Participatory design of healthcare spaces: The case of the University Children’s Hospital in Lublin

Rafał Strojny, Natalia Przesmycka

doi:10.37190/arc260309

Abstract

The article presents a participatory design process for healthcare spaces using the University Children’s Hospital in Lublin as a case study. It focuses on developing design guidelines for outdoor spaces that support the needs of paediatric patients, their families and medical staff. The starting point was the observation that existing spaces around hospitals often fail to meet contemporary user requirements and the principles of therapeutic environments. The authors aimed to determine whether participatory methods and Evidence-Based Design principles enable a more effective understanding of users’ needs and lead to more appropriate spatial solutions.

The research was conducted in 2024–2025 using an action research methodology that combined diagnosis, co-design, evaluation and the preparation of solutions for implementation. The process included an analysis of existing spaces, design workshops with children, the development of design alternatives and their evaluation. Workshop participants included rehabilitation ward patients, parents and medical staff. The methods comprised interviews, preference studies and drawing activities using previously prepared plans and visualisations of the spaces.

The findings indicate that users primarily expect spaces that provide safety, comfort and opportunities to rest, with entertainment functions taking a secondary role. Elements related to nature, greenery, sensory stimuli, activity and social integration were particularly important. Young patients preferred bright colours, organic spatial forms and solutions enabling multisensory experiences. The results confirm that participatory design of healthcare environments helps identify users’ needs more effectively and can lead to friendlier, more therapeutic and more functional hospital spaces.

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Rafał Strojny*, Natalia Przesmycka**

Participatory design of healthcare spaces:

The case of the University Children’s Hospital in Lublin

DOI: 10.37190/arc260309

Published in open access. CC BY-NC license.

Abstract

This article presents the process of participatory design of healthcare spaces using the University Children’s Hospital in Lublin as a case study.

The focus was on developing design guidelines for outdoor spaces that support the needs of paediatric patients, their families, and medical sta. The

starting point was the observation that existing hospital grounds often do not meet the contemporary requirements of users or the principles of ther-

apeutic environments. The authors’ goal was to determine whether the use of participatory methods and Evidence-Based Design principles enables

a more eective identication of users’ needs and leads to the development of more appropriate spatial solutions.

The study was conducted in 2024–2025 using an action research methodology that combined diagnosis, co-design, evaluation, and the prepara-

tion of solutions for implementation. The process included an analysis of existing spaces, design workshops involving children, the development of

design alternatives, and their evaluation. Participants in the workshops included patients from the rehabilitation ward, parents, and medical sta. The

methods employed included interviews, preference surveys, and drawing exercises conducted on prepared oor plans and visualizations of the spaces.

The results indicate that users primarily expect spaces that ensure safety, comfort, and the opportunity to rest, with recreational functions coming

second. Elements related to nature, greenery, sensory stimuli, and opportunities for activity and social integration were of particular importance.

Young patients preferred bright colours, organic spatial forms, and solutions that enable a multisensory experience of the space. The ndings suggest

that participatory design of healthcare environments can improve the identication of users’ needs and support the development of more responsive,

user-friendly, and functional hospital spaces.

Key words: children’s hospital design, child-centred participation, healthcare architecture

Introduction

Contemporary healthcare facility design increasingly

takes into account not only functional and technological re-

quirements but also the impact of the built environment on

users’ well-being, comfort, and recovery process. Outdoor

spaces play a particularly important role, as they can pro-

mote rest, reduce stress, and foster social integration among

patients, their caregivers, and sta. In the case of children’s

hospitals, these spaces are of particular importance due to

the varying stages of development among patients, their

limited independence, and their dependence on parents or

caregivers, which translates into specic physical, emotion

al, and social needs. Despite growing awareness of the con-

cept of a “healing environment”, existing hospitals often

lack appropriately adapted outdoor areas, and the existing

green infrastructure does not meet the actual needs of users.

The subject of the research presented in this article is the

outdoor spaces at the University Children’s Hospital in Lu-

blin (USD) – the largest facility of its kind in southeastern

Poland. The hospital was built in the 1980s, and its archi-

tectural form is typical for facilities of this type: the rst

two oors house general functions (diagnostic, education-

al, oce, and outpatient clinics), while the hospital wards

are located on the upper oors of the building. To provide

additional light to specic areas within the building, there

are atria and courtyards that vary in terms of accessibility,

layout, and proportions. The main entrance is a high-trac

area and the rst point of orientation for parents and pa-

tients. For these reasons, the University Children’s Hospital

* ORCID: 0000-0002-2451-9152. Faculty of Civil Engineering

and Architecture, Lublin University of Technology, Poland, e-mail:

r.strojny@pollub.pl

** ORCID: 0000-0003-0049-1500. Faculty of Civil Engineering

and Architecture, Lublin University of Technology, Poland.

