The intensive care unit of the future - speedier recovery through feel good architecture

Interview with Prof Claudia Spies, Directress of the Berlin Charité Clinic for Anesthesiology

The rooms in German intensive care units are cold and dreary. Hectic movements determine the patient’s everyday life along with noisy surveillance systems. Artificial light often also promotes a disturbed circadian rhythm. Sleeping pills are meant to solve this problem, but they also increase the risk of delirium at the same time.


Photo: Woman with glasses and long red hair - Prof. Claudia Spies; Copyright: Charité Berlin

Prof. Claudia Spies; ©Charité Berlin

This is why Prof. Claudia Spies of the Berlin Charité Clinic for Anesthesiology has launched a pilot project, which matches the design of intensive care rooms with the needs of the patients. In this interview with, she explains why the ambience has a positive impact on the healing process and the prescription of painkillers.

Prof. Spies, what was the deciding factor that inspired you for this pilot project?

Prof. Claudia Spies: Over the past few years, we noticed that patients in intensive care units definitely benefit from being able to participate in the healing process in an alert and cooperative state. When they do this, the perception of the intensive care unit inevitably changes compared to patients that are kept in a medically induced coma. One patient, who counted the holes in the ceiling because he was bored, gave the most concise example. There were several thousand holes.

This is why we decided we needed to do something. Over the past few years, nursing in particular has thought a lot about this issue and created mobile phones with photos and images for patients for instance, so they were able to maintain social contact. A lot happened in this regard, but we never had the chance to explicitly change anything in terms of architectural design.

We subsequently received a grant from the German Federal Ministry for Economics and Technology (German: Bundesministerium für Wirtschaft und Technologie). Together with an architectural firm, a designer and another company we have created a unique project. Our main question was how much you can improve the environment from the patient’s point of view without restricting the safety related requirements. A fusion between hospital architecture and feel-good design was the outcome.

What changes were made inside the patient rooms?

Spies: We have furnished the rooms so they look like a comfortable living room. The furnishings primarily have a wooden design. The surfaces are nevertheless hygienic. The monitors were concealed so that the sound level is automatically reduced. Several devices were also taken to a central monitoring area in front of the patient room. This significantly reduces background noise. For an immediate effect, the materials to treat the patients can be replenished from the outside and simply pushed into the room.

Above all, we changed the ceiling design by finding a way to project different settings onto the ceiling. By regulating the light, six LED layers provide the chance to represent the time of day to maintain the patient’s sense of time. During the day, there are sun and clouds and at night, you can see the stars. The natural light that we normally need to hinder melatonin is being simulated. In doing so, the body can suppress melatonin during the day and patients are able to sleep better at night. You can also display different colors on the ceiling. Patients then lie under a kind of leafy canopy just like in a protected butterfly cocoon. This has a calming effect – especially if they are scared or in pain. Earlier studies have shown that when you look at a green surface or trees you need fewer pain relievers.

We also created a chance for interaction where the patient can use the ceiling as a kind of monitor. This needs to be seen as an interaction measure. The cognitive abilities of the patient are meant to be increased. They exercise those playfully using different elements. The elements at the ceiling can be moved at will with a tablet PC for instance. The goal of this interaction is for people to participate in life again.
Photo: Newly designed ICU room; Copyright: Tobias Hain/graftlab

The green screening does not only contribute to the well-being of the patient. It also regulates the circadian rhythm. The supervision room is located outside in the background; ©Tobias Hain/ graftlab

How do these architectural changes affect the organisms and the healing phase for patients?

Spies: We notice that both caregivers and patients appreciate the feeling of lying in a separate room even though there are two people in one room. Privacy is being protected. Patients feel like they are not being watched as much and don’t feel quite as powerless. What’s more, they are more actively participating in their own recovery. They are mobile much sooner and are more often sitting up in bed or next to it. We also think that dementia or delirium is significantly less common or rather less pronounced. Another factor is that patients need less pain relievers. They need and want less. Whether this really proves true, remains to be seen.

Are there additional expenditures for medical experts and nursing staff due to changed work processes?

Spies: The work processes are different in some ways, but they have not increased or decreased in their volume. However, interaction with patients and family members has changed because of it. There are other ways of communicating from the existing means. Face-to-face contact promotes the self-healing process and reduces stressful situations. This is a complete change in terms of operational procedures. This requires more interpersonal relations, which is also something the nursing staff views as something very positive.

Keyword cost factor: How ready is this intensive care unit patient room to go into series production?

Spies: Our goal is to make these rooms suitable for series production. There are no higher costs for new construction, although reconstruction is somewhat more expensive. It would be desirable for many hospitals to adopt the concept. There have already been meetings with different members of the board of other facilities here at the Charité, who have inspected the rooms. Architects have also been on location. We hope that general hospital design ultimately gets stimulated by this project, which leads to improvement not just in the intensive care unit, but also in many other hospital areas. There is still a big need for adjustment.
Foto: Melanie Günther; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Melanie Günther and translated from German by Elena O'Meara.