Are There Design Rules to Follow?

Research shows that the physical environment can contribute to better health outcomes. But what particular design features do this? Are there specific rules to follow? For example, are there certain colors that work best or specific materials to use?

Unfortunately, there are no hard and fast guidelines on what to do in all cases, because so much depends on the situation: what the site is like, personal preferences, the budget, the cultural context, and many other factors. 

Architecture, interior design, and landscape architecture are problem-solving processes that begin by listening and understanding the needs and preferences of those who will use the space. Often there are competing priorities that need to be considered (for example, the need for staff to have bright lighting to see what they are doing versus the desire of patients to have softer lighting). Thus, the design proposal often provides a range of options to consider.

What about the elements of design?

It is true that while the situations differ, architects and interior designers all work with the same elements and principles of design.

• The elements of design [1] are: Space, Form, Texture, Light, Color, Lines, Point (i.e. focal point), and Time.
• The principles of design [2] are: Rhythm, Proportion, Balance, Emphasis, Variety, Unity, Repetition, and Human Scale

Designers manipulate the elements and principles of design for different effects. For example, if they want to convey stability, they aim for symmetrical balance. If they want to break up monotony in a design and make it more dynamic, they add asymmetrical elements. Thus, depending on the situation, they use the elements and principles differently to meet the diverse needs and desires of each client.

What else impacts design?

Designers apply research or guidelines from various areas in their designs. These include:

Proxemics. This is the study and application of personal space zones-how close we like to be to other people. This differs depending on our relationship to other people and our culture. (For example Americans like 4 to 12 feet between someone they know socially, but not personally.) If we don't have this amount of space, we become uncomfortable and even anxious. So designers need to allow this amount of space between chairs in public places and understand cultural differences that affect this phenomenon.

Ergonomics/Human Factors. This is the study of how well the space, furniture, and other features fit the human body and how well they facilitate the tasks that need to be done in that space. Designers need to make sure the furniture and other elements they select are comfortable and help staff efficiency and accuracy.

Building Codes. These are sets of rules that specify the minimum acceptable level of safety for constructed buildings. The main purpose of building codes is to protect public health, safety, and general welfare as they relate to the construction and occupancy of buildings and structures. The building code becomes law of a particular jurisdiction when formally enacted by the appropriate authority. All building design must meet specific state and federal regulations. The regulations vary by state and jurisdiction in each state.

For healthcare buildings, minimum standards to aid in the design and construction are listed in the book, 2006 Guidelines for Design and Construction of Health Care Facilities. State authorities overseeing the building construction process may adopt these guidelines.

Green Guidelines. The goal of these guidelines is create buildings that nurture the health of not only the patients and staff in the building, but also the surrounding community and environment. They follow these basic principles: build only what you need, reuse when you can, and use natural resources.

Research-Based Design/Evidence-Based Design. Research is increasingly impacting the design and construction of healthcare facilities. While research in design is not new, it is only recently impacting design decisions. Organizations, such as the Center for Healthcare Design [3], are helping to provide information to the general public and working with higher education institutions to identify already published research and to create frameworks for the additional research needed.

What about design theories?

Designers may also follow a particular theory of design that influences how they manipulate the elements and principles. Below are a few examples:

• Environmental Preference: This theory holds that people prefer scenes that are engaging and interesting rather than simple or boring. It presents a framework organized according to four elements that people look for in the environment. Designers following this theory aim for:
  • Coherence (making sense)
  • Legibility (the promise of making sense)
  • Complexity (involvement)
  • Mystery (the promise of involvement)
• Gestalt Theory: This theory maintains that people generally like the following in visual stimuli and that designers should attempt to follow these laws:
  • Law of closure: we want things to look finished
  • Law of similarity: we tend to group similar things together
  • Law of proximity: the closer things are, the more we want to group them
  • Law of continuity: we see points that are connected by straight or curving lines as belonging together in a way that follows the smoothest path
  • Law of foreground: we can only see the positive or negative aspects of an item one at a time (i.e. drawings where can see an old woman outline in black and a young woman in white)
• Feng Shui: This is the ancient Chinese practice of placement and arrangement of space to achieve harmony. This theory applies the following concepts:
  • The Five Elements: wood, fire, earth, metal, and water. A design should use at least three of the five elements-either the actual element (i.e. a water fountain in a room) or a symbolic representation (a path on the floor that suggests a stream). Each element also has an associated color: wood (green), fire (red), earth (yellow), metal (white, neutral), and water (black), and a design should balance these.
  • Qi, which is energy flow. A design should "be the wind and disperse" or "be the water and define."
  • Yin and Yang. A design should provide balance among elements, which leads to harmony. It recognizes and draws from the infinite flow of dynamics between complementary opposites.