90 Rafał Strojny, Natalia Przesmycka

in Lublin can be considered, in many respects, a represen-

tative example of hospital buildings constructed in the sec-

ond half of the 20

century, which are currently grappling

with the challenge of modernization and adaptation to con-

temporary needs.

The reason for undertaking this study was the need to

develop spatial solutions that support the daily functioning

of hospital users and better address their functional, social,

and recreational needs. Another important motivation was

the conviction that the design of healthcare spaces should

be based not only on expert knowledge but also on the ex-

periences and preferences of users. Consequently, the ob-

jective of the study was to develop design guidelines for

the outdoor spaces of a children’s hospital based on design

workshops, surveys, and participatory activities involving

patients, parents, and medical sta.

The hypothesis was that design workshops conducted us-

ing a participatory model and in accordance with the prin-

ciples of Evidence-Based Design enable a more eective

identication of users’ needs and lead to the development of

more appropriate spatial solutions for the hospital environ-

ment. It was also assumed that involving users in the co-de-

sign process reveals needs that are dicult to identify using

standard design methods alone. However, actively engag-

ing end users is still not a widespread design practice. The

study combined qualitative and quantitative methods and

was grounded in action research methodology, the detailed

process of which is presented later in this article.

State of research

Participatory design is not only a practical approach but

also a research tool that ts within the eld of architectur-

al research. Research on healthcare architecture indicates

that the physical environment of medical facilities can in-

uence patients’ well-being, stress levels, comfort of use,

and the course of recovery. A classic point of reference re-

mains the study by Roger S. Ulrich (1984), which demon-

strated the benecial eect of views of greenery on patients

following surgical procedures. Authors of subsequent pub-

lications have expanded on this line of research, pointing

out that design decisions regarding lighting, noise, contact

with nature, spatial orientation, and privacy can be signi-

cant for the quality of care and the safety of users (Devlin,

Arneill 2003; Ulrich et al. 2008).

In this context, Evidence-Based Design (EBD) – which

involves making design decisions based on empirical data

and veried research – plays a signicant role. D. Kirk Ha -

milton and David H. Watkins (2008) emphasized that EBD

does not mean the mechanical application of universal mod-

els, but rather requires the interpretation of research ndings

in relation to a specic program, location, and user groups.

In the case of children’s hospitals, it is therefore particular-

ly important to combine expert knowledge with an under-

standing of the local needs of patients, parents, and sta.

The most important nding from the systematic reviews

conducted between 2009 and 2018 by Emelie P. Bock and

co-authors (2021) was that new or renovated hospital envi-

ronments were generally rated more highly than older facil-

ities by children, parents, and sta alike. At the same

time,

these authors emphasized that although the concept of EBD

has been well developed in relation to the design of hos-

pitals for adults, knowledge regarding paediatrics remains

limited. Children have dierent needs than adults

– the

hospital environment should not only support treatment but

also emotional, social, and cognitive development.

Equally important for the development of research on

healing environments is the concept of “therapeutic land-

scapes”. Wilbert M. Gesler (1992) noted that the therapeu-

tic nature of a space stems not only from its physical char-

acteristics but also from social relationships, experiences,

and the meanings attributed to the place. With regard to gar-

dens and outdoor spaces in medical facilities, Clare Cooper

Marcus and Naomi A. Sachs (2013) emphasized the impor-

tance of designing recovery spaces tailored to dierent user

groups and their subsequent evaluation. Research by San-

dra Whitehouse and co-authors (2001) on a garden at a chil-

dren’s hospital showed that such spaces can be perceived

as supporting stress reduction, energy restoration, and user

satisfaction. Magdalena Jamrozik-Szatanek (2017) high-

lighted the role of broadly dened recreational spaces as

important elements of the therapeutic environment in chil-

dren’s hospitals. The researcher divided these spaces into:

rooms specically dedicated to rest, recreation, and play,

and multifunctional areas, with atria appearing in both cat-

egories. Agata Gawlak (2019) highlighted the importance

of a hospital’s public areas – including lobbies, hallways,

reception desks, waiting rooms, the entrance area, and the

building’s immediate surroundings – in shaping its image.

In these areas, it is possible to incorporate elements of

nature and art, as well as other features that reduce stress

and improve well-being. The importance of contact with

nature has also been conrmed by research in environmen-

tal psychology. Rachel Kaplan and Stephen Kaplan (1989)

described the restorative potential of natural environments,

while Stephen R. Kellert, Judith H. Heerwagen, and Martin

L. Mador (2008) developed the concept of biophilic design,

highlighting the need to incorporate natural elements into

the built environment.

