement: Staff offices should be private to promote worker productivity.

Performance Requirement Statement 2.1: Have centralized staff space with visual accessibility and easy access to patient space, minimizing travel distance from the staff space to the patient space.

23

Performance Requirement Statement 2.2: The patient circulation paths should not cross any staff work areas (i.e., staff offices and break rooms) by having separate entrances for staff and patients.

24

Performance Requirement Statement 2.3: The space should provide clear visual distinctions between staff offices and patient-treatment areas (i.e., signage, wall colors, interior design elements, etc.).

25

Challenge 3: Gastroenterology Problem Statement: The storage area is in conflict with the office area; insufficient temperature-controlled storage for samples.

Goal Statement: The space should have sufficient, appropriate, and accessible storage areas.

Performance Requirement Statement 3.1: The equipment storage (shared across departments) should be located near exam rooms without intruding on patient circulation.

26

Performance Requirement Statement 3.2: There should be a distinct area in the staff area to store samples that require a controlled temperature.

27

Performance Requirement Statement 3.3: Shared exam rooms should have flexible/wheeled storage furniture for different departments.

28

Challenge 4: Rheumatology Problem Statement: Insufficient space in exam rooms for operations that require multiple staff (e.g., Joint injection)

Goal Statement: The exam rooms should have sufficient space and be ergonomically designed for a more efficient staff workflow.

Performance Requirement Statement 4.1: The building should provide at least 1 exam room that is big enough for multiple staff to apply treatments.

29

Performance Requirement Statement 4.2: Patient bed/seat should be movable and adjustable for different treatments.

30

Performance Requirement Statement 4.3: All doors (sliding doors and folding doors) should be no more than 5 lbs.

31

Challenge 5: Endocrinology Problem Statement: A lot of the exam rooms do not have a window, which causes issues with ventilation and lack of daylight.

Goal Statement: The space and equipment should ensure sensory comfort for both staff and patient.

Performance Requirement Statement 5.1: All exam rooms should have visual access to landscape and daylight.

32

Performance Requirement Statement 5.2: All exam rooms should have calming and warmtone wall colors and materials with minimal glaring.

33

Performance Requirement Statement 5.3: Greenery should be placed throughout the entire facility for sensory comfort.

34

Line-by-Line Diagram

Total space that we are renovating (Suite A + C): 5010 + 4518 = 9528 sq ft

Total space planned: 4200 + 1265 + 1185 + 1525 + Corridors = 8175 + Corridors sq ft

Space Name

No

Sqft

Total Sqft

Comments

General/Shared space

- Need auditory privacy (should have a partition between each space)

- Need visual accessibility to patients in the waiting area/entrance

- Need to keep HIPAA regulations (visual privacy to protect patient information)

Reception area

1

450

450

Waiting area

1

1200

1200

- Should provide enough seating for 20-30 patients

- Larger seats for patients of different size

- Indoor plants

- Power outlets

- Space for self-check-in kiosk

- Should be visible to staff from all angles

Body Weight Scale 2

10

20

- Both should be on the way from the waiting area to exam rooms

Patient Bathroom

5

80

400

- 1 for GI patients specifically (to avoid cross-contamination)

- Placed near the waiting room, accessible to all the patients

- ADA compliant

Staff Bathroom

4

50, 75 (includes shower)

225

- Needs to be adjacent to the nurse stations & provider office

- One Bathroom that includes a shower

Phone Booth (for telehealth)

6

25

150

- Soundproof pods for telehealth meetings or zoom conferences

- Provides visual privacy (protects patient privacy)

- Distributed along corridors in the staff office area

35

Space Name

No

Sqft

Total Sqft

Comments

General/Shared space Conference Room

2

250

500

- Multipurpose

- Can support up to 20 people

- Place for staff meetings, patient education, etc.

- Place for staff lunch as well during COVIDera

Breakroom

1

400

400

- Basic kitchen facilities: microwave, coffee machine, refrigerator, etc

- Chairs and tables enough for 6-10 people

- Indoor plants

- Power outlets

- Natural light

Clean Utility

(1 for Derm, 1 for Endo + Rheum)

2

80

160

- Include enclosed cupboard space for the storage of clean linen, sterilized packs, dressings, sterile equipment, and pharmaceutical supplies, respectively

- Clean and soiled utility should be close together

- Should also be close to exam rooms for easy access

For Endo/Rheum:

- Need fridge to keep the injections cold

Soiled Utility

(1 for Derm, 1 for Endo + Rheum, 1 for GI)

3

80

240

- Have fixtures used for cleaning and disinfecting soiled patient-care items

- Need to be able to store soiled equipment

Storage

4

50

200

- For storing different medical items (gloves, tissue paper, sanitizer, etc.)

