Ongoing Research Initiatives

With your support, The Academy on Architecture for Health Foundation funded three research grants for the current research cycle. These studies will provide useful and pragmatic information related to ambulatory care work environments, to the integrated project delivery process, as well as international healthcare. We continue to look for opportunities to partner and fund research that will contribute to the healthcare design practice.

Research funded in 2017

  • AuthorsPrinciple Investigator:
    Shan Jiang, Ph.D. (West Virginia University)
    Davis Allison, FAIA, FACHA, Professor and Director (Clemson University
    Andrew Duchowski, Ph.D., Professor (Clemson University)
  • OverviewLarge hospitals are often complex and highly sophisticated environments due to their functional complexity and the way in which they evolve and grow over time. As a result, they typically present excessively institutional environments that can have negative effects on hospital occupants, such as wayfinding difficulties and spatial disorientation. As a core component of any healthcare facility, hospital circulation spaces remain neglected compared to the healthcare design and research in other domains conducted and reported to date. Visual engagement with nature, which has been proven therapeutic, has been hypothesized as playing the roles of wayfinding cues and facilitating spatial cognition in healthcare complexes. However, there is a paucity of empirical studies conducted on this topic, which has resulted in a significant knowledge gap.
    Hypothesis: Having visual access to nature from within hospital circulation spaces serve as identifiable and memorable landmarks and facilitate people’s spatial cognition and wayfinding performances in a diagnostic and treatment health care environment. The design of hospital circulation spaces with transparent connections and views to nature will be examined in relation to people’s spatial orientation and wayfinding performances compared to hospital corridors with no window views. People’s environmental experience of visual engagement with nature and the distribution of visual attention in hospital circulation spaces will be explored. This study will also examine Immersive Virtual Environment (IVE) technologies as complementary methods and tools in healthcare design research.
    In this exploratory, survey-embedded experimental study, 90 volunteers will complete various wayfinding tasks in fully immersive virtual hospital environments. Participants’ eye movements will be tracked and analyzed, and a series of variables will be measured to compare the time consumed to complete the tasks and the route selection. Participants’ navigation strategies will be interviewed through cognitive mapping. Participants will also take surveys to report their sense of direction.
    This study is meaningful and desirable from the greater emphasis on involving user participation in the caregiving and healing process. Study results will be translated to immediate design recommendations intended to help guide the layout of medical compartments, corridors, and courtyards in a complex hospital design, and provide alternative solutions to hospital wayfinding issues.



  • AuthorsPrinciple Investigator:
    Dr. Farhana Ferdous (Howard University)
  • OverviewThe relationship between the physical environment and prevalence of social interaction have been a core topic of inquiry in environmental gerontology. By 2050, it has been estimated that the world will number 2 billion older adults, aged ≥60 years. Among them around 25 million people worldwide have dementia, and the number of people with dementia is predicted to exceed 80 million by 2040. A growing body of literature in the areas of environment-behavior studies shows that the physical environment affects positive behavioral changes, in turn, affecting individual, group and organizational outcomes, but little research has focused on older adults especially those with cognitive impairment by examining the physical environment of care facilities.Based on previous research this study would like to explore in what level and how does the spatial configuration of the built environment in long-term care facilities (LTCF) could influence the physical activity and social interaction among the residents.  By using non-pharmacological interventions, the purpose of this study is to measure the physical environment by analyzing the spatial configuration and layout in long-term care facilities that are believed to initiate physical activities and positive social interaction among dementia residents, staff and use the findings to give evidence-based design guidelines for future research and design of memory care facilities to promote therapeutic experience for people experiencing early to moderate stage dementia. The results of this study will give evidence-based design guidelines that are generalizable regardless of geographic location of the LTCF and will provide designers about the effectiveness or the weaknesses of their design decisions. As an expected outcome, this study will be able to establish that by combining physical activity with social interaction, the environmental design could have a protective effect against dementia.

    1. This study will objectively measure the spatial configuration of LTCF to evaluate the provision of physical activities (among residents) and social interactions (among residents and staff) to promote a healthy living for people experiencing early to moderate stage.


    1. Use findings of the study to inform more robust, multi-level research analysis and evidence- based design guidelines by suggesting alternative spatial layout of the physical environment in LTCF and thereby aimed at improving the therapeutic experience for people experiencing early to moderate stage.


