A randomized controlled trial of Golden Ratio, Feng Shui, and evidence based design in healthcare.

BACKGROUND: In a global effort to design better hospital buildings for people and organizations, some design principles are still surrounded by great mystery. The aim of this online study was to compare anxiety in an existing single-bed inpatient hospital room with three redesigns of this room in accordance with the principles of Golden Ratio, Feng Shui, and Evidence-Based Design. METHODS: In this online multi-arm parallel-group randomized trial participants were randomly assigned (1:1:1:1) to one of four conditions, namely Golden Ratio condition, Feng Shui condition, Evidence-Based Design condition, or the control condition. The primary outcomes were anxiety, sense of control, social support, positive distraction, and pleasantness of the room. FINDINGS: Between June 24, 2022, and August 22, 2022, 558 individuals were randomly assigned to one of the four conditions, 137 participants to the control condition, 138 participants to the Golden Ratio condition, 140 participants to the Feng Shui condition, and 143 participants to the Evidence-Based Design condition. Compared with baseline, participants assigned to the Evidence-Based Design condition experienced less anxiety (mean difference -1.35, 95% CI -2.15 to -0.55, Cohen's d = 0.40, p < 0.001). Results also showed a significant indirect effect of the Feng Shui condition on anxiety through the pleasantness of the room (B = -0.85, CI = -1.29 to -0.45) and social support (B = -0.33, CI = -0.56 to -0.13). Pleasantness of the room and social support were mediators of change in anxiety in the Evidence-Based Design and Feng Shui conditions. In contrast, application of the design principle Golden Ratio showed no effect on anxiety and remains a myth. INTERPRETATION: To our knowledge, this is the first randomized controlled trial linking design principles directly to anxiety in hospital rooms. The findings of our study suggest that Feng Shui and Evidence-Based Design hospital rooms can mitigate anxiety by creating a pleasant looking hospital room that fosters access to social support. CLINICAL TRIAL REGISTRATION: The trial is registered with ISRCTN, ISRCTN10480033.

The effect of a non-talking rule on the sound level and perception of patients in an outpatient infusion center.

Noise is a common problem in hospitals, and it is known that social behavior can influence sound levels. The aim of this naturally-occurring field experiment was to assess the influence of a non-talking rule on the actual sound level and perception of patients in an outpatient infusion center. In a quasi-randomized trial two conditions were compared in real life. In the control condition, patients (n = 137) were allowed to talk to fellow patients and visitors during the treatment. In the intervention condition patients (n = 126) were requested not to talk to fellow patients and visitors during their treatment. This study measured the actual sound levels in dB(A) as well as patients' preferences regarding sound and their perceptions of the physical environment, anxiety, and quality of health care. A linear-mixed-model showed a statistically significant, but rather small reduction of the non-talking rule on the actual sound level with an average of 1.1 dB(A). Half of the patients preferred a talking condition (57%), around one-third of the patients had no preference (36%), and 7% of the patients preferred a non-talking condition. Our results suggest that patients who preferred non-talking, perceived the environment more negatively compared to the majority of patients and perceived higher levels of anxiety. Results showed no significant effect of the experimental conditions on patient perceptions. In conclusion, a non-talking rule of conduct only minimally reduced the actual sound level and did not influence the perception of patients.

Route complexity and simulated physical ageing negatively influence wayfinding.

The aim of this age-simulation field experiment was to assess the influence of route complexity and physical ageing on wayfinding. Seventy-five people (aged 18-28) performed a total of 108 wayfinding tasks (i.e., 42 participants performed two wayfinding tasks and 33 performed one wayfinding task), of which 59 tasks were performed wearing gerontologic ageing suits. Outcome variables were wayfinding performance (i.e., efficiency and walking speed) and physiological outcomes (i.e., heart and respiratory rates). Analysis of covariance showed that persons on more complex routes (i.e., more floor and building changes) walked less efficiently than persons on less complex routes. In addition, simulated elderly participants perform worse in wayfinding than young participants in terms of speed (p < 0.001). Moreover, a linear mixed model showed that simulated elderly persons had higher heart rates and respiratory rates compared to young people during a wayfinding task, suggesting that simulated elderly consumed more energy during this task.