Holistic Multi-Methods Approach in the Investigation of Environmental and Restorative Functions of Courtyard Gardens in Malaysian Public Hospitals

The introduction of the hospital courtyard garden (HCG) in Malaysia can be traced as early as the 1970s. To date, it is still incorporated in the current planning of newly built hospitals. However, their design quality is yet to be systematically evaluated and no specific framework or design guidelines or evaluation criteria exist to assess HCGs with a focus on the integration of the environmental and restorative functions. Therefore, this study aimed to investigate how the different types of courtyard gardens that have been included in the planning of Malaysian hospitals after 1998 are currently performing in relation to the environmental and restorative functions and how they are used and perceived by the intended users (i.e. patients, staff and visitors). This study also explored how the HCG can be improved to achieve an optimal HCG design to enhance the users’ experiences in the hospital. A representative sample of three different HCGs in three Malaysian public hospitals were selected to systematically evaluate them with a particular focus on users’ perceptions, preferences, experiences and level of satisfaction with the overall HCG design concerning the environmental and restorative functions. To achieve the aim and research objectives, this study employed a mixed methods and case study approach through the intervention of a diagnostic post-occupancy evaluation (POE) which included multiple methods, namely: i) field observation (site analysis and field measurement); ii) participant observation and behaviour mapping; iii) survey interview with the HCG users (n=120) and non-users (n=135); and iv) semi-structured interviews with the architects (n=2) and landscape architects (n=2). Regarding the environmental performance of the HCG, the findings revealed that a proper consideration of both environmental and restorative functions resulted in improved thermal comfort in the HCG and adjacent spaces. The findings also showed that the air temperature in the HCG were found to be several degrees lower than the corresponding air temperature outside the hospital during the day. In terms of restorative functions, this study found that the HCG with a proper combination of landscape elements (a ratio of 70:30 for softscape and hardscape) received a higher restorative score compared to the HCG with a lower percentage of softscape (less than 40%). HCGs also has a significant influence on users’ well-being; the study revealed that over 75% of the 120 users perceived a positive mood change and felt more relaxed and less stressed whilst spending time there. Additionally, based on a total of 48-hours of the video-based and direct observation on both a weekend and a weekday, this study found that all the three HCGs were most used by visitors (72% adult and 22% children), followed by staff (4%) and patients (2%). A Chi-square analysis on users’ satisfactions levels revealed the four most significant factors with the overall planning of the HCG: i) landscape elements (p<.000, C=.442); ii) wall conditions (p<.000, C=.429); iii) access from the main entrance (p<0.04, C=.393); and iv) visibility (p<.000, C=.382). Based on the overall research findings gathered from difference source of data, this research has contributed to the establishment of a comprehensive HCG framework for a Malaysian climatically context which comprised of four interrelated components; i) physical; ii) environmental; iii) social; and iv) operational aspect. The study also has successfully provided recommendations for policy and practice related to the functional and spatial arrangement of HCGs to assist in reviewing and updating the planning and design requirements for optimal HCG design in future.