hospital thesis synopsis

Master of Public Health

A thesis is a substantive and original body of work that allows the student to synthesize and integrate knowledge from their public health course work and practicum experiences, apply it to a particular topic area, and communicate their ideas and findings through a scholarly written product. The thesis represents the culmination of the student’s educational experience in the Vanderbilt MPH Program.

The thesis may take on different formats, depending on the student’s track focus and interests. Regardless of the format chosen, the student must apply critical thought, systematic analysis, and clear presentation.

Each student is responsible for identifying a topic and appropriate format for their thesis with the assistance and guidance of faculty advisers and faculty thesis readers.

The practicum product must be distinct from the thesis. Although the practicum and thesis can be related, the student must be able to articulate how the two projects are independent from one another. The practicum is a practice experience that allows students to apply and develop skills in public health concepts. The thesis is the synthesis and integration of knowledge acquired in coursework and through the practicum and results in an original scholarly work.

View selection of published theses

Additionally, students have the option to pursue publishing their thesis products in scholarly journals.

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How to Write a Research Synopsis: Template, Examples, & More

Last Updated: May 9, 2024 Fact Checked

Research Synopsis Template

• Organizing & Formatting
• Writing Your Synopsis
• Reviewing & Editing

This article was reviewed by Gerald Posner and by wikiHow staff writer, Raven Minyard, BA . Gerald Posner is an Author & Journalist based in Miami, Florida. With over 35 years of experience, he specializes in investigative journalism, nonfiction books, and editorials. He holds a law degree from UC College of the Law, San Francisco, and a BA in Political Science from the University of California-Berkeley. He’s the author of thirteen books, including several New York Times bestsellers, the winner of the Florida Book Award for General Nonfiction, and has been a finalist for the Pulitzer Prize in History. He was also shortlisted for the Best Business Book of 2020 by the Society for Advancing Business Editing and Writing. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 273,178 times.

A research synopsis describes the plan for your research project and is typically submitted to professors or department heads so they can approve your project. Most synopses are between 3,000 and 4,000 words and provide your research objectives and methods. While the specific types of information you need to include in your synopsis may vary depending on your department guidelines, most synopses include the same basic sections. In this article, we’ll walk you step-by-step through everything you need to know to write a synopsis for research.

Things You Should Know

• Begin your research synopsis by introducing the question your research will answer and its importance to your field.
• List 2 or 3 specific objectives you hope to achieve and how they will advance your field.
• Discuss your methodology to demonstrate why the study design you chose is appropriate for your research question.

Organizing Your Research Synopsis

• Find out what citation format you’re supposed to use, as well as whether you’re expected to use parenthetical references or footnotes in the body of your synopsis.
• If you have questions about anything in your guidelines, ask your instructor or advisor to ensure you follow them correctly.

• Title: the title of your study
• Abstract: a summary of your research synopsis
• Introduction: identifies and describes your research question
• Literature Review: a review of existing relevant research
• Objectives: goals you hope to accomplish through your study
• Hypotheses: results you expect to find through your research
• Methodology and methods: explains the methods you’ll use to complete your study
• References: a list of any references used in citations

Tip: Your synopsis might have additional sections, depending on your discipline and the type of research you're conducting. Talk to your instructor or advisor about which sections are required for your department.

• Keep in mind that you might not end up using all the sources you initially found. After you've finished your synopsis, go back and delete the ones you didn't use.

Writing Your Research Synopsis

• Your title should be a brief and specific reflection of the main objectives of your study. In general, it should be under 50 words and should avoid unneeded phrases like “an investigation into.”
• On the other hand, avoid a title that’s too short, as well. For example, a title like “A Study of Urban Heating” is too short and doesn’t provide any insight into the specifics of your research.

• The introduction allows you to explain to your reader exactly why the question you’re trying to answer is vital and how your knowledge and experience make you the best researcher to tackle it.
• Support most of the statements in your introduction with other studies in the area that support the importance of your question. For example, you might cite a previous study that mentions your problem as an area where further research needs to be done.
• The length of your introduction will vary depending on the overall length of your synopsis as well as the ultimate length of your eventual paper after you’ve finished your research. Generally, it will cover the first page or two of your synopsis.

