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Applicable Biophilic principles on hospitals retrofitting. The case study of

Turkish public hospitals

Presentation · September 2018

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Saeid Habibi Behnaz Akrami

Universitat Politècnica de Catalunya Istanbul Technical University
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 Behnaz Akrami, Saeid Habibi. Introduction
Technical University of Catalonia (UPC), School of Architecture of Barcelona (ETSAB), Department of The 21st-century world faces great challenges in terms of delivering wellbeing and healthcare to an increasing and ever-
Architectural Technology, Av. Diagonal 649, 08028 Barcelona, Spain. 34 632 294 304, changing patient demographic. Obviously, there is undeniable evidence which validates how therapeutic as well as
healing environments can help renovate the body physically, mentally and emotionally [1]. In other words, the concept of
[email protected]; [email protected];
therapeutic environment as it relates to human body, the built environment and sustainability including an investigation
of Biophilic design as a possible framework. As Rachel Armstrong stated that “The only way to make truly sustainable

APPLICABLE BIOPHILIC PRINCIPLES ON HOSPITALS RETROFITTING. architecture is to connect our buildings to nature - not insulate them from it”. In fact, therapeutic approaches to
sustainable architecture, reveals that the healthcare spaces designing has actually entered an era of

THE CASE STUDY OF TURKISH PUBLIC HOSPITALS. radical as well as fundamental transformation which it is crucial to incorporate nature within architecture [2]. Also, the
healing power of nature in the clinical context of a hospital was a turning point for the design industry. As a consequent,
Summary the human appreciation for the physical beauty of the natural world is often requested as evidence of Biophilia. Biophilia
On average, people spend ninety percent of their time in artificial built spaces. In addition to homes, this includes offices, is the processes of human inclination to affiliate with nature and natural systems and processes, in particular, life and life-
medical facilities, educational and retail spaces. Recently, reports are showing that this issue is brought several social and like features of the nonhuman environment [3]. According to biologist Wilson [4], humans are biologically interconnected
environmental sustainability challenges due to the lack of connection between user and natural environments in these with nature physically, psychologically, and spiritually which mostly could be seen in healthcare applications to enhance
spaces. Several movements and organizations have been developed in order to promote the isolated relationship of human emotional and physical wellness. Especially, biophilia-based design has a vital impact on successful patient treatment,
and nature in built environments specifically health care's architectural spaces. emerged in recent years. Nowadays recovery and ultimate outcomes in hospitals and clinics which are high-stress environments for patients, visitors and
architectures of health care services by integrating architectural spaces with nature, in any possible way, have succeeded to families, and healthcare professionals alike. Furthermore, integrating nature into healthcare facilities has abundant
improve a large part of sustainability problems from following the bionic principles to generating healthy, productive and benefits on reducing respiration, blood pressure and heart rate and importantly, stress reduction, cognitive performance,
therapeutic spaces. emotion and mood preference on patients and healthcare givers [5].
Accordingly, this research project by focusing on built health centers and surveying and analyzing their social problems, as a
novel project, will present bionic-based retrofitting solutions. One possibility is applying Biophilic principles. Biophilic is an In brief, biophilia hypothesis are important for two reasons: firstly, biophilic elements have real, measurable benefits
innovative and growing design method of architectural spaces within which we live, work, learn, and heal up. relative to such human performance such as productivity, stress reduction, emotional well-being, learning and healing
which connect us to the physical, psychological, and cognitive benefits derived from direct experiences with nature.
Methodology These natural attributes bring back life to build environment through the use of design strategies and materials. Secondly,
Specifically this research project explores the novel ideas in favor of revitalizing built public health centers incorporating from an environmental standpoint, biophilic features foster an appreciation of nature, which in turn, should lead to
Biophilic design patterns. This poster presents the part of an executive research project and will consist in: greater protection of natural areas as well as efforts to eliminate pollution and maintain a clean environment [6]. In
1. Results of carried out surveys on evaluating satisfaction levels in 3 Turkish public hospitals architectural spaces Being conclusion, designing and building sustainable healthcare facilities with high standards in order to incorporation with
thermal, visual, lighting and acoustic comfort levels. Table 1 & Figure 1. nature in the build-up medical facilities in order to reduce patient suffering and enhancing treatment through the notion
2. presenting applicable solutions of biophilic 14 patterns in healthcare centers and their outcomes. of biophilia is the main goal of the research. This will support and guide architects to consider vital elements in their
3. Presenting Biophilic-based retrofitting solutions and strategies for healthcare centers. design such as, meeting the psychological needs of patients and specifically long-term patients.
4. an introduction of two outstanding projects which have been composed by Biophilic principles.
5. Present new MCDM based Spanish MIVES assessment tool in order to assess and evaluate the sustainability of each
alternative.

