An evaluation of a redesigned corridor at Dykebar Psychiatric Hospital
Dr. Eddie Edgerton
Introduction
The report focuses on an evaluation of the impact of a redesigned corridor space in Dykebar psychiatric hospital. Data was collected from hospital staff and patients in three of the hospital wards connected to this corridor.
The aim of this project was to:
Evaluate patients’ and staff perceptions of the corridor before and after the redesign.
Evaluate the impact of the redesigned corridor on patients’ staff and pupils self-perceptions.
Background
Dykebar Hospital is a large psychiatric hospital in the West of Scotland, delivering a range of psychiatric services and in-patient provision. The hospital is currently undergoing a period of significant change and has recently revised its approach to mental healthcare provision and communications. A key aim of this revised approach is to ‘de-institutionalise’ and modernise areas of the hospital in order to create a therapeutic and healing environment for patients, staff and visitors.
In line with this approach, the Arts Commission for Scotland has funded a public art project, “Finding Space” in the hospital. The project has commissioned an artist (Donald Urquhart) to identify and re-design an existing space within the hospital that can be used for patient and staff relaxation and recovery.
Site analysis
During this stage of the project, the initial focus was to conduct a background analysis of the setting. Information was obtained information from the following sources:
Site inspections – these included escorted tours by hospital staff and independent site visits (conducted either alone or with the artist).
Discussions with a variety of hospital staff (both formal and informal).
Discussions with the artist.
After completing the site analysis, it was agreed along with the project artist that the design concept should concentrate on one of the primary corridors in the main hospital block. This corridor leads to an ‘atrium’ with access to wards 5, 6, 7, 8, 9 & 10 (occupied mainly by elderly patients, many of whom suffer from dementia). The hospital shop is located in this corridor and part of the corridor has a seating area that looks onto the internal courtyard.
The decision to focus on this corridor was made for a number of reasons, these were:
The poor design of the current corridor (this is explained with reference to research detailed below).
The importance of the corridor both in terms of users (patients, visitors and staff), and its central location within the hospital.
The ‘stability’ of this area (especially in relation to other areas of the site) i.e. although the overall number of patients in the wards at the end of this corridor are likely to reduce, there are no major building/design changes planned.
The ‘significance’ of the environmental change i.e. it is envisaged that the proposed design would be a major improvement on the current environment (especially considering the constraints of the overall project budget).
The ‘intervention’
The approach adopted by the artist was to remove what is largely ‘institutional’ about the corridor and to imbue the space with a sense of the natural world. To bring a sense of nature and outdoors into this very public interior space at a point where the courtyard garden can be viewed and accessed.
The intervention is intended to create a psychologically subtle sense of the natural world through colour, light and shadow rather than a direct representation of the natural world. This will adapt and enhance what is already there rather than attempt to radically change the structure of the space. In this respect the proposal will utilise the existing architecture, integrating the work directly into the building, changing the environment fundamentally. The key points of the intervention are listed below however, it is important to stress that these are conceived of to work in an integrated and complimentary way; they are listed as separate elements only for the purpose of description:
To change the colouring of the ceiling tiles
To change the colour of the walls
To replace much of the glass
To plant five trees outside the space
To replace the existing floor covering
To introduce two structures to alter the rigid perspective of the space
To introduce timber elements to act as seating
To install two site specific artworks into the architecture
Research methodology
In order to have confidence that the redesign of the corridor has made a significant change, it is essential that a scientific evaluation is carried out i.e. one that is systematic, objective, empirical and verifiable. To achieve this aim, the approach adopted combined two data collection tools. These were an objective measure (behavioural mapping) and a subjective measure (a survey tool comprising a specifically designed questionnaire); information on these tools is provided in section 'Behaviour in the corridor'
Participants
As indicated earlier, the patients in the wards accessed by this corridor are primarily elderly patients (many of whom suffer from dementia); these patients are often associated with decrements in sensory and cognitive processes as well as general mobility. The current corridor design at Dykebar is particularly poor for these patients for a number of reasons, including: long length, absence of rest areas and support aids, glare from surfaces, lack of orientation aids, absence of recognisable features, etc. Since wards 5 and 6 are locked wards, the decision was made to focus on patients in wards 7, 8 and 9/10.
Patients were required to complete a 3 page questionnaire; this was done along with the assistance of a member of the nursing team. Hospital staff were also asked to complete a 5 page questionnaire and the only criteria for inclusion being that they were familiar with the hospital corridor under investigation.
Data collection tools
As mentioned earlier the evaluation utilised a questionnaire and a technique know as behavioural mapping. For the ‘pre-intervention’ phase, data was collected approximately one month before any redesign work took place in the corridor (June/July 2005). For the ‘post-intervention’ phase, behavioural mapping was carried out in March 2006 and the questionnaires were administered in May/June 2006
The questionnaire
Initially three questionnaires were developed for the study i.e. one each for patients, visitors and staff. However, since there were so few visitor questionnaires completed (due to the low number of actual visitors), only the data relating to the patient and staff questionnaires is reported here. The questionnaires were completed before any redesign work had been carried out on the corridor and again once the redesign work had been completed.