• For example, try finding relevant literature through educational journals or bulletins from organizations like WHO and CDC.
• Typically, a thorough literature review discusses 8 to 10 previous studies related to your research problem.
• As with the introduction, the length of your literature review will vary depending on the overall length of your synopsis. Generally, it will be about the same length as your introduction.
• Try to use the most current research available and avoid sources over 5 years old.

• For example, an objective for research on urban heating could be “to compare urban heat modification caused by vegetation of mixed species considering the 5 most common urban trees in an area.”
• Generally, the overall objective doesn’t relate to solving a specific problem or answering a specific question. Rather, it describes how your particular project will advance your field.
• For specific objectives, think in terms of action verbs like “quantify” or “compare.” Here, you’re hoping to gain a better understanding of associations between particular variables.

• Specify the sources you used and the reasons you have arrived at your hypotheses. Typically, these will come from prior studies that have shown similar relationships.
• For example, suppose a prior study showed that children who were home-schooled were less likely to be in fraternities or sororities in college. You might use that study to back up a hypothesis that home-schooled children are more independent and less likely to need strong friendship support networks.

• Expect your methodology to be at least as long as either your introduction or your literature review, if not longer. Include enough detail that your reader can fully understand how you’re going to carry out your study.
• This section of your synopsis may include information about how you plan to collect and analyze your data, the overall design of your study, and your sampling methods, if necessary. Include information about the study setting, like the facilities and equipment that are available to you to carry out your study.
• For example, your research work may take place in a hospital, and you may use cluster sampling to gather data.

• Use between 100 and 200 words to give your readers a basic understanding of your research project.
• Include a clear statement of the problem, the main goals or objectives of your study, the theories or conceptual framework your research relies upon, and the methods you’ll use to reach your goals or objectives.

Tip: Jot down a few notes as you draft your other sections that you can compile for your abstract to keep your writing more efficient.

Reviewing and Editing Your Research Synopsis

• If you don’t have that kind of time because you’re up against a deadline, at least take a few hours away from your synopsis before you go back to edit it. Do something entirely unrelated to your research, like taking a walk or going to a movie.

• Eliminate sentences that don’t add any new information. Even the longest synopsis is a brief document—make sure every word needs to be there and counts for something.
• Get rid of jargon and terms of art in your field that could be better explained in plain language. Even though your likely readers are people who are well-versed in your field, providing plain language descriptions shows you know what you’re talking about. Using jargon can seem like you’re trying to sound like you know more than you actually do.

Tip: Free apps, such as Grammarly and Hemingway App, can help you identify grammatical errors as well as areas where your writing could be clearer. However, you shouldn't rely solely on apps since they can miss things.

• Reference list formatting is very particular. Read your references out loud, with the punctuation and spacing, to pick up on errors you wouldn’t have noticed if you’d just read over them.
• Compare your format to the one in the stylebook you’re using and make sure all of your entries are correct.

• Read your synopsis backward by starting on the last word and reading each word separately from the last to the first. This helps isolate spelling errors. Reading backward sentence by sentence helps you isolate grammatical errors without being distracted by the content.
• Print your synopsis and circle every punctuation mark with a red pen. Then, go through them and focus on whether they’re correct.
• Read your synopsis out loud, including the punctuation, as though you were dictating the synopsis.

• Have at least one person who isn’t familiar with your area of study look over your synopsis. If they can understand your project, you know your writing is clear. If any parts confuse them, then that’s an area where you can improve the clarity of your writing.

Expert Q&A

• If you make significant changes to your synopsis after your first or second round of editing, you may need to proofread it again to make sure you didn’t introduce any new errors. Thanks Helpful 0 Not Helpful 0

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• ↑ https://admin.umt.edu.pk/Media/Site/iib1/FileManager/FORMAT%20OF%20SYNOPSIS%2012-10-2018.pdf
• ↑ https://www.scientificstyleandformat.org/Tools/SSF-Citation-Quick-Guide.html
• ↑ https://numspak.edu.pk/upload/media/Guidelines%20for%20Synopsis%20Writing1531455748.pdf
• ↑ https://www.researchgate.net/publication/279917593_Research_synopsis_guidelines
• ↑ https://writingcenter.unc.edu/tips-and-tools/editing-and-proofreading/
• ↑ https://www.cornerstone.edu/blog-post/six-steps-to-really-edit-your-paper/

