Design as practice to optimize processes and avoid risks
Probably the best known health-promoting effect that design can have is to improve products, systems and processes to reduce errors and maximize safety. What is often described with keywords like „medical design“ includes many approaches from fields like ergonomics, psychology, medical technology and many more.
Design as a method for medical research & development
However, design also represents a certain form of solution development. It does not have to be applied to concrete products, nor does it have to be applied by designers themselves. In the sense of "health design thinking", the core premises of design itself can be applied in biomedical research (e.g. in the form of participatory processes). Design here means using a systems perspective, employing innovative and iterative processes, and questioning what already exists.
Design as a therapeutic agent
What at first appears to be a bold hypothesis is not a new insight. Design measures (e.g. visual contact with the outside, choice of materials and light) have a direct effect on psychological and physical processes. Since the last century, this has been increasingly studied scientifically and applied practically. Among other things, design can reduce symptoms, optimize recovery processes, promote social contacts and generally influence health behavior.
Design as therapy? An old story…
„The effect in sickness of beautiful objects, of variety of objects, and especially of brilliancy of colour is hardly at all appreciated“
Nightingale (1859): Notes on Nursing.
As early as the mid-19th century, the nurse Florence Nightingale was concerned with the central importance of design elements in the medical care of the sick. Her two books "Notes on Nursing" and "Notes on Hospitals" are early works on design research, before the subject even existed. Her work gave rise to the concept of so-called "healing environments", the idea that the environment itself can be conducive to health or even healing.
In 1984 the psychologist Roger Ulrich published a groundbreaking study. Under the heading „View Through a Window May Influence Recovery from Surgery“, he explained his findings according to which patients after gallbladder surgery had a significantly better recovery process if their patient room had a window with a view of trees as opposed to those who had a view of a stone façade. This was the starting point for the scientific investigation of relationships between the design of our physical environment and health, from which so-called „evidence-based design“ has developed.
Ulrich, 1984, p. 421
„In summary, in comparison with the wall-view group, the patients with the tree view had shorter postoperative hospital stays, had fewer negative evaluative comments from nurses, took fewer moderate and strong analgesic doses, and had slightly lower scores for minor postsurgical complications.“
Ulrich, 1984, p. 421
Psychosocially supportive Design
The results Ulrich found in his 1984 study shed new light on architecture and design. It was followed a few years later by his Theory of Supportive Design. An approach that emphasizes the psychosocially supportive effect of design measures.
According to this, good design can reduce stress, promote social support, create positive distraction, and produce many other effects that can have a positive impact on health. Central to this is the role of stress reduction. Design approaches can, for example, reduce the psychoneuroimmunological effects of stress by strengthening the subjective sense of control, providing positive stimulation (e.g. through contact with nature), and avoiding stressors (e.g. noise).
„By focusing on the concept of stress, a theory of supportive design can be developed that conceptualizes human impacts of design in ways that are related directly to scientifically credible indicators or interpretations of wellness.“
Ulrich, 1997, p. 99
„The Salutogenic approach provides a basic theoretical framework for psychosocially supportive design, which can promote health and wellbeing.“
Dilani, 2009, p. 65
Building on the idea of psychosocially supportive design, Alan Dilani developed Salutogenic Design. As the name suggests, this design principle is derived from the health paradigm of salutogenesis. Developed by medical sociologist Antonovsky, this concept seeks to understand the interrelationships of what creates and maintains health. As a complementary approach to the pathologically oriented search for pathogens and risk factors, salutogenesis is thus a resource-oriented approach. Dilani transferred this principle to design. Here, design in the sense of salutogenesis aims to make the world understandable, manageable and meaningful.
Design also works in the invisible.
The health-promoting effect of the design is not always directly evident – and sometimes even counter-intuitive. Evidence-based design (EBD) therefore represents a methodology that consistently uses scientific findings to inform and evaluate designs. Particularly in the medical context, it has been shown to have positive effects, for example on the rate of patient recovery. EBD does not mean to let science dictate design decisions, but to consider available findings as a design impulse and effective corrective.