Research on participation and co-design constitutes a se-

parate line of inquiry. Henry Sano (1999) emphasized the

importance of methods of public participation in design and

planning, while Elizabeth B.N. Sanders and Pieter J. Stap-

pers (2008) described the shift from designing “for the user”

to designing “with the user”. In the case of children, the

concept proposed by Roger A. Hart (1992) is also signi-

cant; he distinguished between apparent participation and

actual co-decision-making. In Polish research on healthcare

facilities, Piotr Springer and Agata Gawlak (2025) present-

ed ways to use statistical methods to assess users’ preferenc-

es and their willingness to participate in the design process.

The study involved medical sta from selected hos pitals

as well as caregivers of patients in the emergency room of

a paediatric hospital and conrmed the usefulness of a sys-

tematic analysis of user needs during the planning and de-

sign phases of a project.

Haohua Zheng and co-authors (2024) presented a more

ad vanced approach to designing children’s hospitals, pro-

posing a model based on the integration of the Analytic Hie-

rarchy Process (AHP), Quality Function Deployment (QFD),

Participatory design of healthcare spaces: The case of the University Children’s Hospital in Lublin 91

and the Theory of Inventive Problem Solving (TRIZ),

which

enables the systematic translation of children’s needs into

specic spatial solutions. This model involved identifying

user needs while taking into account the psychological and

physiological characteristics of children, es tablishing a hie-

rarchy of these needs, translating them into technical re -

qui rements, and resolving design conicts. The ndings of

Zheng and colleagues suggested that the use of theoreti-

cal models can support the creation of more child-friendly

medical environments, taking into account, among other

things, personalization, attractive visual information sy s-

tems, and the impact of colour schemes (Zheng et al. 2024).

Zheng and colleagues emphasized, however, the need for

further research on the evaluation of actual implementa-

tions in order to develop a system for designing children’s

hospitals based on user feedback. A team of researchers

from the Silesian University of Technology, led by Elżbie-

ta Niezabi towska (Niezabitowska et al. 2015), also recog-

nized the role of students’ conceptual and theoretical stud-

ies as architectural research related to design.

The results of research to date thus point to the need to

combine EBD, participation, workshop methods, and the

design of therapeutic outdoor spaces. There is still a lack

of analyses that take children’s perspectives into account,

and it is necessary to develop methods of co-design and

participatory design (Bock et al. 2021). Full processes in

which identifying user preferences, exploring design alter-

natives, conducting survey evaluations, and preparing for

implementation form a single, coherent research-and-de-

sign cycle are described relatively rarely.

Methods

The study was conducted in 2024–2025 at the University

Children’s Hospital in Lublin. The scope of work included

the analysis and development of a concept for the hospital’s

outdoor spaces, particularly the entrance area, atria, and the

hospital park (Fig. 1). The research process was based on the

action research methodology, which combines diagnosis,

co-design, evaluation, and the preparation of solutions for

implementation. The research was conducted in accordance

with the principles of EBD and a participatory approach,

which involves the active engagement of users in the design

process. Qualitative and quantitative methods were used,

including a spatial inventory, interviews, design workshops,

preference surveys, and an analysis of design alternatives.

The research process was divided into three stages: (1) di-

agnosis and context analysis, (2) design workshops with

patient participation, including a preference survey, and (3)

development and evaluation of design alternatives.

The rst stage involved assessing the spatial and func-

tional context through an analysis of existing outdoor areas

and interviews with hospital management and sta. This

made it possible to identify the main organizational and

functional issues and to select the spaces requiring design

intervention.

“Design workshops”, or stage two (Fig. 2), were con-

ducted with the participation of 30 patients from the reha-

bilitation ward aged 9 to 17 (18 girls, 12 boys). As part of

the workshops, interviews were conducted with 15 patients,

and a preference survey was administered to another 15 pa-

tients. After the workshops concluded, a preference survey

was additionally conducted among 15 parents or guardians

of the patients. A total of 45 people participated in the sec-

ond stage of the research activities, although parents and

guardians did not participate directly in the design work-

shops. The drawing activities were carried out on prepared

oor plans and visualizations of the space. For patients who,

due to health reasons, were unable to draw on their own,

architecture students participating in the study acted as their

“personal assistants”, carrying out the drawing task accord-

ing to the child’s instructions. Preferences regarding colour

schemes, spatial forms, furnishings, recreational functions,

and the sensory impact of the space were examined.

