The PhD thesis is based on research which was conducted between 2009 and 2012. It deals with green outdoor environments (GOEs) at acute care hospitals in the capital region of Denmark. The aim of this PhD study is to gain deeper knowledge about the design and use of GOEs which supports mental restoration. For this purpose, five case studies were selected. Site analysis, questionnaire survey and personal interviews with the staff were used to achieve the aim of this study. A literature review was conducted to clarify the state-of-the-art regarding the design recommendations for GOEs at healthcare facilities.
The findings from the literature review revealed that there are two types of publications (peer-reviewed and best practice guidelines) that have offered recommendations for the design of GOEs at healthcare facilities. After the review process, seven main themes were derived which contained 22 design guidelines which formed a survey tool called the Common Design Recommendations (CDRs).
The CDRs were later used to analyze the design characteristics of the five hospitals’ GOEs. The Perceived Restorativeness Scale (PRS), which was included in the questionnaire, was used with the intention of identifying which hospital GOE was perceived by the users as being the most restorative. The findings show that the GOE at Bispebjerg Hospital, the design characteristics of which conform to three themes in the CDR, is perceived as having the most restorative potential compared to the others which conform to more CDRs. The location, surroundings and the facilities were shown to contribute to the success and users’ satisfaction of the GOE.
The findings also show that GOEs are used more by staff, compared to patients and visitors. The most popular activities performed in the GOEs are smoking, having lunch, and relaxing. In general, employees spent the least time in the GOEs (between 5 to 10 minutes) due to their work schedule compared to patients who spent between 10 to 20 minutes. Personal interviews with 15 employees from all five hospitals indicated what employees experience in the GOEs and what improvements they would like to see. Among the recommendations from the employees was easy access, a window view of the GOE and private spaces for staff. The inclusion of water features was the most popular. The preference for sun and fresh air indicates that many hospital users would like to spend time outside the buildings. The majority of users are satisfied with the existing GOEs and the results gained from the PRS indicate that they regard the GOEs as having potential for mental restoration.
The important contributions of this PhD study are that it highlights the importance of having GOE at acute care hospitals and the proposal of a design survey tool (the CDR). The tool can be used as a quick guide for professionals dealing with the design and management of healthcare facilities when evaluating either existing or future GOEs. Based on the results of the CDR and the study of the five cases, thirteen recommendations were proposed. Maintenance aspects have been identified as the weakness concerning the CDR which gives areas for the survey tool to be improved in the future. The findings of this study indicate that GOEs have potential as restorative settings and should therefore be considered as valuable assets at healthcare facilities.