Researchers at the University of California San Diego use a remote wand to navigate the StarCAVE, a 360-degree, virtual reality laboratory that measures human responses to the designs of hospitals and rehabilitation facilities.
All photos by Claudia Ambriz

Researchers have long pioneered advances in medicine and rehabilitative therapy, and for neuroscientist and architect Eve Edelstein, the renovation of the San Diego VA Medical Center offered an opportunity to expand that research into the realm of architecture.

Edelstein, a senior vice president of research and design at HMC Architects, is currently studying the impacts of hospital design on patients and caregivers alike, collaborating with the California Institute for Telecommunications and Information Technology (Calit2) at the University of California’s San Diego campus, where she is a visiting scholar.

Immersion in the virtual building gives Eve Edelstein of HMC Architects a real-scale perception of form and function.
Tiffany Fox of Calit2 wears an array of 256 electrodes that record EEG brain waves as she experiences the StarCAve.

Edelstein and the Calit2 team are exploring the human response to design features in healthcare and institutional environments using a novel tool called the StarCAVE: a 360-degree, virtual-reality laboratory in which a test subject moves through 3-D architectural environments that are projected on an array of fifteen 12-foot-high panels. Researchers measure the subject’s real-time response to the architecture with a prototype device that synchronizes virtual reality behavior with the test subject’s electroencephalography (EEG) measurements. The upshot is a detailed cognitive portrait of how we react to the spaces around us.

The team is also using the StarCAVE to discover how neural structures are associated with wayfinding, thus gaining insight into how best to help patients navigate a complex medical facility. Using this research to influence design could eventually save hospitals a significant amount of money in lost staff time, while improving the patients’ experience and decreasing adverse health effects such as cross-contamination.

Edelstein and her HMC colleagues, including healthcare practice leader Jerry Eich and Rebecca Hathaway, a former nurse and hospital CEO who is now HMC’s senior vice president of healthcare, are currently working with the San Diego VA Medical Center to design a masterplan for future renovations of the facility’s operating suites. They are drawing on the so-called Planetree model of patient care that focuses on making hospital environments less intimidating.

Furthermore, according to Eich, VA hospitals are in the midst of a significant transition from a predominantly male population with aging issues to a younger population including a never-before-seen demographic: combat-wounded female veterans. For an agency already charged with caring for both the physical and psychological damages of combat—each with its own long-term effects—accommodating women’s needs adds another layer of complexity for designers at work on veterans-care facilities.

Edelstein has also been investigating how light can improve both health and hospital environments. “We can’t just say more light is better,” she said. “The science says that we need a certain pattern of dynamic lighting. If we’re going to be working 24/7, how do we adapt our lighting so that our staff is at their most cognitively aware?” In fact, much of the team’s research-based solutions support the caregivers’ well being—an especially important goal in VA medical facilities, where the medical staff often acts as surrogate family for patients who are far from home. “How can we change our work and care environment so that it can serve the sensory and cognitive needs of a doctor or nurse, and the emotional and cognitive needs of the patient?” Edelstein asked.

While exploring the outer reaches of virtual experimentation, HMC, whose offices are based primarily in California, also hopes to bring its evidence-based design practice to the mainstream by developing new acoustic solutions with Arup, for example, in the development of emergency rooms where alarm systems and intimate conversations require different levels of audibility.

Hospitals contain many competing needs such as these, and Edelstein’s collaboration with UCSD has helped move design to the forefront of diagnostic and rehabilitative therapy. “We have been talking to psychiatrists and other doctors to see how we might be able to use some of our research in that way,” she said. “The department of defense hospitals offer an opportunity for clinicians and researchers to really collaborate with cutting-edge research and be involved in development of state-of-the-art care.”