Research funded in 2014

  • Designing Emergency Departments to Provide Efficient, Patient-Centered Care: An Analysis of Split Flow and Sub-Waiting Area Models

  • AuthorsPrinciple Investigator:
    Jennifer Wiler, MD, MBA, FACEP (University of Colorado School of Medicine)
    Co-Primary Investigator: James Lennon
    Negin Houshiarian
    Benjamin Easter
    Mentor: David Vincent
    Consultant: Debajyoti Pati
  • OverviewAs ED crowding has worsened and its deleterious effects catalogued, ED managers have sought numerous process improvement methodologies to improve efficiency. Architects have described changes to the physical design of EDs to achieve the same goal. Unfortunately, these efforts have been largely independent of one another, failing to cross the professional boundaries that impede their dissemination and implementation. The present study, conceived by a joint team of architects and emergency physician managers, explores the essential interaction between emergency department (ED) design and flow with a goal to optimize split-flow patient care systems. The results of the study will offer novel opportunities to understand ED split flow models. By studying the interaction of physical design and flow typologies, we emphasize the need for solutions that account for both variables. In contrast to prior, mostly descriptive studies which analyze only a single factor for a given ED, our study will provide broad generalizability by examining nine different flow-design sub-types across 3 different annual census levels.


  • Mental and Behavioral Health Environments: Measurement of Building Performance

  • AuthorsPrinciple Investigator:
    Mardelle McCuskey Shepley, Ph.D., FAIA, FACHA (Cornell University)
    Angela Watson (Shepley Bulfinch Architects)
    Francis Pitts (architecture+)
    Anne Garrity (Shepley Bulfinch Architects)
    Elizabeth Spellman (Shepley Bulfinch Architects)
    Andrea Fronsman (Cornell University)
    Janhawi Kelkar (Cornell University)
  • OverviewApproximately 60% of people with mental health disorders and 90% of those with addiction disorders are not receiving adequate care. New inpatient facilities are being designed in response to the 2010 Patient Protection and Affordable Care Act, which mandates mental health coverage for insurance plans, but research on behavioral health (BH) environments is inadequate to support the design process. This research describes an empirical study on behavioral and mental health facilities. The purpose of the study was four-fold: to develop a tool for the evaluation of mental and behavioral health facilities, to identify design features that are believed to positively impact staff, patients and families in psychiatric environments, to evaluate the quality and presence of these features in existing facilities and to make recommendations for recommended research.

  • Malawi Material Waiting Homes: Measuring the Impact of Holistic Design Approach on Maternal & Infant Health

  • AuthorsCo-Investigators: Michael Murphy and Alan Ricks (MASS Design Group)
  • OverviewThe Safe Motherhood Initiative is seeking to redesign a Maternity Waiting Home, where near-term pregnant mothers can stay in close proximity to a health facility. This study seeks to demonstrate how design can encourage facility-based deliveries and support improvements in maternal and neonatal health outcomes. By measuring the impacts of the redesigned MWH, Malawi hopes to generate evidence that can support the Malawian government as they scale this care model across the country.
  • Preliminary Findings Can design influence user satisfaction and use?
    Adding to the literature of evidence-based design is a recent study funded by AAHF comparing user satisfaction of two maternity waiting homes in Malawi, each with a different architectural design. One home was built following a standard “barracks-like” design developed by the Ministry of Health, and the other a “village” design, developed by MASS Design Group, which responds to user needs by breaking up the sleeping quarters into more intimate spaces, adding toilets and showers, and integrating additional indoor and outdoor common spaces. Use of maternity waiting homes (residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care) are being promoted in developing countries, including Malawi, to provide access to safer facility-based deliveries but, in many cases, are being underutilized. This study sought to empirically show how designing maternity waiting homes to better meet mothers’ needs can influence user satisfaction and encourage their use — thereby increasing medical facility deliveries, and ultimately in reductions in maternal and infant morbidity and mortality.
    In the study, women at both sites were surveyed about their experiences staying at the maternity waiting homes. The “village” design had higher satisfaction ratings for the majority of design factors examined (sleep areas, private storage space, toilet and shower amenities, kitchen facilities, outdoor spaces, air and water quality, building maintenance, thermal comfort, and overall satisfaction) and final models showed that toilets and showers, guardian spaces, safety, building maintenance, sleep areas, and private storage spaces were the most important factors related to overall satisfaction. These findings not only demonstrate that design matters, but also identify where to focus limited resources to improve maternity waiting home design. Due to the study’s pending publication further reporting on results will be shared at a later date.