- Needs to be close to the exam rooms

IT

2

30, 75

105

- 1 for Dermatology (30 sq ft) and 1 for Gastroenterology (75 sq ft)

- For electric wires & codes

Mechanical

1

40

40

- For Heating, Ventilation, and Air conditioning system storage/maintenance

Vestibule

2

55

110

Corridor

1

TBD

TBD

- For keeping warm air in and cold air out

- For effective circulation

Total

4200 + corridor

36

Comments

No

Sqft

Total Sqft

Exam Room Type A

3

120

360

- 1 provider (comes in on Tues. and Thurs) with 1 PSR and 1.5 nurses

- Going to be shared with Endocrinology

Applicable for all exam rooms:

- Stool, moveable tables, sink, exam bed with curtain (privacy)

- Sink should be near the door to promote handwashing

- Door always swings inward → should leave enough space in the room → can have slide doors to save space

- Small windows for more privacy

- Should be away from Offices → create off-stage/on-stage work environment

- Need great acoustic privacy → voice-conversion documentation machine as they speak to patients

- Need easy to access storage space

Procedure Room

1

220

220

- Need to accommodate surgery equipment

- Should be away from reception and close to utilities to provide effective circulation

Provider and Registered Nurse Office

1

200

200

- Provider comes on-site every Tuesday and Thursday

- Shared by 1 provider and 1 registered nurse

Doctor Office

1

160

160

- Provides acoustical privacy (protect patient information)

- Provide visual privacy

Registered Nurse Office

1

160

160

- 2 nurses share the space

- Needs to promote acoustical privacy through partitions

Nurse Triage & Station

1

165

165

- Should be close to provider office and far from reception

Space Name Dermatology

Total

1265

37

No

Sqft

Total Sqft

Exam Room Type A

6

120

720

Practice Manager Office

1

100

100

1

200

200

1

165

165

Space Name

Comments

Gastroenterology

Provider Office

Nurse Triage & Station

Total

- Usually has 2 providers working in the space

- On Friday morning: 3 providers (busiest time)

- Future expansion: 2 more practitioners

- Size fit for 2 to 3 people

- Office of PM

- Needs to be adjacent to the Nurse Triage & Provider Office

- Needs acoustical privacy (when disciplining staff members)

- 3 practitioners use the space at the same time

- Partitions in between them to support acoustical privacy

- 2 members of staff use the space together

- Needs a partition between the nurses for acoustic privacy

- Should be further away from reception / PSR station

1185

38

Space Name

No

Sqft

Total Sqft

Comments

Endocrinology / Rheumatology Exam Room Type A

6

120

720

- 2 providers and 2 nurses

- Going to be shared between Endocrinology and Rheumatology

Exam Room Type B

1

180

180

- Used by patients, practitioners, and nurses

- Approximately 2 to 4 people per room needs to be able to use the space at the same time

- Needs visual privacy

- Needs acoustical privacy (avoid private conversations to be heard from outside)

- Has an Ultrasound machine

Nurse Station

1

325

325

- Accommodates 1 front desk and 2 nurses

Provider’s office

1

200

200

- Shared by one provider and one doctor

- Provider comes on-site three days a week

- Have space for personal appliances (coffee machine etc.)

- Need to be near the nurse station

- Need acoustical privacy

Program Manager Office

1

100

100

Total

- Office of PM

- Needs to be adjacent to the Nurse Station & Provider Office

- Needs acoustical privacy (when disciplining staff members)

1525

39

REFERENCES & APPENDICES This section includes our list of bibliography and references, as well as the appendices with detailed interview scripts and literature review notes.

40

References Baldwin, A. L. (2012). How do plants in hospital waiting rooms reduce patient stress? The Journal of Alternative and Complementary Medicine, 18(4), 309–310. https://doi.org/10.1089/acm.2012.0116

Borten, K., 2014. Identifying Visual Privacy Concerns in Healthcare. 3M, [online] Available at: <https:// multimedia.3m.com/mws/media/993452O/identifying-visual-privacy-concerns-in-healthcare-pdf.pdf? fn=Identifying%20Visual%20Privacy%20Conce>

Bueno, S., Rodríguez-Baltanás, G. and Gallego, M.D. (2018), "Coworking spaces: a new way of achieving productivity", Journal of Facilities Management, Vol. 16 No. 4, pp. 452-466. https://doi.org/10.1108/ JFM-01-2018-0006

Dijkstra, K., Pieterse, M. E., & Pruyn, A. (2008). Stress-reducing effects of indoor plants in the built healthcare environment: The mediating role of perceived attractiveness. Preventive Medicine, 47(3), 279–283. https:// doi.org/10.1016/j.ypmed.2008.01.013

Haapakangas, A., Hallman, D. M., Mathiassen, S. E., & Jahncke, H. (2018, September 11). Self-rated productivity and employee well-being in activity-based offices: The Role of Environmental Perceptions and workspace use.