Table 2. Biophilic Design Patterns and their Health Impacts 4. ALTERNATIVES The future step is applying this new tool in order to determine the
1. SURVEY AND RESULTS
In the first stage, we selected 3 health centers in urban areas Patterns Cognitive Functioning Psychological Physiological Two hospitals were selected as a case study. The first one is the most most sustainable biphilic-base hospital for this case study. This
Health Health and first biophilic hospital in Asia, ‘Khoo Teck Puat Hospital (KTPH) and application included a sensitive analysis in order to prove this new tool
of Istanbul and Ankara by interviewing patients who were Visual Improved material Positively Lowered blood the second one is the newest and modern hospital in Istanbul, Turkey, robustness. After evaluating and assessing, the project will develope
about to go home after examination. The questionnaire Connection engagement impacted attitude pressure and heart
Altunizade Acibadem Hospital. Both qualitative and quantitative
with Nature and happiness rate an initial prototypes and designs and evaluate again their sustainability
consisted of demographic data rating scale of 10 items Non-Visual Postively impacted on Postively Reduced systolic methods were used. The methodological framework is about analyzing by studying their future installation in a real cases in Turkey.
measuring the satisfaction of outpatients. Connection cognitive performance impacted on blood pressure and hospitals through WELL Features that parallel 14 patterns of biophilic We defined the specialized MIVES tool to assess the previously
The studied hospitals are: a) Cerrahpasa public hospital ,b) with Nature cognitive stress hormones design. mentioned 2 alternatives. The MIVES have been defined by
performance
Zakai Tahir Hospital, c) Sisli Etfal Hospital. Non- Observed and Positively impacted P1. Visual Connection Rooftop Gardens, multidisciplinary experts which are followed three phases:a) determine
Rhythmic quantified behavioural on heart rate and with Nature Moderate visual access of outdoor vistas from the indoor especially the basic tree of sustainability requirements for the decision model
Sensory measures of attention systolic blood patient rooms. composed by the most important requirements, criteria and indicators
Stimuli and exploration pressure and Properly landscape with indigenous materials, But not well planned
Satisfied Dissatisfied landscaping and vegetation. for the case study, both quantitative and qualitative; b) calibrate the
nervous system
activity
No adequate provision of therapeutic gardens. value functions that will unify the scales and units of each indicator to
variable N Number % Number % P P5. Presence of No available water features.
Thermal & Positively impacted İmproved Positively impacted a 0 to 1 satisfaction value; c) assign the weight for each tree
water
Gender 0.144 Airflow concentration perception of comfort, well-being |P6| Dynamic & Color tuning lighting that produces white light during the day, and
requirements component. These experts assigned weights using
Variability temporal and and productivity Diffuse Light minimizes blue light at night. Analytic Hierarchy Process (AHP) [10] or direct assignation.
Male 182 120 65.9 62 34.1 spatial pleasure Day light preserving window treatments.
The Table 6 is showing the defined requirements tree.
Presence of improved Observed Reduced stress, Daylight from multiple angles.
Female 392 282 71.9 110 110 Water concentartion and preferences and increased feeling of Direct sunlight
Requirements C# Criteria I# Indicators
Ambient diffuse lighting on walls and ceiling.
memory resoration. positive tranquility,lower R1 Economic C1 Cost I1 Production & installation cost
Differing orientation of windows create variability in light.
Age group 0.003 Enhanced perception emotional heart rate and R2 Environmental C2 Fabrication I2 Energy consumption
|P7| Connection Natural patina of materials
and psychological response blood pressure with Natural Systems Simulated daylight systems that transition with diurnal cycles
I3 Embodied Carbon