The patient questionnaire collected general information on gender, age, length of time as a patient at Dykebar and how often the patients received visitors. The questionnaire focused on how often patients used areas of the hospital connected to the corridor, who patients spent time with in these areas and their perceptions of the corridor and garden courtyard area. Since the project relating to the garden courtyard had not been initiated by the time of this report, the subsequent data analysis will only focus on questions relating to the corridor.
The staff questionnaire collected general information on gender, age, length of time as a member of staff at Dykebar and how job position title. The questionnaire focused on staff perceptions of the importance and impact of the overall hospital environment, their perceptions of the corridor and garden courtyard area and their usage of the garden courtyard. Again, the subsequent data analysis will only focus on questions relating to the corridor.
Findings
Behavioural Mapping data
Use of the corridor
Table 1 shows the mean number of people in the corridor at each of the three observation periods before and after the corridor was redesigned.
Table 1: Mean number of people in the corridor for each observation period, pre and post intervention
|
|
Sunday (pm)
|
Monday (am)
|
Thursday (pm)
|
Total
|
|
Pre-intervention
|
2.52
|
3.33
|
2.26
|
2.70
|
|
Post-intervention
|
2.82
|
3.56
|
2.08
|
2.82
|
|
Total
|
2.67
|
3.45
|
2.76
|
|
Although there was a slight increase in the number of people in the corridor after it had been redesigned (from 2.70 to 2.82), this change was not significant.
When the users of the corridor were broken down into category i.e. patients, staff and visitors, the results showed that again indicated that there was no significant change in the number of people in the corridor. The redesigned corridor did not result in more patients or staff or visitors using this space.
Behaviour in the corridor
A key aim of the corridor redesign was to increase ‘positive’ behaviours in the patients and also to reduce ‘negative’ behaviours. The actual number of times that a patient was recorded engaging in certain types of behaviour (pre and post-intervention) is shown in figure 1.
Figure 1: Number of observations of patients’ behaviour pre and post-intervention
For two of the three ‘positive’ behaviours there was a slight increase in the number of times that patients were observed engaging in this behaviour (walking and talking). The increase in talking was significant. For the ‘negative’ behaviour (stereotypy), there was a small but non-significant decrease.
One final area of analysis looked where people were in the corridor i.e. what areas of the corridor were most used. The results from this analysis showed that there was a significant increase in the number of people observed in areas 2 and 4 post-intervention. One effect of redesigning the corridor was that people were likely to be found in the area directly in front of the hospital shop (area 2) and the area from the hospital shop down to the atrium area that lead to the wards (area 4).
Questionnaire data
The data from the two questionnaires (i.e. the patient and staff versions) were analysed separately.
Patients
This section begins with some descriptive statistics before moving on to more detailed analyses.
Descriptive statistics
100 patients in total completed a questionnaire. These were:
• 53 pre-intervention and 47 post intervention
• 42 from ward 7, 30 from ward 8 and 27 from wards 9/10
• 72 males and 27 females (1 patient did not provide this information)
• Pre-intervention (20 males from ward 7, 17 males from ward 8 and 16 females from ward 9/10).
• Post-intervention (22 males from ward 7, 13 males from ward 8 and 11 females from ward 9/10)
This information is summarised in table 2
Table 2: number of patients that completed a questionnaire based on ward, gender and data collection phase.
Table3: Number of visitors that patients’ received pre and post-intervention
Areas of the hospital used by patients
Tables 4-8 show how often patients use certain areas of the hospital pre and post-intervention
Table 4: How often patients’ went to the hospital shop pre and post-intervention
Non-significant result
Table 5: How often patients’ went to the entertainment hall pre and post-intervention
Non-significant result
Table 6: How often patients’ went to the garden courtyard pre and post-intervention
Non-significant result
Table 7: How often patients’ went to the corridor sitting area pre and post-intervention
Non-significant result
Table 8: How often patients’ went to the atrium area in the corridor pre and post-intervention
Non-significant result
Overall, these results indicate that there is no change in how often patients went to these areas of the hospital before and after the corridor was redesigned.
Who do patients spend time with in different areas of the hospital?
Tables 9-13 indicate who patients’ were most likely to spend time with when they went to different areas of the hospital that were connected to the corridor.
Table 9: How do patients’ spend time with when they go to the hospital shop pre and post-intervention.
This table indicates that in the redesigned corridor, patients are significantly more likely to visit the hospital shop with a member of staff and a visitor and less likely to go alone.
Table 10: How do patients’ spend time with when they go to the entertainment hall pre and post-intervention.
This table indicates that in the redesigned corridor, patients are significantly more likely to visit the entertainment hall with amember of staff and are less likely to go alone.
Table 11: How do patients’ spend time with when they go to the garden courtyard area pre and post-intervention.
This table indicates that there is no change in who patients’ are likely to be with when they visit the garden courtyard in the redesigned corridor.