Building and Environment. Retrieved November 11, 2021, from https://www.sciencedirect.com/science/article/ pii/S0360132318305651.

Jacobs K. (2016). Patient Satisfaction by Design. Seminars in hearing, 37(4), 316–324. https://doi.org/10.1055/ s-0036-1593999

K. P. Roy, "Acoustic comfort in healthcare facilities—What is it? and What does it mean to both patients and medical staff?", J. Acoust. Soc. Amer., vol. 134, no. 5, pp. 4041, Nov. 2013.

Pouyan, A. E., Ghanbaran, A., &amp; Shakibamanesh, A. (2021, July 6). Impact of circulation complexity on hospital wayfinding behavior (case study: Milad 1000-bed hospital, Tehran, Iran). Journal of Building Engineering.

Retrieved October 28, 2021, from https://www.sciencedirect.com/science/article/pii/S2352710221007890.

Robelski, S., Keller, H., Harth, V., & Mache, S. (2019). Coworking Spaces: The Better Home Office? A Psychosocial and Health-Related Perspective on an Emerging Work Environment. International journal of environmental research and public health, 16(13), 2379. https://doi.org/10.3390/ijerph16132379

Rongrong Yu, Matthew Burke, Nowar Raad, Exploring impact of future flexible working model evolution on urban environment, economy and planning, Journal of Urban Management, Volume 8, Issue 3, 2019, Pages 447-457, ISSN 2226-5856, https://doi.org/10.1016/j.jum.2019.05.002.

Schreuder, E., Lebesque, L., & Bottenheft, C. (2016). Healing environments. HERD: Health Environments Research & Design Journal, 10(1), 87–105. https://doi.org/10.1177/1937586716643951

Shafaghat, A., Keyvanfar, A., Ferwati, M. S., & Alizadeh, T. (2015, August 15). Enhancing staff's satisfaction with comfort toward productivity by Sustainable Open Plan Office Design. Sustainable Cities and Society. Retrieved October 28, 2021, from https://www.sciencedirect.com/science/article/pii/S2210670715300226.

Spreitzer, G., Garrett, L., & Bacevice, P. (2015). Should your company embrace coworking? MIT Sloan Management Review, 57(1), 27-29. http://proxy.library.nyu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarlyjournals%2Fshould-your-company-embracecoworking%2Fdocview%2F1719425719%2Fse-2%3Faccountid%3D12768

The Wisdom of Biophilia—Nature in Healing Environments. Barbara J Huelat, AAHID, FASID, IIDA. Journal of Green Building (2008) 3 (3): 23–35. https://doi.org/10.3992/jgb.3.3.23

Zamani, Z. (2019). Effects of Emergency Department Physical Design Elements on Security, Wayfinding, Visibility, Privacy, and Efficiency and Its Implications on Staff Satisfaction and Performance. HERD: Health Environments Research & Design Journal, 12(3), 72–88. https://doi.org/10.1177/1937586718800482

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Appendix A - Interview Scripts Kayla (Endocrinology PM)

Patients don’t get tested for covid when coming in.

Her office includes herself, her endo provider, and PA (physician assistant).

2 providers for each department.

Kayla wants her own office space in case she needs to call somebody in the office, and private individual space would help when launching zoom meetings. (Others do not need to go out when one person is having a meeting.) I will normally go to the exam room if it’s not busy (rarely).

Convenient talking with other staff members. (No patient)

Communicate with patients in their exam rooms.

Typical day:

Coming in at 7:30

First meeting at 8:45 (Everyday)

Usually lots of meetings, including Zoom meetings.

Usually, sit for all-day

Bring her own lunch box and have lunch in her office

Has Coffee machine in the room

Hope break rooms are not too far so she could walk there easier

Do day to day budgets

Try to leave by 4:00 to get her kids (45min away), sometimes would run late.

People would decorate their offices, 2nd home.

The motivation of coming to work here:

Her staffs are really great, work in CMA for 7 years already.

Wants more exam rooms: 4 exam rooms and 1 nurse visit practice room. (I have 3 for now, I need 1 more exam room and 1 more nurse room).

Better flow for exam rooms.

Tammy needs a bed and cabinet for the nurse’s visit room. Nurse rooms are for teaching.

“Multi-function is always good.”

How to arrange exam rooms?

Usually, just follow where providers are.

Patient:

Come in and check-in with the covid questionnaire.

Come up to the floor and check-in with the receptionist. (Sometimes they sit)

Go in and get weight in the hallway.

Go to the exam room go over problems they are having and the medications

The nurse would come out and tell the provider that his/her patient is ready to go

Provider be prepared and wait couple min

Go in and do the visit

Some providers walk patients out to the waiting rooms when they are done

Check out with the receptionist

Leave

There are not a lot of complaints

Pods are color-coded

Krystyna (Rheumatology Medical assistant)

Work by the other hospital as well

Does anyone sit beside you?