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Multi-Speciality Hospital by Ishika Mukherjee

Hospitals are a dynamic organisation. They have been changing to adapt to the advancement in the field of medicine, as well as the socio-economic changes around them. But the ambience of a typical hospital continued to stay stark and often dreary. But in the present day, as design innovation and thinking gradually starts to spill over to the various public sectors – like healthcare, institutions, education among others – I had the opportunity to propose a healing environment. A well designed, holistic environment in a hospital would not only be uplifting to one’s immediate mood but also affect their mental health in the long run.

Architects:  Ishika Mukherjee Location: India

The aim of the project was to rethink the usual hospital and create a more warm and comforting atmosphere, while still accommodating the sterile nature as well as the functional efficiency of one, especially in terms of transition and circulation of the patients, visitors and staff.

THE SITE AND CHALLENGES

The site for the 100 bed, a multi-speciality hospital is located in Yadavgiri, Mysore. Although the locale is primarily residential, there was railway track and a factory that overlooked the site. The functionality of the space had to position such that no disturbance is caused – from the railway/ factory to the patients, or from the patients to the residences nearby. The site was also immediately flanked by the main road prone to heavy traffic and noise pollution.

SPATIAL PLANNING

Every zone was planned such that each gets immediate connectivity to the next possible stage of Medicare – for instance, the outpatient department had a close proximity to the Labs, as did the emergency trauma care unit; whereas the in-patient department was kept upstairs, since it didn’t need to be accessed immediately by an outsider.

The two blocks of the hospital, simply put emergency and non-non-emergency were connected together through glass walkways within the dense green spaces, giving one the feeling of walking in a forest. The spaces were also placed keeping in mind the noisier zones and the remote zones of the site.

BRINGING IN NATURE

It has been scientifically proven and spiritually taught that nature is, in fact, the best healer. My preliminary idea to make space more “healing” was to bring in pieces of nature, however, in ways that do not affect hygiene.

The built area had 4 dense patches of green, the plan was to plant trees, plants and saplings at the initial stage, and let the ecosystem develop on its own over time, says a lot of maintenance. Aside from the dense patches, there are also smaller cubes of plants in the double height areas -foyer and cafeteria, making it feel like a park. The green areas not only make the environment feel comforting and healing but also act as insulation for sound.

Covering about 16% of the buildable area, the project is planned to succinct and efficient. While designing it was also kept in mind that no existing trees were harmed, only new trees added. All of the trees on the inside were to be transferred in from local areas.

MATERIALS AND STRUCTURE

The primary material for the building was to be Hempcrete. Hempcrete is a concrete made out of hemp. The material super lightweight, strong and easy to work with. The material, being lightweight is also easy to support, while extremely resilient.

The floor height of space is about 4m, giving a person enough room so the area does not feel claustrophobic. Between each ceiling-floor slab is an area of 1.2m. This area is used for 1. Services like pipelines, O2 lines and HVAC; and 2. Depth for the garden’s soil to fit in.

The jail walls were designed to act as a contemporary Indian aesthetic, a way to let in air and sunlight in private spaces, as well as to submerge ducts. The massive roof gave the first floor, inpatient area a height of 7m at places. The structure is supported by a simple space frame, that again, adds volume to space.

The building is designed to be made of ecological materials, while also adding to the greens of Mysore. The ambience is simple, straight-forward, yet natural and remedial.

Ishika Mukherjee

Ishika Mukherjee is an architect, designer and a writer. Her strong opinions on the climatic and social conditions of today, and the role design has to play – both as the culprit as well as the potential to be the hero – is what shapes her career as a creative. Having worked for various architecture firms across India – The Architect’s Office, Hemal Surti Architects, Aequinox architects to name a few, she branched out to also become a design journalist, understanding design from the perspectives of renowned designers. With the zeal to constantly be at the edge of innovation, she is currently pursuing a masters in Design Innovation and Environmental Design from the Glasgow School of Art.

Rethinking The Future (RTF) is a Global Platform for Architecture and Design. RTF through more than 100 countries around the world provides an interactive platform of highest standard acknowledging the projects among creative and influential industry professionals.