18-39 334 236 70.7 98 29.3 response C3 Use & I4 Energy consumption
Wall decal, paint style or texture
Dynamic & Positively impacted Artwork depicting nature scenes such as Istanbul views maintenance I5 Embodied Carbon
40-59 172 108 62.8 64 37.2 Diffuse Light circadian |P8| Biomorphic Absence of botanical motifs within the interior spaces I6 Reliability
finctioning Forms & Patterns Arrangement of the structural system Acoustic paneling, wall or ceiling C4 End of life I7 Solid waste
60 and over 68 58 85.3 10 14.7 Furniture form I8 Recyclability
increased visual
Presence of botanical interior motifs. R3 Social C5 User comfort I9 Thermal comfort
comfort
Marital status 0.156 |P9| Material sufficient use of sustainable building materials. I10 Acoustic comfort
Connection Enhanced positive Extensive use of wooden finishes.
Connection with I11 Dynamic & Diffuse Light
Single 100 64 64 36 36 with Natural health responses Nature Using natural color palette
Systems shifted perception I12 Visual Connection with Nature
Warm color
of environment |P11| Prospect Using transparent materials
I13 User safety added value
Married 442 312 70.6 130 29.4
Biomorphic Observed view Proper orientation of fenestration & building to optimize visual access C6 flexibility I14 Biomorphic Forms & Patterns
Forms & preference to outdoor vistas. I15 Material Connection with Nature
Divorced 32 26 81.3 6 18.8
|P12| Refuge Differing orientation of large operable of windows creates change in I16 Connection with Natural Systems
Patterns
Material Reduced diastolic light levels and provides a sense of refuge. Table 6. requirements tree to assess the biophilic hospitals and assigned
Educational level 0.034
Spaces reserved for reflection, meditation, rest, relaxation, reading, or
Connection blood pressure weights.
complex cognitive tasks
Illiterate 68 56 82.4 12 17.6 with Nature |P13| Mystery Using sharp corner edges within the interior spaces.
Complexity & Observed view Positively impacted Winding paths interior spaces As a consequence, the result obtained from two case studies will be
Primary school 258 182 70.5 76 29.5 Order perceptual and |P14| Risk/Peril no available peril features
preference physiological stress done in next steps. This section will deals with the biophilic design
Secondary and over 248 164 66.1 84 33.9 responses Table 4. Case Study 1. Oncology Department, Altunizade Acibadem Hospital, analysis to find out the reflection of patterns under study and seeking
Istanbul, Turkey
Prospect Reduced boredom, Improved comfort Reduced stress to implement the basic conditions necessary to achieve the WELL
total 574 402 70 172 30 irritation, fatigue and perceived Certification.
safety |P1| Visual Provision of therapeutic gardens.
Table 1. The satisfaction percentage of outpatients with health centers. Refuge İmproved Connection with Establish 140 fruit trees in one of rooftops
concentration,attentio Nature  Patient-oriented gardens and terrace gardens at ICU CONCLUSION
n and perception of Rooftop Gardens, ‘Biophilia’ was initially used to characterize a psychological orientation.
environmentally-friendly landscape features
safety
water features with aquatic species and plants that attract birds and
Consequently, Biophilic design emerged as a design approach and
Examination time Mystery Induced strong butterflies developed creating a natural-based setting or where the built
pleasure response |P5| Presence Use of cascading waterfall and bio ponds.
Risk/Peril Induced strong
environment is restricted from interfering with natural elements. This
Transport of water Linear water garden.
pleasure response Marshland and floating wetland in the pond paper supports assessable, positive influences of biophilic design on
General comfort
Fountain and aquarium health, reinforcing the pragmatic evidence of human nature connection
3. BIOPHILIC ARCHITECTURE RESPONSE STRATEGIES Views to natural Yishun pond and increases its importance level within both design research and
|P6| Dynamic & Access natural lighting