Jane usually sits next to me, and she is the PN (Practitioner Nurse)

How much time do you spend in the current hospital?

About three whole days

Do you like the space?

I like it, but might like it better if it is a little bit longer (desk)

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Do you want a divider?

I don’t think so. Because a lot of the times we work together

Do you feel like the noise level in this room is okay because it is not enclosed?

Sometimes loud, but fairly good for most parts

Interact with patients

Rooms have sliding doors.

Go in, set up, Close main doors, bring patients in, do nurse stuff, and come out to the nurse station.

How do you control the patients from coming in? Do they often move through the door into the staff area?

Not really, and try to close the door when leaving out towards the staff area.

How do you like the sliding doors?

I like the sliding doors, but they are heavy. And we have a lot of older patients - concern.

Does it slide on only one side?

Yes. Patients leave only one way so that they won’t be wandering into the staff area. Good circulation.

Difference between exam rooms for rheum and endo?

Share the rooms, so there aren’t many issues, but it may get hard with only 3 rooms a piece. If we have ultra providers, it gets difficult.

Walkthrough typical workday

Get in. turn the computer on. Set up rooms. Clean rooms if needed. Send all portal messages to doctors. 8 AM patients come. Work for Dr. Sedari and Zsofia. So work until lunchtime.

Mostly in the office or exam room?

I would mostly be in the exam room, as we have patients at 8, 8:20, 8:40, and on.

How do you invite patients in at their time?

Watch on-screen, and see when the patients are in. Try to grab patients as soon as they can. Then, have them go on the scale and in the room. Takes about 7 minutes each.

Do you need them on the scale?

Yes, unless they refuse

Overview of the setup of work environment?

In a typical exam room? Biggest exam room.

Pull out a paper sheet on the bed.

Good room for the procedure because they have sonograms. Syringes, gowns, gloves, gauze, under the bed.

On the shelf: facemasks, alcohol pads, some spray stuff, more gloves, more syringes, cups, drawers, basic stuff with bandaids, gauze, and patient education stuff. Documents.

Difference / overlapping facilities for endo/rheum?

Totally different. They don’t use an A1C machine or all this stuff

All the stuff stays here. General stuff in rheum drawers. The particular exam room is dedicated to rheum.

Prefer bigger rooms?

Yes, because a lot of our patients come in wheelchairs. And if we need to do procedures or something, there would be four people in the room. So definitely bigger rooms are needed.

When does the room get cleaned?

In between every single patient

Zsofia mentioned concerns about ventilation during Covid, especially about the double-sliding doors, which create good circulation but sacrifice the windows.

Do you prefer windows or your current layout?

I definitely prefer windows because I like the view; I like to see outside, but the doors work well.

Do you like the lighting?

The lighting is fine and adjective because we have some patients with migraines, and it is nice that we can lower the lights a bit.

If we are to make improvements, what would you definitely need to have after renovation?

I don't know...I pretty much like this. I like most of it; just the doors are a bit heavy.

Bigger rooms, even the nurses’ room, may have a room (doesn’t have to be big) just for the nurses. Right now, nurses just use whichever room is available.

Are you ok with the privacy of this space?

I think the space is good. Maybe a little bit larger

Do you also prefer an on-stage, off-stage layout?

The current layout is good; we are like a team.

The doors really give you control of the area, increasing privacy. Would sacrifice the windows for the doors

Do you have any other special demands? Like having coffee in a pantry?

It might be nice to have that set-up because it also gives me a chance to get up, as I sat at my desk a lot.

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How do the nurses really spend time here (Breakout room)

Eat here, training, CPR meeting, before Covid; we had big staff meetings here

So would you want to have separated spaces here?

This (the current layout) is nice, though, because it is small and you have 3 departments in this office space, and you have your nursing staff, doctors, providers, receptionists all at lunch. Though, we do have a staggering lunch.

I noticed that there is a corridor this way. Do patients have access this way?

This one is mostly for staff; patients have different stairs/hallway access...

I use entrances depending on how busy we are; I will use this corridor more often if there are many patients.

For the exam space, is there a place you need to have close by?

I don’t think so, but it is nice that we have the patient bathrooms close by.

Tammy (Endocrinology Registered Nurse/Medical Assistant)

Walk us through your typical day.

Come at 7:30. Patients come at 8. On the computer. Messages from patients, medications, which involves getting patients to a room, getting vitals, history, diabetic then getting fingerprints or getting blood to pass on to the practitioner

Current feeling about the hospital space?

Like the space. I don’t want to leave

Favorite part?

Everything. Like the brightness, flow of the space. Getting patients in and out is easy.

Rooms can be a teeny bit bigger, but this space is overall very functional

One trouble you encountered in the current space?

Not having enough rooms. Need nurse visit space but don’t have it

Staff break room?

Don’t use it. I sit most of the day, so I like to walk outside during break hours unless it is too cold or raining.