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2 Hospitals. An architects perspective. Synopsis, 2500BCE to the Present. Rev. 140613

Related Papers

https://www.ijrrjournal.com/IJRR_Vol.7_Issue.12_Dec2020/Abstract_IJRR001.html

International Journal of Research & Review (IJRR)

The history of medicine and different healing therapies have been extensively studied and published, but the history of ‘Hospitals’ or the place where these healing activities were actually carried out, often escapes attention of medical historians. In this review article the authors have presented a lucid account of the Ancient History of Hospitals from approx. 6500 BC to 650 AD. Beginning with the etymological investigation of the word ‘Hospital’, the author describes in detail the Neolithic ‘Cave Hospitals’, Ancient Indian ‘Ayurvedic Medical Schools’ of Takshila and Kasi, the Buddhist ‘Monastic Hospitals’ in Srilanka, Mesopotamian ‘House of Life & Healing’, Tibet’s ‘Palace hospitals’, Greek Temple Hospitals ‘Asclepeions’, Roman Military Hospitals ‘Valetudinaria’, Medicity ‘Basilias’, and ‘Bimaristans’ of Gondeshapur. This endeavour reviews the ancient history of hospitals to highlight the charisma of the past ‘achievements’ in an innovative style and through a new paradigm.

Daphne Kapsambelis

My aim is to discuss the question of whether – and to what extent – the emergence of the hospital in the Eastern Mediterranean is the outcome of the healing tradition of the ancient Greek world rather than of the new values and structures of the Christian society that becomes established in the fourth century AD in the Eastern Roman Empire. I will begin by briefly outlining the situation in the area of medical care in this part of the world up until the fourth century AD, which is the date at which most historians of medicine conventionally place the “birth” of the hospital.1 I will then look at cases of hospitals between the fourth and the middle of the seventh century, in order to determine whether there were new elements that came into play in Late Antiquity in the East with respect to the society’s attitude towards the sick, especially the indigent sick, and its manner of dealing with them. This examination will lead to me to suggest aspects in which there appears to be a predom...

Acta Theologica

Louise Cilliers

The evolution of the hospital is traced from its onset in ancient Mesopotamia towards the end of the 2nd millennium to the end of the Middle Ages. Reference is made to institutionalised health care facilities in India as early as the 5th century BC, and with the spread of Buddhism to the east, to nursing facilities, the nature and function of which are not known to us, in Sri Lanka, China and South East Asia. Special attention is paid to the situation in the Graeco-Roman era: one would expect to find the origin of the hospital in the modern sense of the word in Greece, the birthplace of rational medicine in the 4th century BC, but the Hippocratic doctors paid house-calls, and the temples of Asclepius were visited for incubation sleep and magico-religious treatment. In Roman times the military and slave hospitals which existed since the 1st century AD, were built for a specialized group and not for the public, and were therefore also not precursors of the modern hospital. It is to the Christians that one must turn for the origin of the modern hospital. Hospices, initially built to shelter pilgrims and messengers between various bishops, were under Christian control developed into hospitals in the modern sense of the word. In Rome itself, the first hospital was built in the 4th century AD by a wealthy penitent widow, Fabiola. In the early Middle Ages (6th to 10th century), under the influence of the Benedictine Order, an infirmary became an established part of every monastery. During the late Middle Ages (beyond the 10th century) monastic infirmaries continued to expand, but public hospitals were also opened, financed by city authorities, the church and private sources. Specialized institutions, like leper houses, also originated at this time. During the Golden Age of Islam the Muslim world was clearly more advanced than its Christian counterpart with magnificent hospitals in various countries.

The roots of modem medicine can be traced back to the 5th century BC when Hippocratic rational medicine originated on the Greek islands of Cos and Cnidos. In this study we examine the way in which practitioners conducted their profession in Graeco-Roman times, as well as their training. Medical training was by way of apprenticeship with recognized doctors, but no qualifying examinations existed and the standard of practice thus varied enormously. Even in the Roman era the vast majority of medical doctors were Greek and in private practice as itinerant physicians. Civic doctors in the paid service of local communities appeared in Greek society from the 5th century BC onwards, but much later in Rome - probably as late as the 4th century AD. Rome’s unique contributions to medicine lay in public health measures (e.g. their aqueducts, public baths and sewages systems) and an excellent medical service for their armies and navy. Hospitals (valetudinaria) were established for military purpo...

