Design Isn't Decoratio It's Measured Against Outcomes
In 1984, Roger Ulrich published a study that became a landmark in evidence based healthcare design. He compared surgical patients recovering in rooms with a view of trees with matched patients whose windows faced a brick wall.
Patients with the natural view had shorter postoperative hospital stays, received fewer negative comments in nurses’ notes and used fewer potent pain medications than the matched group facing the brick wall. The study was small, 46 patients in total, but it demonstrated something important: aspects of the physical environment could be examined against measurable clinical outcomes rather than treated purely as a matter of aesthetic preference.
That principle underpins Aliento’s approach. A courtyard is not there simply to look considered, and a staff wellbeing space is not decoration added once the clinical brief is complete. Environmental decisions can influence how people experience care, how staff use a building and how effectively a space supports its purpose.
The strength of evidence varies between different design interventions, which is why we do not treat every design decision as though it carries the same clinical proof. The aim is to use the best available evidence alongside clinical, operational and user experience.
It hasn’t stopped since.
The research has continued to develop. In southern Sweden, an emergency department was refurbished using evidence based design principles, including changes to light and colour. Researchers compared patients’ and family members’ experiences before and after the intervention using a validated questionnaire. Perceived environmental support improved significantly following the redesign.
The significance is not that one colour or lighting treatment provides a universal answer. It is that the physical environment can be evaluated systematically through the experience of the people using it.
This is still being tested, rigorously.
A randomised controlled trial conducted in 2022 and published in 2024 took the comparison further. Researchers recruited 558 people with previous hospital experience and showed them simulated versions of a single bed hospital room based on evidence based design, Feng Shui, Golden Ratio principles or an existing room used as the control.
Participants viewing the evidence based design room reported lower anxiety and stronger ratings for sense of control, social support, positive distraction and pleasantness. It was an online simulation rather than a trial involving patients recovering in physical rooms, but it adds another useful layer to the evidence around how design decisions can affect people’s experience of healthcare environments.
For Aliento, evidence does not replace design judgement, clinical experience or consultation with the people who will use a space. It strengthens them. That combination informs how we approach healthcare, recovery and wellbeing environments.