Art and Design
Art and Design
ISSN 2617-0272 e-ISSN 2617-0280
DOI: 10.30857/2617-0272
Submit an article

Article

Download article

Democratising hospital design: Reconfiguration of disciplinary power via M. Foucault’s theory

Ke Zhao, Danylo Kosenko

Received 01.07.2025, Revised 13.11.2025, Accepted 27.11.2025

Abstract

Hospital interiors remained decisive sites where spatial form, materials, lighting, and acoustics structured everyday conduct, making the democratisation of design a timely concern for healthcare quality and dignity. The purpose of this study was to theorise and test a “democratisation design” logic that reconfigured disciplinary power into emancipatory spatial practice. A mixed qualitative design method was employed that combined literature synthesis, discourse analysis of briefs and standards, and comparative case studies of five contemporary hospitals to evaluate spatial layout, material language, adjustable lighting, and participatory navigation. How traditional interiors encoded hierarchy through radial zoning, cold hard finishes, uniform high-illuminance lighting, and voice-controlled soundscapes was investigated; these configurations produced routinised flows and asymmetric visibility. Decentralised layouts, nature-based materials, and circadian-tuneable lighting were established to rebalance perception and privacy while sustaining hygiene and throughput. Dialogic interfaces – open corridors, shared decision-making corners, and self-service information – were analysed and were found to reduce information asymmetry, improve perceived control, and increase trust and satisfaction. The findings were summarised as a four-part framework (movement, material, light, sound) showing where specific interventions reinforced or redistributed power across entry, waiting, and treatment zones; across five cases, queuing stress was reduced, wayfinding times were shortened, and staff coordination was supported without increasing infection-control risk or compromising clinical workflows. The results could be used by healthcare architects, engineers, and hospital managers to inform design guidelines and post-occupancy evaluations that align safety and efficiency with agency, dignity, and participation in both new builds and phased renovations


Keywords:

environmental design; healthcare interior; patient-centred design; environmental perception; spatial layout; interior finishing; interior lighting

