TY - JOUR T1 - Changing buildings; building change! JF - British Journal of General Practice JO - Br J Gen Pract SP - 798 LP - 799 VL - 54 IS - 507 AU - Jacques Mizan Y1 - 2004/10/01 UR - http://bjgp.org/content/54/507/798.abstract N2 - This essay has an ambitious aim: to enrich and revitalise our daily work. I hope to do so by encouraging change in our work environment. Strikingly simple, perhaps, but sometimes simple solutions are best — and most easily overlooked.To begin with, consider the term ‘built environment’ — ‘architect-speak’ for the structural landscape that surrounds us. Architects think of the built environment as more than a pile of bricks — and rightly so; buildings are considered in terms of form, function, spaces, and textures. Ask an architect to define ‘the built environment’ and they will get quite excited, as if they are talking about a spiritual entity. Do they know something we don't?The answer rests with Florence Nightingale, pioneer of the ‘new’ healthcare environment. She found that recovery from illness could be improved by introducing light and fresh air to the previously dank, dark spaces of the early hospitals. The results created the template for ward design for the next century.Some 100 years on, the principle behind the Nightingale ward layout was tested by Ulrich.1 He found that recovery from surgery could be hastened if patients had access to a window with views onto a natural landscape. This single study triggered further research addressing the following questions:How does the built environment influence the ability to cope with illness?Is there a psychological basis for the effect of the built environment?Can the effect be illustrated in terms of clinical, and other meaningful, outcomes?The key word here is stress. Ulrich suggests that the built environment can contain features that are stressors in themselves.2 Where there is added stress, the ability to cope with illness is reduced. This should not be too difficult a concept to digest — as GPs we see this happening every day. … ER -