At a hospital, patients are always one conversation away from good or bad news. When not being rushed into treatment rooms, the sick are often left to feel stressed about their health. Healthcare workers have one of the most stressful jobs, with sudden changes in patient conditions. The general atmosphere in traditional hospitals seems tense and worrisome, and this has an adverse effect on patients’ well-being.
In the late 1970s, Aaron Antonovsky, a professor, researcher, and medical sociologist identified the aftermath of stress on health. A survivor of concentration camps, he wondered how most people constantly fighting illnesses manage to survive and stay healthy. Antonovsky shifted his research approach from disease to the origins of health, uncovering how stress and lifestyle impact health. The resulting model is called Salutogenesis, derived from ‘salus’ meaning health and ‘genesis’ meaning origin.
Salutogenesis views health on a spectrum of ‘ease and disease’ and pinpoints aspects that shift an individual from one state to the other. These aspects, termed stressors, may be internal or external demands that disturb the body’s homeostasis. Rather than trying to make an ill patient well, salutogenesis seeks to help people cope with or mitigate stressors.
The theory began with an inquiry into the origins of health. Antonovsky found his answer in what he calls Sense of Coherence, the key concept of the salutogenic model. Sense of coherence is a scale that evaluates how people view life and maintain their health through a feeling of optimism and control. The concept clarifies why some individuals under stress fall sick while others stay healthy. Three main components define a sense of coherence - comprehensibility, manageability, and meaningfulness.
Salutogenic Design
In the 1990s, architect Alan Dilani suggested that the salutogenic method be applied not only to medical treatment but also to the architectural design of healthcare facilities to encourage good health. Through his own research based on Antonovsky’s work, Dilani proposed Psychosocially Supportive Design as a framework for eradicating anxiety through the physical design of spaces. The framework illustrates the causes of stress and introduces wellness factors that support the healing process.
Branching from the concept of Sense of Coherence, Dilani has identified design qualities that strengthen an individual's sense of comprehensibility, manageability, and meaningfulness. While salutogenic design can be applied to any structure, it proves most advantageous to healthcare facilities where the built environment influences patient recovery and fosters a natural healing process.
Sense of Comprehensibility
In the context of salutogenic design, comprehensibility refers to the extent to which one might notice their surroundings as ordered, clear, and structured. People should be able to grasp the context they find themselves in. Hospitals have a record of being places where understanding is delegated - patients rarely comprehend their illness or how treatments work. They are usually ushered between rooms, having no sense of the space on their own.
Architects can design spaces to accentuate more intuitive paths through master planning and design of wayfinding systems. Healthcare design can also bolster the sense of comprehensibility through colors, landmarks, and views of nature. These tactics not only help patients comprehend their surroundings but also build their confidence in carrying out their own initiatives.
Sense of Manageability
Manageability deals with an individual's sense of control of their situation and surroundings. Traditional healthcare designs have been able to make spaces manageable for staff with centralized services, infection control, patient oversight, and efficient organization of space. For patients, intravenous drips, incubation, heating/cooling, dialysis, and other forms of ‘life support’ help them feel that they can get better on their own.
Salutogenic design can enable further functionality of healthcare facilities to improve a sense of independence in patients. By providing operable windows or access to facilities, a patient feels capable of taking decisions for their health and acting upon them. Accessibility to resources, staff, family, and friends also authorizes patients to exercise control of their environment.
Sense of Meaningfulness
The motivational aspect addressing the feeling of life having an emotional meaning is what Antonovsky labels Sense of Meaningfulness. People’s source of meaningfulness usually lies outside the walls of hospitals as family, friends, art, music, sports, or religion. This makes it difficult to establish meaning in healthcare facilities where patients are cut off from social interaction and the outside world. Healthcare architecture is also stereotyped as seeming sterile and bleak.
Through the salutogenic approach, health centers can incorporate art installations, spaces for music and social support, and recreational spaces like libraries or gyms. Hospitals may incorporate nature and animals in their facilities to inspire patients. Views of landscapes serve as positive distractions and have a proven effect on boosting patient recovery.
Architecture as Treatment
Several other models of salutogenic architecture have been developed like Jan Golembiewski’s ‘ Neurology of Salutogenic Design’, Tye Farrow’s ‘Salutogenic Design Method’, and Roger Ulrich’s ‘Theory of Supportive Design’. What these models share in common is prioritizing the mental state of the patient as a means of facilitating recovery. The salutogenic model and its allied design philosophy support the idea that individuals have an innate ability to heal themselves.
It is also recognized that salutogenic architecture requires more than a design team. The entire healthcare organization must understand the meaning and impact of salutogenic design within their existing systems. This form of design thinking encourages architects, healthcare workers, and patients to brainstorm how building features can enhance a sense of coherence and equip architecture as a form of medical treatment.