Solution of health problem Biophilic design can be organized into three categories as follows: Diffuse Light Used facades designed with Low-E glass to enhance daylight, reduce solar design practice. It also, helps to close the gap between current research
Nature in the Space, Natural Analogues, and Nature of the Space by gain and patient discomfort. and implementation by exploring how biophilic design patterns were
Waiting time the means of providing a framework for understanding and enabling Light shelves bring daylight into the interior, reduce glare. used in improving the biological responses of patients. Broadly, with
Differing orientation of windows creates variability in light.
thoughtful incorporation of a rich diversity of strategies into the built Polished ceramic and wooden finishes enhance light reflection. 90% of our time estimated to be spent indoors, buildings have an
Listening to patient by physician environment. An analysis of existing works on biophilic design and |P7| Using natural patina of wood, stone, glass undeniably profound impact on the health, happiness, and well-being
collecting the all data in the ‘14 Patterns of Biophilic Design’ book Connection Visual connection surrounding landscape environment, which dramatically of its occupants.
Information given by physician with Natural changes in appearance
showed that the fourteen biophilic patterns are integrated into built Systems
General satisfaction with services environment using various strategies as shown in Table 3. |P8| Presence of botanical interior motifs. REFERENCES
Biomorphic Low reflection on organic shapes and forms. 1. R. Muzarch, “Salutogenic and Biophilic Design as Therapeutic Approaches to
Biophilic Patterns Biophilic design strategies in Architecture Forms & Using carpet wallpapers in floor Sustainable Architecture.”, Architectural Design Journal, vol. 87, p47, March/April
Physicians' professional adequacy
Patterns Accosting paneling 2017.
-Provision of varied landscaping and vegetation |P9| Material Using of sustainable materials. 2. R. Guenther, “Transforming Hospitals”, Architectural Design Journal, vol. 87,
0 20 40 60 80 100 ‘Nature in the Space’ -Unrestricted views of nature and vistas from the Connection Recyclable materials.
p129, March/April 2017
1.Visual Connection with interior with Nature Use of wooden finishes and glass
PERCENTAGE SATISFIED Use of warm shade of green as paint for sensory stimulations. 3. S. J. Kellert, J. H. Heerwagen, & M. Mador, “Biophilic design: The theory, science
Nature -Provision of healing gardens
|P11| Prospect Locating stairwells with glass façade and interior walls to enhance prospect and practice of bringing building to life”. New Jersey: John Willet & Sons Inc. p.
2.Non-Visual Connection -Access to nature sound over urban sounds
Proper orientation of fenestration & building to optimize visual access to 2008.
with Nature -Integration of natural ventilation and presence of
outdoor vistas. 4. E.O. Wilson,” Biophilia: The Human Bond with Other Species.” Cambridge:
The results are showing low satisfaction level of users from water Designed to blend with the existing pond.
3.Non-Rhythmic Sensory -Use of warm colors for sensory stimulations Harvard University Press. 1984.
|P12| Refuge Differing orientation of large operable of windows creates change in light
hospitals transportation issues and architectural spaces. The Stimuli -Provision of indoor landscape that will attract birds levels and provides a sense of refuge.
5. R. Ulrich, “Biophilic theory and research for healthcare design.” In Kellert et al,
low quality of architectural spaces directly effects users and butterfly |P13| Mystery Low maintenance gardens with winding path. Biophilic Design. 2008.
4.Thermal & Airflow -Design with respect to sun and wind orientation Sharp corner edges within interiors spaces. 6. Browning, W.D., Ryan, C., Clancy, J. 2014. 14 Patterns of Biophilic Design,
general comfort being low thermal, visual, lighting and Variability -Placement of windows to allow natural ventilation |P14| Risk/Peril Double height atrium with balcony Improving Health & Well-Being in the Built Environment. New York: Terrapin Bright