Zsofia F. (Rheumatology Nurse Practitioner)

How do you like the space layout?

A big disadvantage in this building during Covid was that we couldn’t open the windows. Since most exam rooms here don’t have windows, ventilation is a big issue. At the beginning of Covid, when we didn’t know how long the virus would survive on the surface, it was a big issue for us to keep the exam rooms running. We cleaned it with sanitizing wipes and closed the rooms for about 1.5 to 2 hours in between patients. So the ventilation system is super important during this time.

I like the double doors of these exam rooms. It’s easy to get patients in and out. Especially for providers, we mostly stay in the office area and go into exam rooms when needed.

What do you think of the office space?

I like it with the big windows and desk. I’m sharing it with Dr. Sidari. We are having lots of telemedicine appointments these days. But I wish I could have individual rooms, so we don’t interrupt each other. Now, if one of us is on a Zoom meeting, the other person would just go to an empty exam room.

What’s your weekly schedule?

I’m here three days per week. The other two days I will be in a very, very old hospital office. There is very little space for providers and nurses there.

However, some patients liked it better. They think it's so much homey and

looks less medical. There are these old wooden drawers in the doctor’s office and vintage furniture. But the space is so small; patients always bump into each other. I don’t really understand why some patients like them better.

How do patients like the double doors? Do they feel insecure?

The patients are not bothered by the double doors. When they are brought in, this door on the office side is always closed.

Could you please walk me through your daily routine?

I came directly to the office. I would check on all appointments on my laptop. I can see if a patient has arrived or is “in the room.”

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Krystyna would bring them in, and I would just go room by room to check on them when needed. I also do internal medicine in another department, so I go back and forth between these department “pods.”

Krystyna also sets up the rooms and cleans up afterward. I just go in during appointments.

Where do you go during the break?

Some providers would go to the break room. But most of us just bring in food and eat in our office while making the notes. The break room is heavily used. Many nurses go there for lunch/break.

But there are a lot of Zoom meetings going on during lunchtime, so I eat in the practitioner's room for lunch so that Dr. Sidari can have his meeting in the office.

Can you show us your office?

We are sitting back to back. Sometimes we have Zoom meetings simultaneously, so we just keep our voice off while the other is talking. So we have to keep switching back and forth.

One problem is that Dr. Sidari is just Rheumatology, but I also work for the internal medicine department. So there are times I need to meet my patients separately. But if he stays in the room, that’s not a good idea.

Another issue is acoustics. Our office has glass walls. So I can always hear people who talk loudly in the office area. It doesn’t bother me since I’m not a native speaker, but it would definitely be a problem for native speakers.

Jennifer (Rheumatology Arthritis Patient)

What do you like the most about the hospital and the room?

The comfort of it

Was very nervous. I suffer from agoraphobia. Does not like new buildings at all. I would not go to new places or the mall until the last moment.

Has Arthritis

Do you like the waiting room?

A lot of places have closed waiting rooms, but this one isn’t. So it doesn’t feel like people are on top of me.

Have you ever felt insecure in the exam room?

Not really for here. I would not want to go there if it were dark and gloomy like other hospitals, lacking energy or motivation. That is why I stopped going to the other one.

During COVID, did you want to come in person or not?

I don’t like computers. I wanted to come in person.

I don’t like online stuff at all. I have privacy concerns that people near the doctor might hear what I say over Zoom.

Other notes

We need to consider people’s differences and anxieties, such as people with agoraphobia or claustrophobia.

The dermatology office here inside is all handicapped but outside the building is not at all.

I had a therapy place, needed to sit, but to go for therapy but needed to open a 20-pound door. We go for therapy as we can’t walk, and the building is not accessible for us. No button to open the door as well. Building construction was annoying. Need handicap accessible building both inside and outside. We need to consider the types of people when building. Don’t exclude anyone.

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Wendy (GI Registered Nurse)

How's the flow of the space? This hallway looks pretty wide, but do you ever find yourself feeling crowded as you're like, walking back and forth?

I mean, during COVID you're trying to avoid people more, but I don’t think it's pretty good. There's a little bit of congestion. We talked about the wheelchair accessibility. I'm sure it's not up to code.

How do the different groups and you interact, like the nurses and the physicians? How does everybody kind of interact and do you find like people are ever too far away or you have like good lines of communication between people in this space?

Well, I was the only one for about a year. But now Kevin, he's not here right now, but yeah, yeah, it's nice to be within talking distance. I don't think I'd want him in another whole area now. For the rest of staff, I think it's better if I'm not near like the front.

Do you ever find that if you ever have to talk about a case, is privacy ever an issue?

Here now not too bad. It would be nice if the doctor's offices were nowhere near the patient's room or secluded.