Table 12: How do patients’ spend time with when they go to the corridor sitting area pre and post-intervention.
This table indicates that there is no change in who patients’ are likely to be with when they visit the corridor sitting area in the redesigned corridor.
Table 13: How do patients’ spend time with when they go to the atrium area in the corridor pre and post-intervention.
This table indicates that there is no change in who patients’ are likely to be with when they visit the atrium area in the redesigned corridor.
Patients’ perception of the hospital corridor
Questions 15 to 24 of the questionnaire asked patients to rate certain aspects of the corridor. The even numbered questions were phrased in a positive way and the odd numbered questions were phrased in a negative way. However, for the purposes of this analysis, the answers to the odd numbered questions have been reversed. This means that for all questions a positive rating indicates a positive perception of this aspect of the corridor and vice versa.
Corridor aspect
Q15. The main corridor is unpleasant
Q16. The corridor is clean
Q17. The corridor it too quiet
Q18. The corridor is welcoming
Q19. The corridor is too long
Q20. The corridor is interesting
Q21. I do not like spending time in the corridor
Q22. The overall appearance of the corridor makes me feel good
Q23. The corridor is in poor condition
Q24. The corridor is bright and airy
The average rating of these different aspects of the corridor (pre and post-intervention) is shown in table 14. The highest rating any aspect could achieve is +2 and the lowest rating was -2. A rating close to zero indicates a neutral position.
Table 14: Mean ratings by patients of specific aspect of the corridor pre and post-intervention
|
|
Mean Rating
|
|
Corridor
aspect
|
Pre-intervention
|
Post-intervention
|
|
Q15. Pleasant
|
-0.04
|
+0.05
|
|
Q16. Clean*
|
+0.29
|
+0.73
|
|
Q17. Quiet*
|
+0.53
|
-0.18
|
|
Q18. Welcoming
|
-0.04
|
+0.33
|
|
Q19. Length
|
-0.08
|
-0.14
|
|
Q20. Interesting
|
-0.57
|
-0.35
|
|
Q21. Like spending
time there
|
-0.16
|
-0.23
|
|
Q22. Makes me feel good*
|
-0.45
|
+0.04
|
|
Q23. Condition
|
+0.04
|
+0.30
|
|
Q24. Bright and airy
|
-0.06
|
+0.11
|
|
Overall
|
-0.67
|
+0.71
|
The only significant differences were for questions 16, 17
and 22. This indicates that patients were more likely to rate the redesigned
corridor as being cleaner, quieter and more likely to make them feel good
compared with the corridor before it was redesigned.
Staff
The average rating of the ten different aspects of the
corridor (pre and post-intervention) is shown in table 15. The highest rating
any aspect could achieve is +2 and the lowest rating was -2. A rating close to
zero indicates a neutral position.
Table 15: Mean ratings by staff of specific aspect of the
corridor pre and post-intervention.
|
|
Mean Rating
|
|
Corridor
aspect
|
Pre-intervention
|
Post-intervention
|
|
Q9. Pleasant
|
-0.43
|
-0.91
|
|
Q10. Clean
|
+0.31
|
+0.62
|
|
Q11. Quiet
|
+0.33
|
-0.11
|
|
Q12. Welcoming
|
-0.63
|
-0.71
|
|
Q13. Length
|
-0.11
|
-0.38
|
|
Q14. Interesting
|
-0.45
|
-0.75
|
|
Q15. Like spending
time there
|
-0.43
|
-0.65
|
|
Q16. Makes me feel good
|
-0.69
|
-1.14
|
|
Q17. Condition
|
-0.14
|
+0.14
|
|
Q18. Bright and airy*
|
-0.07
|
-1.00
|
|
Overall
|
-0.24
|
-0.51
|
The only significant difference was for question 18. This indicates that staff were more likely to rate the redesigned corridor as less bright and airy compared with the corridor before it was redesigned.
Conclusions
The impact of the redesigned corridor can be summarised below:
• Based on the observational data it can be seen that although there is no overall increase in the number of patients using the corridor, those that do use the corridor, are more likely to spend time walking and talking in the redesigned corridor.
• Across all types of people in the hospital (staff, patients and visitors), there is more use of the area directly in front of the hospital shop and the area from the hospital shop down to the atrium area that lead to the wards in the redesigned corridor.
• * There is no change in how often patients report going to specific areas of the hospital (connected to the corridor) before and after the corridor was redesigned. However, when visiting the hospital shop and the entertainment hall, patients are less likely to be alone.
• Patients perceived the redesigned corridor as being cleaner, quieter and more likely to make them feel good compared with the corridor before it was redesigned.
• Overall, staff were generally less positive in their perceptions of the redesigned corridor and more specifically they rated the redesigned corridor as less bright and airy.
The author would like to thank the staff at Dykebar hospital in particular the ward managers, for their cooperation and help throughout this project.
Dr Eddie Edgerton is a Lecturer in Psychology in the Psychology Division of the School of Social Sciences at the University of Paisley