acoustic comfort levels. 5.Presence of Water Use of water as a landscape element Façade with floor to ceiling transparency Green.
Passing under, over or through water 7. Alarcon, B. et al. (2011) ‘A value function for assessing sustainability: Application
As previously stated, nowadays the 14 patterns of biophilic 6.Dynamic & Diffuse Light -Placement of windows to capture dynamic and to industrial buildings’, Sustainability, 3(1), pp. 35–50. doi: 10.3390/su3010035.
designs can helps a lot for optimizing users comforts in all diffuse light within the interior of the building. Table 5. Case Study 2. Khoo Tech Puat Hospital, Yishun, Singapore (KTPH). 8. Büyüközkan, G. and Karabulut, Y. (2018) ‘Sustainability performance evaluation:
-Use of reflective surface to enhance lighting and
architectural spaces. specially in health care centers. mitigates glare.
Literature review and future directions’, Journal of Environmental Management,
Some of these instructions which are effects users 7.Connection with -Provision of visual connection to existing natural
The Khoo Teck Puat Hospital (KTPH) in Singapor and the modern 217, pp. 253–267. doi: 10.1016/j.jenvman.2018.03.064.
Altunizade Acibadem Hospital of Istanbul have been selected using 9. Meiboudi, H. et al. (2015) ‘Creating an integrative assessment system for green
comfortableness are in following. Natural Systems system within the site.
General Morphological Analysis (GMA) and their total sustainability will schools in Iran’, Journal of Cleaner Production. Elsevier Ltd, 119, pp. 236–246. doi:
‘Natural Analogues’ -Use of botanical interior motifs 10.1016/j.jclepro.2016.02.004.
8. Biomorphic forms & -Applications of organic shapes in building be evaluated by applying WELL building standards and a new 10. Saaty, T. (1990) ‘How to make a decision: The analytic hierarchy process’,
patterns exterior sustainability assessment tool using the Spanish Integrated Value European Journal of Operational Research, (48), pp. 9–26.
2. 14 BIOPHILIC DESIGN PATTERNS 9. Material connection Use of sustainable building materials. Model for Sustainability Assessment (MIVES) that was designed during 11. Pons, O. la Fuente, A. Aguado, A. (2016) The Use of MIVES as a Sustainability
Biophilic design is the designing for people as a biological with nature -Use of natural color pallet like green within the sessions with experts. This new tool design and calibration was based Assessment MCDM Method for Architecture and Civil Engineering Applications.
interior spaces
organism, respecting the mind-body systems as indicators of on the aforementioned defined case study, sample and problem. MIVES Article in Sustainability · May 2016. DOI: 10.3390/su8050460
10. Complexity & Order -Complex architectural expression and landscape
health and well-being in the context of what is locally planning. is a Multi-Criteria Decision Making (MCDM) method that incorporates
appropriate and responsive. The table below Table 2. ‘Nature of the Space’ -Orienting building, fenestration or corridor to the value function concept in order to define specialized holistic
11. Prospect optimize visual access to outdoor vistas sustainability evaluation tools to obtain global and partial satisfaction
represents the relationship between biophilic design patterns -Designing around existing or planned savannah-like
indexes [7].
and mind-body impacts. This influence of biophilic design on ecosystem.
12. Refuge Change in light levels within the interior. Compared to other interesting MCDM for Architecture and Civil
human body produces the proper response to the Engineering [8] and schools specifically [9] MIVES has those particular
13. Mystery -provision of low maintenance garden with winding
physiological and psychological needs of patients. path characteristics [11] that made it the best method from which to
-Preference of curve edges than sharp corners within develop a tool for this case study.
the interior spaces
14. Risk/Peril

Table 3. Biophilic Architecture response strategies

20-22 September 2018
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