https://doi.org/10.30857/2617-0272.2025.4.7

Retrieved from Volume 8, No. 4, 2025

Pages 80-90

References Suggested citation

References

  1. Aghajari, S., & Chen, C.-C. (2023). The effectiveness of lighting design for improved patient care considering energy conservation. Engineering Proceedings, 55(1), article number 91. doi: 10.3390/engproc2023055091.
  2. Al Khatib, I., Samara, F., & Ndiaye, M. (2024). A systematic review of the impact of therapeutical biophilic design on health and wellbeing of patients and care providers in healthcare services settings. Frontiers in Built Environment, 10, article number 1467692. doi: 10.3389/fbuil.2024.1467692.
  3. Bae, S. (2023). A qualitative study of hospital interior environments during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 20(4), article number 3271. doi: 10.3390/ijerph20043271.
  4. Bogaert, B. (2022). Moving toward person-centered care: Valuing emotions in hospital design and architecture. Health Environments Research & Design Journal, 15(2), 355-364. doi: 10.1177/19375867211062101.
  5. Chaeibakhsh, S., Novin, R.S., Hermans, T., Merryweather, A., & Kuntz, A. (2021). Optimizing hospital room layout to reduce the risk of patient falls. arXiv. doi: 10.48550/ARXIV.2101.03210.
  6. Chowdhury, S., Islam, R., Paul, S., Nur, O., & Nizam, R. (2025). Exploring indoor environmental design factors in healthcare settings towards users’ well-being. Journal of Basic and Applied Research International, 31(2), 81-95. doi: 10.56557/jobari/2025/v31i29205.
  7. Dalton, B. (2024). Paul B. Preciado’s queer hospital: Healthcare architectures for pleasure, transformation and subversion. The Senses and Society, 19(3), 337-350. doi: 10.1080/17458927.2024.2392954.
  8. de Lima Andrade, E., da Cunha e Silva, D.C., de Lima, E.A., de Oliveira, R.A., Zannin, P.H.T., & Martins, A.C.G. (2021). Environmental noise in hospitals: A systematic review. Environmental Science and Pollution Research, 28, 19629-19642. doi: 10.1007/s11356-021-13211-2.
  9. Draganov, P., & Sanna, M.C. (2021). Evidence of power expressed in architectural projects of Santa Catarina Hospital (1974-2002). Saúde e Sociedade, 30(1), article number e181106. doi: 10.1590/S0104-12902021181106.
  10. Fiddler, M. (2022). Phantom architecture: Jeremy Bentham’s haunted and haunting panopticon. Incarceration, 3(2). doi: 10.1177/26326663221101571.
  11. Foucault, M. (1995). Discipline and punish: The birth of the prison. New York: Vintage Books.
  12. Foucault, M. (2003). The birth of the clinic: An archaeology of medical perception. London: Taylor & Francis e-Library.
  13. Ghalehnoei, M.P., Massoud, M., & Yarmohammadian, M.H. (2022). Presenting a conceptual model for designing hospital architecture with a patient-centered approach based on the patient’s lived experience of sense of place in the therapeutic space. Journal of Education and Health Promotion, 11(1), article number 188. doi: 10.4103/jehp.jehp_629_21.
  14. HMC Architects. (2019). What is a greenfield project and what are its architectural advantages over a brownfield project? Retrieved from https://hmcarchitects.com/news/what-is-a-greenfield-project-advantages-brownfield-project-2019-04-03/.
  15. Ismaeil, E.M., & Sobaih, A.E.E. (2022). Enhancing healing environment and sustainable finishing materials in healthcare buildings. Buildings, 12(10), article number 1676. doi: 10.3390/buildings12101676.
  16. Kallestad, H., et al. (2024). Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial. PLOS Medicine, 21(12), article number e1004380. doi: 10.1371/journal.pmed.1004380.
  17. Kumar, S., Ng, R.Q., & Lee, H.P. (2020). Experimental investigations of acoustic curtains for hospital environment noise mitigations. arXiv. doi: 10.48550/arXiv.2008.06690.
  18. Kwak, S., & Choi, K. (2025). Visual perceptions of wood-integrated material combinations: Effects on psychological and physiological responses. Journal of Wood Science, 71, article number 20. doi: 10.1186/s10086-025-02191-3.
  19. Lamb, M.D. (2021). Health inequity by design: Waiting rooms and patient stress. Frontiers in Communication, 6, article number 667381. doi: 10.3389/fcomm.2021.667381.
  20. Lee, J., & Yoon, S.Y. (2023). Nature and patient waiting: Mediating effects of anxiety and perceived wait time on the association between nature and service perception. Journal of Environmental Psychology, 91, article number 102113. doi: 10.1016/j.jenvp.2023.102113.
  21. Lenzi, S., Lindborg, P., Spagnol, S., Kamphuis, D., & Özcan, E. (2024). Perceived quality of a nighttime hospital soundscape. Noise Mapping, 11(1), article number 20240010. doi: 10.1515/noise-2024-0010.
  22. Lundberg, A., Hillebrecht, A.L., & Srinivasan, M. (2024). Effect of waiting room ambience on the stress and anxiety of patients undergoing medical treatment: A systematic review and meta-analysis. Advances in Integrative Medicine, 11(2), 47-68. doi: 10.1016/j.aimed.2024.04.004.
  23. Maj, A.M., & Kusmierska, A. (2020). Human-friendly new way of seeing architecture. Architectural Studies, 6(2), 220-229.