Nuran Saliu

In the construction industry, where in recent times every detail is looked over and planned with the most scientific and technological responsibility, hospitals represent the most investigated and scrutinized facilities. Related closely with institutional and medical practices, hospital design has undergone many reconfigurations. The second half of the past century experienced and produced many hospital models (L, H, T, K type, Patients Tower, Block Plan, etc.), all with the same denominator – too big, isolated and highly complex structures, strictly opposed to nature, oriented towards medical technology rather than patient’s well-being. By the end of the twentieth century, a group of researchers arose in supporting the importance of ‘nature’ in the healthcare structures. The paradigm is changing. New models and configurations are emerging with the intent of improving the psycho-emotional well-being and social development of the patients who spend long time period of time in hospita...

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Catherine Banaag

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Why hospital design matters: A narrative review of built environments research relevant to stroke care

Julie bernhardt.

1 Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia

Ruby Lipson-Smith

Aaron davis, marcus white.

2 Centre for Design Innovation, Swinburne University of Technology, Hawthorne, Australia

Heidi Zeeman

3 Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

Natalie Pitt

4 Silver Thomas Hanley (STH) Health Architecture, Australia

Michelle Shannon

Maria crotty.

5 Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia

Leonid Churilov

6 Melbourne Medical School, University of Melbourne, Parkville, Australia

7 School of Education, Health and Social Studies, University of Dalarna, Falun, Sweden

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.

Introduction

Imagine (re-)designing the very hospital you work in. What would you design differently? What would you change, to benefit you, your patients, and their families? What evidence might help guide those design decisions?

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. 1 Once built, hospitals remain in service for decades and are difficult to modify. With stakes this high, considering how building design best supports healthcare services is important. In this narrative review, we outline why the built environment matters, with particular focus on stroke care. We also discuss challenges inherent in designing healthcare environments, undertaking research and evaluating completed architecture.

The planning and design process for new healthcare environments is incredibly complex, but, in general, it occurs in three overlapping stages: (1) the planning stage in which the healthcare provider describes the users’ needs, model of care, and clinical program in a functional brief that summarizes the requirements for the new hospital; (2) the design stage in which these requirements are interpreted by architects to develop an initial concept which is then refined to a more detailed design; and (3) the delivery stage in which the building is constructed. The extent to which hospital staff and patients are included at each stage of this process can vary significantly between projects. 2

Healthcare professionals have long advocated for design features thought to benefit health and well-being, such as natural light, ventilation, and space between patients—for example, the circular hospital design proposed by the physician Antoine Petit 3 and long “Nightingale wards” proposed by Florence Nightingale. 4 Hospital design is now informed by a process termed “evidence-based design” (EBD), in which research evidence is used alongside other considerations such as the healthcare context, budget, and architects’ experience, to inform the design of the healthcare built environment. 5 , 6 In this context, the “healthcare built environment” encompasses: (1) the physical construction (layout, room dimensions, doors and window placement, outdoor and community access, etc.), (2) ambient features (noise, air quality, light, temperature, etc.), and (3) interior design (furniture, signage, equipment, artwork, etc.). 7 Analogous to evidence-based clinical practice, hospitals designed following best research evidence garnered from EBD processes have better safety, patient outcomes, staff retention, and operation costs. 8 , 9 The Center for Health Design, established in 1993 to advance EBD, now maintains a repository of over 5,000 articles on healthcare design ( https://www.healthdesign.org ).

The field is growing; however, many healthcare contexts, including stroke, have a limited built environment evidence base. 10 Establishing geographically organized stroke units has been an important focus 11 ; however, these studies rarely address specifics of the built environment, and we know little about optimal stroke unit design. Stroke clinical guidelines rarely mention the built environment nor provide guidance on how the environment might best support care. There are currently no stroke care-specific building standards, nor standardized checklists to evaluate the quality of these environments. 12

Why is the built environment neglected? Clinicians may identify as knowing less about how the environment might influence patient care or staff well-being. They may also feel uninformed about the design process and how to contribute their clinical expertise to influence decision-making. To begin to address these gaps, our objectives for this review were: (1) to introduce readers to healthcare built environment research and (2) to highlight evidence that underpins acute, subacute, or rehabilitation stroke care facility design. This review is in three parts:

• Overview of healthcare built environment research;
• Stroke care built environment evidence; and
• Planning and design of new healthcare environments: Challenges and opportunities.

