Biophilic Design for Dialysis Clinics

May 2021 - May 2022 | Master’s Thesis | Advised by: Professor Vivian Loftness

The purpose of this Master’s thesis is to examine the impact of biophilic design strategies in dialysis clinics on patient health outcomes. Biophilia is a concept that humans have an innate tendency to connect ourselves with nature. Ongoing research has found that the integration of biophilia into the built environment can positively impact occupant health and well-being. Thus, the results of this study will be used to help architects and healthcare facility stakeholders make informed design decisions that will have a significant positive impact on patient health outcomes.

Hypothesis 1: The integration of biophilic design into the physical environment of outpatient clinics, such as dialysis clinics, has a significant impact on patient health outcomes.

Hypothesis 2: There are ranges of biophilic design that can be prioritised along a scalar, of which higher intensity biophilic investments will have better patient outcomes.

Methodology: Mixed-Methods (Literature review, online survey, statistical analysis, case study)

About Dialysis:

Kidney damage can be caused by high blood pressure, diabetes, kidney inflammation, kidney cysts, inherited disease, etc. When the kidneys are damaged, the body’s ability to filter and remove waste from the blood becomes impaired. There are five stages of kidney disease, of which the last stage is kidney failure, which is diagnosed as “end-stage renal disease” or ESRD. For people with kidney failure, this leads to a buildup of waste in the blood that can become fatal. Dialysis treatment and/or kidney transplant are the only options for prolonging one’s life.

Before starting dialysis, a minor surgical procedure is done on the arm to allow for easier access to the blood vessels. During dialysis, a needle is inserted into the blood vein to draw blood out to the machine for filtering. The filtering works by allowing smaller waste and toxins to pass through a machine between the washing fluid and the blood. The filtered blood then gets pumped back into the body through another needle. This whole process takes about four hours per session. However, it is not a one-time procedure. Patients must undergo a four-hour dialysis session three times a week for the rest of their lives, unless they are qualified and able to get a kidney transplant. Dialysis takes up almost 10% of the hours in a week. As you can imagine, dialysis requires a huge commitment and can majorly change the lives of people with kidney failure, such as their work, their typical routine, their well-being and more. Undergoing dialysis can impact a patient physically, psychologically, and socially. These can all affect the patient’s health outcomes, particularly their adherence to dialysis treatment sessions. To put this into context, one missed appointment is dangerous, and two consecutive missed appointments can become fatal.

Oftentimes, dialysis clinics are converted from strip malls that are not designed as a patient-centric dialysis clinic. Also, based on CMS (Centers for Medicare & Medicaid Services) regulations, nurses must be able to clearly see the patient’s face from the nurse’s station. This typically results in patients sitting with their backs against the window. Imagine spending 12 hours of your week in some of these spaces.

Online Survey

A survey was developed to ask experts with some association to dialysis clinics (or other outpatient clinics with a similar medical procedure) for their perception of the impact on patient health and well-being given a series of images of biophilic design investments in dialysis clinics around the world.

There are 17 scalars used in the survey: