Have you ever been truly comfortable in a healthcare setting? Few people have, but maybe that is beginning to change thanks to the work of environmental psychologists like Dr. Ann Sloan Devlin at Connecticut College. Dr. Devlin is an expert in the field of evidence-based design (EBD), which emphasizes using credible evidence to influence design decisions that in turn may affect your health. In a recent phone interview, she explains how an environment can affect your well-being, strategies for using EBD to help select a healthcare provider, and more.
|How Does Your Environment Affect Your Well-Being?
With Ann Sloan Devlin, PhD
|Bradley Cannon, Psi Chi Writer
|View this issue in PDF and Digital formats.
Getting to Know Dr. Devlin
More aware of and able to communicate about her environment than most, Dr. Devlin describes her setting with ease. She sits in her home at a desk that was once a part of a bowling alley at Connecticut College. The desk has four 2-drawer black filing cabinets, and is about eight feet long and four feet wide. Surrounded by books, she works on one side of the desk, and her husband works on the other. Beyond this, she is encircled by three and a half walls with prints and posters of places that she has been and things that she loves. Outside, she observes that the snow has almost melted.
Dr. Devlin once thought that she wanted to be a physician, but she jokes that this was before she enrolled in chemistry! After that, she studied environmental psychology with Drs. Stephen and Rachel Kaplan at the University of Michigan. She says, “There was a moment then when I thought to myself, ‘This discipline combines so many things that I am interested in: psychology, architectural studies, and the arts.’ That was the moment when I discovered that you can investigate the role of the environment in human well-being.”
Since then, Dr. Devlin has published extensively on healthcare environments, in particular on the role of a facility’s appearance in people’s judgements of expected care. She currently examines the roles of perceived control, social support, and positive distraction as mediators of stress in healthcare settings, and perceptions of psychotherapists’ offices.
In addition to her academic career, she regularly maintains her talent as a figure skater. She says, “I used to do that seriously when I was young. Even as an older adult, I still skate two or three times a week, and I am still doing double jumps. Skating is my escape from the stresses of day-to-day living. I really enjoy it.”
What Is EBD?
“From a definitional standpoint,” she explains, “EBD is used to provide data or evidence from credible research to make sure that the decisions being made about design have been tied to measurable outcomes and aren’t just based on intuitions, whims, or aesthetics. I think people ordinarily think about EBD in the context of healthcare because that is where it has been most widely applied. But from my point of view, there isn’t any reason why you couldn’t take the same concept and apply it to other facility types such as educational, workplace, and even retail environments.”
When asked if EBD is sometimes overlooked, Dr. Devlin laughs. She says, “I would say that it is frequently overlooked. And I think that the academy is at least partly at fault—if not more than just partly. This is because, as academics, we want to have our research published in high-impact journals but we don’t spend enough time making our research understandable to people who don’t have the same kind of training that we do. I think that leads to a good portion of the research we do not being accessible or understandable to practitioners.”
Dr. Devlin also places part of the blame on design schools that do not put enough emphasis on helping design practitioners understand the fundamentals of this research. She explains, “I’ve been to enough conferences to know that the level of knowledge about basic statistics is sometimes pretty low.” To remedy this, she suggests that design schools, and architectural programs in particular, need to place more emphasis on the importance of research.
“I think awareness is growing,” she says, “and I think it will continue to grow because the premier area for EBD is healthcare, and healthcare is big business. A number of the larger architectural firms like HOK, HKS, Cannon, BBH, and Perkins+Will are beginning to have staff members who are trained as researchers so that they can help the firms evaluate their projects. That is certainly a value added to their clients and will lead to better outcomes.”
Another example that she believes will lead to growth in the field is the recent acquisition of Health Environments Research and Design journal by Sage. “The publisher will give the field more prominence, and I think it is a testament to the fact that people believe this work has a role in helping to inform the quality of the physical environment.”
Effects of the Physical Environment
According to Dr. Devlin, her mentors, Drs. Stephen and Rachel Kaplan, are more interested in the natural environment than the built environment. “But I’ve taken what I learned from them about the role of landscaping and nature as a part of the built environment, so I see myself as taking their foundation and moving it into the built environment, which is where my interests are.”
For example, in another article, Dr. Devlin discussed how taking students to Rome gave her a new perspective on how the layout and size of the environment and proximity to natural elements contrasts with the experience of American architecture. In particular, she noted that she never once had to get in a car when she was in Rome (Ballinger, 2011).
Other cities have also altered her understanding of how the built environment shapes our perceptions. “Most recently, I have conducted research on healthcare environments in Portugal and the United States. Interestingly, participants in the United States talked about what we call a health status whiteboard, which is generally located at the footwall of the room across from the patients’ feet. Healthcare practitioners write patients’ statuses on this board such as when your next physical therapy appointment is or what your last level of indicated pain was. That is what patients like in the United States, but they didn’t have that in Lisbon” (Devlin, Andrade, & Carvalho, 2015).
To explain this discrepancy, she says, “If you think about contrasting the two countries, the United States is much higher on the individualism-collectivism dimension than Portugal is, so being more in control and having information about one’s healthcare status was really important in the United States, although that didn’t emerge at all in Portugal. This is just one example of how the physical environment—in this case, a status whiteboard—can be used to help reveal that kind of information.”
“Lisbon is known literally as the city of light,” Dr. Devlin continues. “When I went there the first time, it became very clear that natural light affects physical settings like healthcare facilities. This really changed my view of how climate plays such a significant role in what is possible in different settings because their window walls were significantly larger in Lisbon than they would be in the northeastern United States.” When Dr. Devlin and her coauthors did research in that setting, the patients talked about the kinds of variables that made a difference in their judgments of their surroundings. Sure enough, natural light and window wall size clearly came through in Lisbon in a way that it didn’t in the United States.
Like Dr. Devlin’s trip to Rome, she also spent a semester with students in Hanoi, Vietnam, through a program called Study Away/Teach Away offered at Connecticut College. In this more temperate climate than the northeastern United States, “the transition between indoors and outdoors is less definite, so I again found examples of how climate and weather play a role in shaping our settings and what is possible and what isn’t from an energy standpoint.”
Applying This Research
So how can patients use their settings to help them select a healthcare provider? According to Dr. Devlin, “If you do an Internet search on a practitioner and all you have available to you is simply that (a) no complaints have been made about this person and (b) the price charged for a particular procedure, it is hard to know how environmental design will play a role in your decision. However, if you make a visit to someone’s office or see photographs of a facility on a website, I think those are moments when the look of a place or the quality of the place communicated through the design can certainly make a difference in people’s judgements.”
“If you ask me how I choose a physician, I choose based on qualification: ‘Where did the person go to school?’ ‘How many years of practice has the person had?’ and ‘How many of the procedures that I might need has the person done?’ There are certainly questions like these that have priority. After that, in my perspective and in my research, the quality of the surroundings is a reflection of the physician. If a physician doesn’t care enough to create a welcoming environment for patients in the reception area and the waiting area, or if a physician’s own office is cluttered with stacks of files and things on the floor, which is less likely to be the case anymore given the move to electronic health records, I think it reflects negatively on the provider.”
This was the case in a series of studies that Dr. Devlin and Dr. Jack Nasar from Ohio State conducted about psychotherapist offices (e.g., Devlin & Nasar, 2012). She says, “In this study, we used 30 photographs of therapists offices from Manhattan, and participants, about 50% of whom had been in therapy at least once, made judgements about the quality of care that they expected to receive in these settings. Then, we essentially did some regression analyses, and we could predict the kinds of settings in which people thought highly of the practitioner. Those settings had a couple of qualities, and one was that they were orderly. The second quality was that they had some degree of personalization so that they were welcoming, comfortable, and weren’t sterile or austere. I do think the quality of the surroundings is one of the factors involved in that relationship, especially if you are considering spending a lot of time in an office as would be the case if you were seeing a psychotherapist.”
How You Can Get Involved
Dr. Devlin enjoys working with students and has coauthored a number of articles with student authors. She says, “One of the activities that we have in our Psi Chi chapter is a day-long annual conference, which I think has been a model for other chapters. A lot of my research methods students present their culminating work at that conference, so it is always a very exciting day to see them stand up and present professionally.”