  24. Mikkelsen Architecter. (n.d.). Steno Diabetes Center Copenhagen (SDCC), Herlev Hospital. Retrieved from https://en.mikkelsengroup.dk/projekt/steno-diabetes-center-copenhagen.
  25. Morley, C., Jose, K., Hall, S.E., Shaw, K., McGowan, D., Wyss, M., & Winzenberg, T. (2024). Evidence-informed, experience-based co-design: A novel framework integrating research evidence and lived experience in priority-setting and co-design of health services. BMJ Open, 14(8), article number e084620. doi: 10.1136/bmjopen-2024-084620.
  26. Nordic Office of Architecture. (n.d.). LHL Hospital. Retrieved from https://nordicarch.com/project/lhl-private-hospital.
  27. Park, H.Y. (2023). Hospital space interpreted according to Heidegger’s concepts of care and dwelling. Medical Humanities, 50(1), article number e012696. doi: 10.1136/medhum-2023-012696.
  28. Pekarchuk, O., & Palianytsia, Kh.B. (2024). Specificity of the interior formation of the universal physical rehabilitation hall for military personnel. Series of Architecture, 6(2), 133-143. doi: 10.23939/sa2024.02.133.
  29. Perry, C., Boaden, R.J., Black, G.B., Clarke, C.S., Darley, S., Ramsay, A.I.G., Shackley, D.C., Vindrola-Padros, C., & Fulop, N.J. (2022). “Attending to History” in major system change in healthcare in England: Specialist cancer surgery service reconfiguration. International Journal of Health Policy and Management, 11(12), 2829-2841. doi: 10.34172/ijhpm.2022.6389.
  30. Polka, N.S., Makhniuk, V.M., Chorna, V.V., Podolian, V.M., & Yurchenko, S.T. (2022). Hygienic assessment of new architectural and planning solutions of buildings of psychiatric health care facilities. Medical Perspectives, 27(3), 135-141. doi: 10.26641/2307-0404.2022.3.265960.
  31. Pratiwi, A.B., Padmawati, R.S., & Willems, D.L. (2022). Behind open doors: Patient privacy and the impact of design in primary health care, a qualitative study in Indonesia. Frontiers in Medicine, 9, article number 915237. doi: 10.3389/fmed.2022.915237.
  32. Qian, F., & Luo, Y.S. (2022). Reflections on historicizing epidemics: Diagrams of spatial practices amid pandemics. Journal of Human Settlements in Western China, 37(1), 40-47. doi: 10.13791/j.cnki.hsfwest.20220107.
  33. Ríos-Rodríguez, M.L., Testa Moreno, M., & Moreno-Jiménez, P. (2023). Nature in the office: A systematic review of nature elements and their effects on worker stress response. Healthcare, 11(21), article number 2838. doi: 10.3390/healthcare11212838.
  34. Salvati, C.D.O., Gomes, C.A., Haeffner, L.S.B., Marchiori, M.R.C.T., da Silveira, R.S., & Backes, D.S. (2021). Humanization of the hospital: Participatory construction of knowledge and practices on care and ambience. Revista da Escola de Enfermagem da USP, 55, article number e20200058. doi: 0.1590/1980-220X-REEUSP-2020-0058.
  35. Smith, C.Q., Williams, I., & Leggett, W. (2024). A matter of (good) faith? Understanding the interplay of power and the moral agency of managers in healthcare service reconfiguration. Social Science & Medicine, 342, article number 116553. doi: 10.1016/j.socscimed.2023.116553.
  36. SmithGroup. (n.d.). Advocate Illinois Masonic Medical Center, center for advanced care. Retrieved from https://www.smithgroup.com/projects/advocate-illinois-masonic-medical-center-center-for-advanced-care.
  37. Spence, C. (2020). Senses of place: Architectural design for the multisensory mind. Cognitive Research: Principles and Implications, 5, article number 46. doi: 10.1186/s41235-020-00243-4.
  38. Suijker, C.A. (2023). Foucault and medicine: Challenging normative claims. Medicine, Health Care and Philosophy, 26, 539-548. doi: 10.1007/s11019-023-10170-y.
  39. Tang, K., & Chen, B. (2023). Resilient hospital design: From Crimean War to COVID-19. Health Environments Research & Design Journal, 16(4), 36-55. doi: 10.1177/19375867231174238.
  40. Tronstad, O., Flaws, D., Patterson, S., Holdsworth, R., Garcia-Hansen, V., Rodriguez Leonard, F., Ong, R., Yekovich, S., & Fraser, J.F. (2023). Evaluation of the sensory environment in a large tertiary ICU. Critical Care, 27(1), article number 461. doi: 10.1186/s13054-023-04744-8.
  41. Verstas Architects. (n.d.). Lapland Central Hospital. Retrieved from https://verstasarkkitehdit.fi/projects/lapland-central-hospital/.
  42. Yong, L.X., & Calautit, J.K. (2023). A comprehensive review on the integration of antimicrobial technologies onto various surfaces of the built environment. Sustainability, 15(4), article number 3394. doi: 10.3390/su15043394.
  43. Zinoski, M., Petrunova, I., & Brsakoska, J. (2025). The architecture of public buildings as a transformative model toward health and sustainability. International Journal of Environmental Research and Public Health, 22(5), article number 736. doi: 10.3390/ijerph22050736.

Suggested citation

Zhao, K., & Kosenko, D. (2025). Democratising hospital design: Reconfiguration of disciplinary power via M. Foucault’s theory. Art and Design, 8(4), 80-90. https://doi.org/10.30857/2617-0272.2025.4.7