We include research from recent, relevant systematic reviews, other evidence summaries, and selected qualitative and mixed-methods research focusing on healthcare environments and design. Healthcare environments are complex and context-specific, with many interdependent variables that can rarely be isolated. This complex system does not readily lend itself to highly controlled experimental research designs in real-life settings. 13 Qualitative methods, such as case studies and pre- and post-occupancy evaluations (before and after a redesign or redevelopment), are common. With research still developing, heterogeneity exists in research designs, outcomes, environments, populations, and theoretical frameworks employed. 14 Hence, robust summary evidence derived from meta-analyses is lacking.

Healthcare built environment research

Research is dominated by studies conducted in acute environments such as emergency, surgery, and intensive care units (ICUs) ( Figure 1 ). 6 , 15 , 16 Older people, including those in dementia care, are frequently studied post-acute populations. 17

The volume of built environment research conducted in different healthcare settings. Circle size indicates the number of published research articles based on systematic literature review in preparation 18 and articles listed in the Centre for Healthcare Design research repository. Pink circles represent all built environment research, and the dark gray circles indicate stroke-specific research. (The aerial sketch in this image has been adapted with permission from Architectus + HDR.)

In this section, we introduce three topics relevant to most healthcare contexts: (1) design of internal spaces; (2) outdoor spaces; and (3) ambient features including light, noise, and air quality (with particular focus on infection control).

Internal spaces

The design of internal spaces, such as ward configuration, corridor design, and nurse station placements (centralized vs. decentralized), can influence patient visibility, safety, teamwork, distances staff walk in a shift, and time spent providing direct care to patients. 10 For example, open-plan, larger convex spaces can lead to greater patient visibility, and corridor width impacts staff circulation, informal communication, and teamwork. 19 In ICU, designs with centralized nurse stations and visibility of most patient rooms from that location are increasingly being replaced with decentralized nurses’ stations, arguably without strong evidence. 19 In emergency departments, with similar critical visibility requirements for teamwork and patient monitoring, some authors argue that physically separated zones or “pods” are neither efficient nor safe. 20 Decentralized nursing stations can lead to more patient room visits by staff. 21 , 22 This highlights current uncertainties.

The layout of hospital spaces and line of sight influences patient and visitor orientation and their ability to find their way around (“wayfinding”). 23 Signs, information boards, and “landmarks” (artwork, furniture, views, etc.) are typical wayfinding elements. 24 , 25 Inadequate wayfinding leads to delays in accessing services or finding people or places, associated stress, and higher staff burden as they provide directions for lost individuals. 25 While some standards exist, wayfinding is often not optimized in healthcare. 26

The proportion of single versus multiple(two or more)-bed rooms is a prominent ward design consideration. There is evidence that single rooms can support staff/patient communication, privacy, infection control, and noise reduction, but they are also associated with patient isolation and increased falls risk. 27 This evidence is, however, of mixed quality, limited to certain populations, with neutral and/or contrary results. 27 A higher proportion of single rooms generally results in longer corridors, longer staff walking distances, perceived decrease in patient visibility due to compromised sightlines, and higher construction and cleaning costs. 28 The inherent trade-offs will be different in every healthcare context. Less controversial is location of sinks and hand sanitizers; highly visible and standardized positioning promotes more consistent use. 29 , 30

Outdoor spaces

Hospital gardens were historically commonplace 31 ; however, less priority has been given to green space over time. Access to the outdoors and time in nature has been linked to stress reduction, improved physical symptoms, and emotional well-being in many healthcare settings. 32 Views of nature have been linked to reduced length of stay. 33 Good hospital garden design principles include creating opportunities for exercise, exploration, socialization, and to engage with and escape in nature. 32 Surprisingly, patients and visitors are often not aware of hospital gardens, and proactive approaches to increasing patient and family use of gardens have been recommended. 34 Usually conceptualized as spaces for patients and visitors, staff are often their primary users. 32 Outdoor spaces can be restorative for hospital staff, helping to reduce stress and improve attention, which may improve patient care and staff retention. 35