She also recognizes the value of mentorships. When comparing the way that most psychotherapists can trace their roots to Sigmund Freud, she says, “I can trace my roots to the Kaplans. They are extraordinarily giving in terms of the time they spend to help you achieve your goals. They are some of the founding members of the environmental psychology movement, and they have a very impressive track record of people who follow in their footsteps.”
In her own students, she looks for passion and commitment. “They need to show up to class!” she laughs, adding, “I like people who are observant and curious because I think sometimes the best research questions simply come from looking at the world around you and observing what is going on.” For anyone interested in environmental psychology, she provides the following four suggestions.
|If there is an environmental psychology class, she highly recommends taking it, but also believes that students can learn about many of the concepts of environmental psychology (e.g., personal space, territoriality, coping, and resiliency) in courses such as Social Psychology or Health Psychology.
|Outside of psychology, she encourages students to take an architectural studies program if they are able to do so, as well as environmental studies. She says, “Although I haven’t stressed this in our conversation today, there is a big aspect of environmental psychology that deals with environmental conservation, restorative environments, and sustainability; environmental studies is a good home for that.”
|For those interested in healthcare work or healthcare design, she suggests that they check out the Center for Health Design. This organization has a great source of short articles dealing with current topics in healthcare design and “empowers healthcare leaders with quality research that demonstrates the value of design to improve health outcomes, patient experience of care, and provider/staff satisfaction and performance” (Center for Health Design, n.d.).
|The Environmental Design Research Association (EDRA) is also a group of people from a variety of disciplines (e.g., architecture, landscape architecture, psychology, sociology, and urban and regional planning) who come together for an annual conference to present work on behavior and environment studies (EDRA, n.d.). According to Dr. Devlin, “For those of us involved in this area of work, EDRA is our home. It has likeminded people and is a good place to go and sort of recharge your batteries.”
Although you might never have felt at ease in a healthcare setting, Dr. Devlin is as comfortable there as she is skating figure eights on the ice. She says, “I come from generations of healthcare providers; my grandfathers and father were physicians, and my mother was a surgical nurse, so I sort of grew up with it.” Seeking to help share her knowledge with others via EBD, her dedication has led to a variety of accomplishments including her new role as editor-in-chief of Environment and Behavior, a new research methods book under contract with Sage, and another book she has been approached to write related to environmental psychology. Thanks to her advice today, many readers of this interview may already feel more comfortable with and aware of the importance of their environments, both in healthcare settings and beyond.
Ballinger, B. (2011, September). Ann Sloan Devlin: Defining your space. Realtor Magazine Online. Retrieved from http://realtormag.realtor.org/news-and-commentary/last-word/article/2011/09/definingyour-space
Center for Health Design (n.d.). About us. Retrieved from https://www.healthdesign.org/about-us
Devlin, A. S., & Nasar, J. L. (2012). Impressions of psychotherapists’ offices: Do therapists and clients agree? Professional Psychology: Research and Practice, 43, 118–122. doi:10.1037/a0027292
Devlin, A. S., Andrade, & C. C., Carvalho, D. (2015). Qualities of inpatient hospital rooms: Patients’ perspectives. Health Environments Research and Design Journal. Advance online publication. doi:10.1177/1937586715607052
Environmental Design Research Association (n.d.). About. Retrieved from http://www.edra.org/content/about
Ann Sloan Devlin, PhD, is the May Buckley Sadowski ‘19 Professor of Psychology at Connecticut College. Devlin’s fourth book, Transforming the Doctor’s Office: Principles From Evidence-Based Design, focuses on healthcare environments. Another of her books, What Americans Build and Why: Psychological Perspectives, focuses on a range of facility types (residential, educational, medical, office, and retail), and the evidence from psychology that fosters our understanding of behavior in these settings. In January 2016, she became editor-in chief of the journal Environment and Behavior; she is past Environmental Design Research Association board member and secretary. At Connecticut College, she has received the John S. King Faculty Teaching Award and the Helen Brooks Regan Faculty Leadership Award. She is a fellow of Division 34 of the American Psychological Association.
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