Doctor Brennan has a very, very strong voice. He would need an office somewhere in the back. I think all the doctors should have their own office. The current office does not work. It's right in the middle of everything. Patients are walking by and they're talking about their cases. It's right next to the bathroom, can't stand that. It would be nice if the offices and the nursing station were near each other because Rachel and I will yell back and forth. So it's kind of nice if I think they're kind of centrally located. And then the front end probably doesn't need to be near outside things and then maybe have the room somewhere in between, yeah?

How do you feel about combining multiple different specialties into one? Why?

I would hate that. Just because you get more people in more of a space, I think that just becomes more drama sometimes right. I used to work at a place where it seemed like I was the only one who did anything and there was eight other nurses and it drove me crazy.

Are there any specific spaces in the building you prefer being in the most versus some that you don't want to be in at all? Do you ever use the like back break room?

It's hard right now with COVID. You know we're not supposed to eat together. So I usually stay here for everything.

There we go for a walk.

Are there any spaces in here that you feel are just the wrong sized, either cramped or that you would like bigger?

The exam rooms, I don't think they're too bad except for the wheelchair accessibility. But some of these you go close the curtain, you're closing it right down people sitting there. Right in front of them. Yeah, and I think if you made more room for wheelchair accessibility, Then that wouldn't be an issue.

What does a typical visit look like?

They usually come in and they get weighed and they go in their room and they have their interview with me and then the doctor comes in after that.

Have you heard any frequent complaints from patients about the space?

Not really. Nothing to do with the space, but to do with the covid.

Do you have anything you want to see in the workplace in the future or is there anything on your wish list?

Pet friendly. Aquariums. I was thinking soft serve ice cream machine. A chair that doesn't sink. My chair sucks. But yeah, I mean I have more computer screens now. I have two screens now. Like I don't feel like every room needs like a computer you can log onto. I've been in some practices where I felt maybe having a designated computer in every room would have been good, but I don't feel like that's needed here. I'd like another blood pressure machine. That that would be nice.

In five to 10 steps, can you just walk us through your typical day?

Oh yeah, charts which is what I am answering now because I have 17 patients to do by Monday. I do triages I'm the only RN here so if anybody calls. I have to take care of anything. Their needs and I do anything to do with their patients. Triages I do, roaming I do, all the charts.

How would you set up your work environment? Just like the table settings, do you just work with your laptop?

Yeah, I mean I have the second screen here, which I put the hospital up here and then I have my CMA here. And that's how I find out what I need. I got my drawer full of charts. I like everything in reachable to disaster, like everything right where I need it. That's obviously convenient, and I would not want to share spaces with other modalities.

I heard you talk about how you didn't like how loud it was, the space.

Yeah, well, I just feel like all the doctors need their own office. They need their own personal office. I think maybe the MPs could share, but I think the doctors would need to be close to me, but separated from the patients. But not with me, a bit of separation yeah, yeah. I think it's nice to not be with the front end though, because I mean it's nice sometimes 'cause they need to ask me questions, but we're both really loud when we're talking and I'm like if I hear them on the phone, I'm listening 'cause I don't know if it's something I need to deal with.

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Would that help with circulation if you try to have them like close by?

I think we can call each other now. It doesn't seem any worse and because I used to have Christy like 5 feet from me and now it seems to be working just as fine with her being up there.

Is this setting okay for you, like regards to visual privacy, so would patients be able to come up and see you?

No, it's not bad here. That would be private right here and they usually wouldn’t come any farther. They really have no reason to come back here. Generally I go to them, in the rooms. I mean they could come in, but I guess the colors help. Sometimes people try to go out that door all the time like this. Patients get a little confused. I've been to some offices and it happens to me too. I'm like how the hell do I get out of here, you know? Like Dermatology is really good. Like you come in this one area. You go this way Like it's basically like a big circle and you're out. So I think that's nice to kind of give them a flow of where they're supposed to go in situations.

Is this office currently used by one person?

Yes, that's Daphne, that's our manager, and she does get kicked out of there all the time because the doctor and the providers need to work with Telehealth and with the phone messages and stuff. You can't have three people in the same room talking about different things in that little space. And that's where we have our samples and the refrigerator. Like I need to go in there and bug her sometimes when she’s in a meeting The problem is with the samples. If I had a locked cabinet out here, I mean that's locked, but that's my only place to put jackets. It had to have a pretty big locked cabinet in the nursing area and a fridge in the nursing area.

Which factors affects your productivity the most? What helps you work.

I usually look at the clock at 8:05 and the next thing it’s 4:30. Like it goes so fast, like I wish I had more time today so I don't. I have so much to do like all the time. I was the only nurse for 8 and 10 months, for three providers.

When that door is closed, you probably wouldn't have access to natural light, would that be okay for you?

It would be kind of nice. I do enjoy that. So even just that little crack there and over there. It would be nice to be able to have some type of window, yes. Because I've been in places where they like turn off these lights. That would drive me nuts, I feel like I'm going to bed. This is again a sharing thing. I used to work in like an asthma allergy office like eight people at the same time, standing in the space like this. It's always nice when you have space.