Ambient features

Ambient features, such as light and noise, can impact patient well-being and comfort, sleep, and communication with staff. 36 , 37 Light and noise also impact staff well-being and attention 38 and contribute to medication errors and other safety concerns. 39

Air quality is important for both comfort and infection control. Infection control is particularly prioritized in acute environments and is receiving deserved attention in the COVID-19 pandemic. A recent review of COVID-19 transmission showed that spatial configuration can affect patient density and thereby transmission. 40 Optimized systems for heating, ventilation, and air conditioning (HVAC) can filter microparticles such as viruses. Different HVAC systems also affect humidity, airflow velocities, air pressure—all important for exposure to active aerosols. Window ventilation, daylight, and electric UV light are recommended to aid disinfecting surfaces and use of surface materials that affect pathogen survival. 40

Stroke care built environment evidence

In this section, we outline how the built environment can influence important outcomes such as: (1) evidence-based stroke care, including rehabilitation; (2) efficiency of stroke care, staff processes, and communication; and (3) patient safety and well-being. The evidence-base specific to stroke care is small. 41 In Figure 2 , we summarize the design features and how they may influence a range of outcomes including patient and staff behavior. This should be considered illustrative rather than exhaustive. Where possible, we draw directly from stroke or brain injury-specific evidence, supplementing evidence from other populations where relevant.

A summary of the evidence specific to stroke care environments. Dotted lines = a hypothesis, garnered from research in other populations; thin lines = limited evidence, < 3 studies; thick lines = moderate evidence, ≥ 3 studies, based on systematic literature review. 41

Evidence-based practice including rehabilitation

We found no stroke-specific research to underpin built environment recommendations for optimal delivery of either time-critical acute stroke treatments or evidence-based care, including rehabilitation. Guidelines recommend early commencement of both structured and incidental physical, cognitive, and social activity for all stroke patients, 42 , 43 although recommended levels vary. Patients in both acute and subacute environments spend most of their day alone and inactive in their bedroom. 44 , 45 While we can hypothesize that providing “draw-them-out” features on a ward may improve activity and engagement, evidence is limited. These features may include green spaces and indoor communal (social) spaces. Unfortunately, communal spaces, when present, often appear to be underutilized in both acute 46 and rehabilitation environments. 47 Many factors may influence whether patients use communal spaces, including not knowing they exist or where to find them, difficulty accessing them without help, or feeling they don’t have permission to use them. 48 In a Norwegian study across 11 stroke units with communal areas, patients were more active and spent less time in their bedroom in units where meals were served in the communal area. 49 Providing resources (games, music, books) in personalized activity packs and in communal spaces (“environmental enrichment”), with the aim to improve physical, social, and cognitive activity, has recently been tested in acute and subacute settings with mixed results. 50 – 52 Importantly, this approach relies on staff to encourage use and engagement, rather than embedding activity opportunities into the building itself. Hallways and circulation spaces are generally underrecognized as providing spaces for incidental activity and interaction. 53

There is limited stroke-specific research about the value or harm of single- versus multiple-bed rooms. A higher proportion of single rooms may be associated with lower levels of patient activity in acute stroke. 54 , 55 A systematic review of single- versus multiple-bed rooms in older people and those with neurological disorders found potential benefits (e.g. infection control, patient satisfaction) and harms (e.g. falls, isolation) with single rooms. 56 In rehabilitation facilities with a high proportion of single rooms, patients emphasize the importance of communal areas. 57 Further work is needed to identify and test how modifications to layout and communal and circulations spaces could enhance patient engagement, activity, and optimal care provision.

