Academy of Architecture for Health

Erin:

The research problems you describe (that the physical healthcare environment has a direct impact on patient outcomes, staff workplace effectiveness) are very interesting. In the context of behavioral economics (a discipline that is engaging other professionals and interests me,) I would describe your research as "first-order" in the sense that you are studying the "absolute" effects of good and bad environments on people in healthcare situations. As you say, these questions are of significance at present to healthcare architects and others so it is important to establish these first-order effects.

According to me, behavioral economics looks at "second-order" or "relative" effects. It is when two things are compared that losses and gains become relevant. So, if you have a well-designed patient room and then a poorly designed procedure room, that relative difference would be experienced as a loss, so that a later return to the patient room (after the procedure) would not be experienced as a return to the status quo owing to loss aversion effects. (Losing something is worse than getting it back later, contrary to what common sense might suggest.) This means that the investment in a well-designed patient room has been wasted to some degree because the procedure room was poorly designed, a non-intuitive conclusion. So even though the effects are second-order and subtler, they are no less important in terms of their consequences.

I would argue that even the first-order effects you are studying have implicit behavioral economics parameters in them like the implicit or hidden dependence on a *reference point* in evaluations of whether an environment is "good" or "bad." Because you have to ask, "good or bad *relative* to what?"

There are many other mechanisms in behavioral economics besides loss aversion so this is just an illustration. I'm sure your research experiments can be adapted to test these predictions. In any event, I appreciate your interest in getting our feedback.

Hello Avani,

Thank you for your response. It is always nice to hear someone talking about research in a comprehensive way. It is important that the field looks beyond, as you say, the "good" or "bad", and looks at the impacts of both individual and bundled factors. It is important to look at the health and welfare of all building occupants throughout their experience while additionally taking into consideration the impacts of factors outside of the hospital. This is why much of the research being done now, including research I am currently working on, is multi-method, and investigates research and design issues from multiple perspectives. In this case, these studies do not solely look at whether the individual likes the OR, ED or patient room, but rather correlations between numerous factors that impact the care, health and safety of individuals in those spaces. You are right in saying that second-order or subtle effects are valuable and I am happy to say that these items are an integral part of many great research studies that going on now and are part of the healthcare research canon.

Thank you for your insightful comments. As we investigate the healthcare environment it is important to understand how each item affects the overall experience.  

In regards to my previous posting, would you say that you are most interested in hearing more about the overall patient/occupant experience vs. a focused look at specific departments?

Warm regards,