For circulation, so is it generally convenient for you to go to like each exam rooms and talk to the doctors?

Yeah, they're just right there.

Do you ever need to go to the like the front reception?

Oh yeah, but we can call. We do triages a lot, a lot of times we talk back and forth

You mentioned you like a lot of the improvements you got moving from the old office. What were the main points of improvement that really helped?

Well, I had a really tall desk and I was always like pulling myself up into the chair and they actually pulled my muscle in my arm and then like I had this much space and the patients literally walked behind me where I was working and so they could see my computer, so that was not the HIPAA compliant at all.

And then Doctor Brennan, he was just super messy. He has a lot of papers. It just was really small and the scale was right here and they had three rooms. That's it. And they have never had enough space for all patients. So that's why I had to move 'cause they kept getting bigger. I was there only for 8 months before we moved over here. Yeah, it was just too cramped. Their office there was even smaller than it is here, but they had just two people then.

So do you think you need more storage are, potentially in this area in the future? Because I think last time they mentioned like the pharmacy medicines are also in the cabinet.

Yeah, yeah. If I had a locked cab now here I could move them out here.

The samples, are they stored in fridge or are they just stored in cabinets?

I only have one thing that I have to store in refrigerator. So just a small one.

So when you put the patients in the room, would you just close the curtain?

Just the door.

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Appendix B - Literature Review 1.Privacy increases productivit Staff were disturbed by ED noise levels (M = 2.24, n = 63, SD = .89). Noisy environments accounted for a 34.2% of variance among those feeling distracted and unfocused, F(1, 60) = 31.15, p < .001. However, the perception of a noisy environment was not a significant predictor of staff satisfaction, communication within or across pods, or the need for pod modifications Ease of private interaction with patients accounted for 7.4% of variation in staff satisfaction, F(1, 60) = 4.8, p = .032..Users mentioned the need for sound-absorbent materials that support private conversatio Providing acoustic comfort decreases patient’s recovery time and promotes staff productivity

2.Circulation helping productivity Open plan design has positive effects on communication and office cost, but has negative effects on employee's attitude and behavior. increases the level of workplace nois increases disturbances and distraction increases the feelings of crowdin losses the privac reduces the functional efficiency and decreases the staff performance reduces required square meters per perso decreases the cost and labor number for maintenance and reconfiguratio A good physical office arrangement and design helps workers to perform their tasks more quickly, easily and efficiently. The supervision and monitoring of workers also becomes easier, the communication system becomes easier and faster, the planned layout allows more space to maximum use and economy, and also, provides comfort as well affect the behavior and employees’ works.

3.Co-Working Space/Flexible working space Improves Productivity/Work Efficiency/Gets better results 1. Companies see sharing space as a way to tap into new ideas.

2. Employees value the flexibility and autonomy of coworking.

3. Coworking can reduce real estate costs and provide employees with more workspace options. positive perceptions of the ABW(Activity-based Workplace) environment and communication and more active use of workspaces were associated with higher productivity and well-being at work, whereas the time spent looking for a workspace was associated with lower productivity and well-being.

An activity-based workplace (ABW) refers to an office where workers do not have dedicated desks but are supposed to switch between workspaces designed for specific activities, such as collaboration, concentration and speech privac satisfaction with the physical environment had a positive association with both productivity and well-being at wor Satisfaction with privacy and communication had the largest effect size Lack of privacy may impair productivity directly through the effects of noise on cognitive performance but it is also a source of stress affecting well-bein Coworking: Bringing together of people who have common interests, to generate innovation, creativity, entrepreneurship, and an opportunity to create working communities and collaboratio Social interaction at coworking locations provide opportunities for collaboration and innovatio Flexibility in work spaces provide increase in job satisfaction and reduced psychological stres Flexibility benefits: improved work-life balance. Increased sense of autonomy Coworking space preferred over home offic Reduced social isolatio 71.9% of the sample agreed to or totally agreed to that they can better concentrate at the coworking spac 81.3% experience higher overall job satisfaction in coworking space than home office 4.Visual/Acoustic privac “Office design that facilitates easy access, privacy, family inclusion, and comfort, whether the practice is situated in a hospital,[...], are universally going to promote lower stress, increase compliance with treatment plans, and improve staff accuracy and mood, ultimately resulting in higher patient satisfaction, patient referrals, and patient retention.

“The patient experience is made up of sensory building blocks or clues that are being delivered to the patients, consciously and unconsciously.”

