Positive distractions are a set of environmental features or conditions that effectively reduce patient and staff stress by providing a moderate level of pleasant environmental stimulation. It’s well known that gardens, artwork, videos with nature scenery, window views of nature, and music can serve as positive distractions in various healthcare settings, benefitting patients and families as well as healthcare workers.

Multiple rigorous studies have shown that positive distractions often result in significant improvements in healthcare outcomes, such as reduction in stress responses (high blood pressure, accelerated heart rate), reduction in pain and pain medication use, expedited recovery, better psychological and emotional well-being, and increases in patient and staff satisfaction.

But while positive distractions have been applied to imaging rooms, their effects have not been previously evaluated.

One example of environmental design intervention utilizes technology to integrate various types of positive distractions (programmable colorful ambient lighting, theme animations, music) and other design features (de-cluttered space, integrated storage design, patient choice of themes and music) to improve patient and staff experience in imaging rooms.

In the past several years, the environmental intervention has been implemented at various inpatient and outpatient facilities across the country. This provides great research opportunities for critically evaluating the effects of positive distractions in imaging rooms on patient and staff.

Since 2008, the research team at The Center for Health Design (CHD) has been working on a series of research studies on behalf of the environmental intervention’s manufacturer, evaluating its impact from the impartial point of view of a third party not associated with its development and installation. Two studies have been completed and published, and one study is in progress.


Study 1—staff perception (completed)
The first study focused on how imaging technologists, who spend a considerable amount of time in imaging rooms, perceived the positive distractions. It was hypothesized that the technologists working in magnetic resonance imaging (MRI) and computed tomography (CT) imaging rooms with the positive distractions (the intervention rooms) would report more positive views about the physical environment, lower stress level, higher job satisfaction, and higher perceived service quality than technologists working in rooms with the traditional design (non-intervention rooms).

In addition, the study also aimed at exploring technologists’ perception about different design features (colorful lighting, theme animation) and  the use of positive distractions.

Accordingly, two self-administrated anonymous questionnaires were developed based on existing validated instruments. The first questionnaire included items measuring outcomes (such as perceived quality of the physical environment, job stress, job satisfaction) and control variables (supervisor support, teamwork) on a five-point Likert scale, as well as demographic information.

This questionnaire was distributed to staff in both the intervention and non-intervention rooms. The second questionnaire was designed to measure technologists’ overall perception about the environmental intervention and their preferences for different aspects of environmental intervention, and was distributed only to staff working in the intervention rooms.

A total of 54 technologists from six healthcare organizations across the nation completed and returned the first questionnaire—including 28 responses from those working in the intervention rooms and 26 from those working in the non-intervention rooms. Thirty-five technologists from four organizations completed the second questionnaire.

Results showed that the environmental intervention led to a significant perceived improvement in the pleasantness of the environment, even though there were no significant differences found in job stress, satisfaction, and perceived quality of care. The vast majority of technologists reported that the positive distractions were helpful to their work.

Colorful lighting and decluttered space were the two components most liked by staff. One lesson learned from this study was that facility factors other than physical environment (such as organizational culture) might impact the results. These confounding factors were difficult to disentangle because of the limited number of the participating organizations and limited number of survey respondents from each individual organization.


Study 2—patient perception (completed)
The second study examined the impact of the environmental intervention on patient perceptions. The study was conducted at two MRI rooms in a large acute-care hospital. The positive distractions were installed in only one of the MRI rooms. Otherwise, minimal differences exist between the two rooms. Both rooms  serve mostly adult outpatients. It was hypothesized that patients would perceive the intervention room more favorably, leading to higher patient satisfaction and customer loyalty. Patient perception was measured by a questionnaire adapted from existing instruments.

The questionnaire included items measuring patient perception of the physical environment (pleasantness, noise, control of the environment, safety, quality of patient space), patient satisfaction, and patient loyalty (willingness to recommend and willingness to return). A total of 400 questionnaires were handed out by imaging service staff members to adult outpatients who visited the MRI rooms during the data collection period.

About 40% of these patients completed and mailed the questionnaires directly to CHD researchers. Results from statistical analysis confirmed that patients viewed the intervention rooms to be more pleasant, providing a higher level of patient control over the physical environment. This improvement was important because pleasantness and environmental control were the two lowest rated environmental aspects in the non-intervention, traditional MRI room.

In addition, patients who visited the intervention room were significantly more willing to recommend the hospital to others. Trends in data also showed that intervention rooms were associated with a higher level of patient satisfaction and willingness to return, but the differences in these two outcome variables were not statistically significant.


Study 3—pediatric patient experience (in progress)
Unlike the previous studies focusing solely on subjective data, the pediatric patient study is measuring both objective outcomes (observed behavioral distress, duration of scan) and subjective outcomes (self-reported mood status, satisfaction). It targets pediatric patients visiting two X-ray rooms at a major outpatient clinic.

The two rooms have been intentionally selected so that they are similar in almost all aspects of the physical environment except that only one has positive distractions installed in the room. In addition, the study compares two conditions in the intervention room—one when only colorful lighting is used and the other when both theme animation and colorful lighting are used.

It is hypothesized that the environmental conditions with a higher level of positive distractions will lead to a lower level of behavioral distress, shorter scans, better mood status, and higher satisfaction. The main methods of data collection include video recording and coding, visual analog rating scale, and a questionnaire survey. Currently, the study is in the process of data collection and analysis, with anticipated completion by the end of December 2012.


The triangulation of subjective and objective evidence from different populations and settings
is an important way of validating the effectiveness and generalizability of a new design intervention. The empirical data from the first two studies suggest that positive distractions such as design examples that involve lighting, animation, and other features may improve the aesthetic quality of imaging rooms, enhance patient personal control, and increase patient satisfaction and loyalty.

Although these studies have been conducted on one specific environmental intervention in imaging rooms, the results may be applied, to a certain extent, to other similar healthcare settings. Further research may help in providing a more comprehensive study of the design intervention’s effects on other outcomes and identify the relatively weaker components in the current design, allowing for continuous improvement.

Xiaobo Quan, PhD, EDAC, is a research associate and Anjali Joseph, PhD, EDAC, is vice president/director of research for The Center for Health Design. For more information on this research and to obtain a complete list of references sourced by the authors in conjunction with this study, contact Anjali Joseph at ajoseph@healthdesign.org.