Efficiency of care, staff processes, and communication

Interprofessional communication and teamwork between physicians, nurses, and allied health professionals supports best practice stroke care. 11 Shared staff spaces support team communication and collaboration, enabling better understanding of patient needs, and greater knowledge about other team roles. 58 , 59

Therapy spaces are often discrete locations (e.g. gym, occupational therapy rooms), rather than being holistic, context-based environments that reflect the connectivity and continuity necessary for rehabilitation and transition beyond discharge. 60 , 61 Separation of clinical and therapy spaces can impact staff travel time, patient practice and activity, and even clinical decision-making. For example, Blennerhassett et al. 47 found that patients spent less time engaged in physical activity and more time in corridors when the ward was located further from the gym, on a separate floor. This also impacted wheelchair use and patient travel time. 47 Inaccessible therapy spaces can also change therapists’ intervention choices. 62

Safety and well-being

Falls are common after stroke, 63 yet the relationship between the built environment and falls is largely unexplored. The presence of a fellow patient (multiple-bed room) may help reduce falls, especially for older patients with neurological injury. 56 , 64 Roommates play an important role in monitoring the physical and mental health of others in stroke rehabilitation. 48 Stroke patients often experience loneliness when in hospital, 65 , 66 and some patients will choose a shared room over the privacy of a single room. 57 Sleep is important for recovery. Unsurprisingly, visual and aural privacy is less in multiple-bed rooms. However, noise traveling between corridors and bedrooms and lack of dedicated staff spaces for confidential conversations are also important. 48

Planning and design of new healthcare environments: Challenges and opportunities

Healthcare environments research and design is a multistakeholder endeavor involving government, healthcare providers, managers, clinical staff, patients, architects, quantity surveyors, construction companies, building managers, etc. This collaborative process can be challenging, 67 , 68 considering interdisciplinary differences in knowledge and approaches. 69 The complexity of hospital procurement and the fact that design and construction processes are foreign to many healthcare professionals adds further challenge. Clinicians often do not understand what the “user group” consultation process is supposed to achieve, and their involvement may be inconsistent throughout the design process, which limits their contribution to the process and ability to influence decisions. 67 While collaboration between architects and healthcare professionals is not new, 70 limited evidence informs current consultation processes. 67 , 71 High-quality healthcare environments are produced when shared decision-making and collaboration happens across healthcare, construction, and architecture to create designs based on evidence and end-users’ perspectives. 69

A number of research approaches are suggested to facilitate this collaboration, including participatory design, co-design, and Living Labs. 2 , 72 , 73 Over many years, our team has built partnerships between healthcare environment practitioners, clinicians, researchers, and people living with stroke, which have served to create a common understanding of the barriers and opportunities for redesigning and optimizing stroke care environments. With the creation of the Neuroscience Optimized Virtual Living Lab (NOVELL) for stroke rehabilitation redesign ( www.novellredesign.com ), we are working to develop new models for stakeholder engagement and research, and to contribute new evidence to stroke rehabilitation design.

In addition to collaboration challenges, research is infrequently embedded in the planning and design of new healthcare environments, and leaders in EBD have long called for appropriately funded, transparent, and freely available evaluations of completed buildings. 74 – 76 Given the cost of constructing and running healthcare buildings, the absence, or non-disclosure, of evaluations to determine whether desired outcomes were met is concerning. 77 , 78 Hospital design and construction is underpinned by technical and generic building guidelines and standards that differ within and between countries. The degree to which these standards are “evidence-informed” varies. In stakeholder consultations, understanding what is evidence-based and what is open to change can be difficult. Design innovation is essential if hospital buildings are to respond to new healthcare models or processes. For example, the recent COVID-19 induced surge in utilization of telehealth and other e-health technologies for rehabilitation, other treatment, and communication with people with stroke has implications for healthcare design, increasing demand for spaces for videoconferencing, equipment storage, and potential changes to waiting rooms and on-site consultation spaces. 79 , 80 Future design considerations for stroke recovery should also extend to the home environment. 81

The built environment matters. It can impact healthcare delivery and patient and staff outcomes. An evidence base is growing in some areas of healthcare design, while others require significant further research. The potential for both hospital and health services design innovation is strong. By continuing to build this evidence base, EBD can complement architectural processes to deliver high-performing healthcare assets. Involving engaged and informed clinicians in built environment design and research will help shape hospitals of the future.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: NOVELL is funded by the Felton Bequest and the University of Melbourne. Julie Bernhardt is funded by an NHMRC Research Fellowship (1154904). The Florey Institute of Neuroscience and Mental Health acknowledges support from the Victorian government and in particular funding from the Operational Infrastructure Support Grant.