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Signage: Have clear signage so that patients feel in contro Acoustic Privacy: potential HIPAA (Health Insurance Portability and Accountability Act) violation; acoustic barriers increases a patient's sense of security when sharing personal information and feelings → When feeling secure patient will “be more honest and forthcoming with personal information Visual privacy concerns: many privacy incidents and breaches occur because of human error and low-tech, rather than high-tech. → ex) exposure of confidential patient information on a computer or smartphone display scree Problem 1: human behavior, such as failure to log off / failure to shred papers → Solution: Re-trainin Problem 2: display screen exposure for fixed location devices → Solution: move or reposition computer monitors + privacy screens or filters are reasonable and appropriate improvement For mobile devices → Using screen savers, user awareness training, and privacy filters or films

5. Natural light, artificial light This article introduced natural light and artificial light as a treatment for seasonal depression patients Natural light exposure improved all self-ratings According to the Hamilton depression score, 25% remitted after low-dose artificial light and 50% after the walk (natural light) The morning walk phase-advanced the onset and/or offset of salivary melatonin secretion, but individual clinical improvement could not be correlated with specific phase-shifts.

From this article, we know how light could be used as a treatment for depression patients since it could function as a moderator for melatonin release, which directly affects sleeping quality and moods. For our project, staff and patients in Cayuga medical center all need an appropriate amount of light for better working experience.

6. Circulation: Wayfinding and Avoiding Congestio longer pause resulted in increasing sign usage demonstrates the level of individual confusion during user's pauses on-route in hospital circulation patterns.

Circulation patterns with irregular forms and lopsided deep corridors can affect wayfinding experience and sense of direction negatively Providing in straight visual access to destination can facilitate movement dynamics Radial and Racetrack circulation patterns lead to the environmental guidance of the participant if hospital interior spaces load as a whole on their mental map and its organizational structure.

No spatial design alternative such as an opening in intersection or curvature points in corners was predicted for helping individuals' movement dynamics Low wayfinding performance due to anxiety, stress, cultural differences, pre-emotional effects, crowding, and literacy level in hospital environments results in lowering the level of therapeutic services for all users. These issues would make patients wander around, anxious, tired, and represent bad behavior towards hospital staff.

7. Sensory Comfort “Being in control’, ‘stimulating people interaction’ and ‘sensory variability’ play a role in the appreciation and comfort of interior built environments Temperature is the number one complaint by occupants and affects productivity and health risks. People prefer to be in control of their own temperature and they will move in and out of varying temperatures not only for comfort but also for social interaction.(p.164 Light: adequate brightness, lack of glare, neutrality of colo The human sensory system welcomes variety, some degrees of randomness referred to as contrast pattern recognition, or sensory variability. The interior design effects on patient comfort were studied in a waiting room.

'Sensory variability’ is an important element in the Feng Shui design approach. The element of ‘sensory variability’ was most often present in the interior designed by the Feng Shui expert and showed the highest comfort level for the patients.

Windows, appropriate lighting and temperature settings, number of beds, sound absorbing materials, and ventilation type (fresh air) are DCs associated with sensory comfort Participants exposed to the hospital room with indoor plants reported less stress than those in the control condition.

8. Biophili Studies in both laboratories and real environments have consistently found that viewing nature produces significant physiological restoration within three to five minutes at most, as evidenced, for example, in brain electrical activity, blood pressure, heart activity, and muscle tension.

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A study of patients recovering from abdominal surgery found that those assigned to rooms with a bedside view of nature (trees) had significantly less pain, shorter post-surgery stays, better emotional well-being, and fewer minor complaints than matched patients assigned to identical rooms with windows overlooking a brick wall (Ulrich, 1984) Gardens in healthcare facilities have been found to not only provide restorative and pleasant nature views, but also reduce stress and improve outcomes through other established mechanisms such as fostering access to privacy and social support, creating opportunities for restorative escape (and control) with respect to stressful clinical environments, and providing settings that enable physically active pursuits in pleasant nature surroundings ranging from active play to physical rehabilitation can also be important for reducing stress in healthcare workers and increasing job satisfactio Awakening the bond between humanity and nature is especially important in the medical environment, because it often appears to be harsh and bereft of nature Light blue and white flowers would be best for reducing anxiety men tend to favor yellow-based reds (like scarlet women tend to favor blue-based reds (like burgundy Blue flowers have a calming effect, according to Johnson. Lighter hues are preferred over darker ones if you want to send a message that promotes relaxation.

White blooms send a message of cleanliness, orderliness, and precision.

Mixing textures and adding other colors in with a white floral arrangement can help to soften a clinical feel Awakening the bond between humanity and nature is especially important in the medical environment, because it often appears to be harsh and bereft of nature Light blue and white flowers would be best for reducing anxiety men tend to favor yellow-based reds (like scarlet women tend to favor blue-based reds (like burgundy Blue flowers have a calming effect, according to Johnson. Lighter hues are preferred over darker ones if you want to send a message that promotes relaxation.

White blooms send a message of cleanliness, orderliness, and precision.

Mixing textures and adding other colors in with a white floral arrangement can help to soften a clinical feel.

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