Involving parents in the research was very important

given the contemporary approach to their role in the treat-

ment and rehabilitation process. The role of family mem-

bers in a children’s hospital is much more signicant than

in hospitals for adults. Caregivers are increasingly taking

an active role in their child’s treatment and remain in the

hospital continuously, in some cases for quite a long time

(Del Nord 2006).

In the third stage of the project, based on the collected data

(Fig. 3), several design variants were prepared for individu-

al areas of the hospital (3 variants for each of the analysed

spaces). The design proposals were presented as clearly illu-

strated architectural concepts comprising oor plans, visuali-

zations, and descriptions.

First, evaluative participatory workshops were conduct-

ed with 50 participants: 20 patients, 20 parents, and 10 sta

representatives. Following the workshops, a separate eva-

lu a tive survey was conducted among a dierent group of

respondents, comprising 15 patients, 15 parents, and 30 me -

dical sta members. The purpose of the survey was to

evalu ate the proposed solutions and select the preferred de-

sign options. Both activities were part of the third stage of

the research and served to verify the developed concepts.

The results obtained formed the basis for formulating de-

sign guidelines and developing solutions intended for im-

plementation.

Results

Initial status – diagnosis

As a result of the rst stage of the study, four spaces

were selected for further analysis and design development:

the main entrance area (1), the atrium for children and par-

ents (2), the atrium for sta (3), and the area of undevel-

oped tall vegetation – the park (4). Table 1 presents their

basic characteristics and the constraints resulting from the

current local zoning plan.

First workshop

• User preferences regarding spatial elements

In order to conduct workshops with children of various

ages and health conditions, it was necessary to prepare in-

troductory materials that would facilitate eective commu-

nication. During the workshops, the children were shown

92 Rafał Strojny, Natalia Przesmycka

Fig. 1. The area of the University Children’s Hospital in Lublin covered by the study and design project: a) entrance area,

b) atrium for children and parents, c) staff atrium, d) park adjacent to the hospital, e) location map of the spaces covered by the study

(photo by R. Strojny, map: R. Strojny based on google maps)

Il. 1. Obszar Uniwersyteckiego Szpitala Dziecięcego w Lublinie objęty badaniem i opracowaniem projektowym: a) strefa wejściowa,

b) atrium dla dzieci i rodziców, c) atrium dla personelu, d) park przy szpitalu, e) schemat usytuowania przestrzeni objętych opracowaniem

(fot. R. Strojny, mapa: R. Strojny na podstawie google maps)

c e

Participatory design of healthcare spaces: The case of the University Children’s Hospital in Lublin 93

Fig. 2. Diagram of

the second stage of the study

(elaborated by N. Przesmycka)

Il. 2. Schemat przebiegu

drugiego etapu badań

(oprac. N. Przesmycka)

Fig. 3. Diagram of

the third stage of the study

(elaborated by N. Przesmycka)

Il. 3. Schemat przebiegu

trzeciego etapu badań

(oprac. N. Przesmycka)

Table 1. Summary of the basic characteristics and constraints of the analysed outdoor spaces at the University Children’s Hospital in Lublin

(elaborated by N. Przesmycka)

Tabela 1. Zestawienie podstawowych cech i uwarunkowań analizowanych przestrzeni zewnętrznych Uniwersyteckiego Szpitala Dziecięcego

w Lublinie (oprac. N. Przesmycka)

Space

Characteristics

accessibility area [m

] tall vegetation site furnishings / local zoning plan notes

1. Main entrance

area

publicly accessible;

public space

2900 none

Benches, an unused fountain, an informal smoking

area, and retaining walls. According to the local zoning

plan, the main pedestrian and bicycle route is to pass

through this area and connect with the route in Area 4.

2. Atrium

for children

and parents

accessible during

specified hours

500

one tree – an approximately

30-year-old spruce

wheelchair-accessible swing

3. Staff atrium

accessible

to staff only

80 none none

4. Undeveloped

area of

tall vegetation

publicly accessible;

public space

5200

approximately

30-year-old self-seeded trees

– lindens, maples, and ashes

No site furnishings. A well-worn informal path crosses

the area. According to the local zoning plan, part

of the site is designated for development,

with provision for a dedicated public space.

94 Rafał Strojny, Natalia Przesmycka

examples of solutions based on geometric and organic

spa tial design. A total of 87.5% of respondents preferred

organic forms, whereas 12.5% preferred geometric forms.

This trend was conrmed by further observations: among

the motifs the children “liked,” rounded, uid forms based

on curved lines predominated.

The children were then asked to draw or indicate the

desired elements within the atrium space. To this end, sim-

plied oor plans and sketches of characteristic views of

the spaces under study were provided for the children to

complete on their own. Children who, for various reasons,

were unable to draw or write on their own were assigned

an assistant – an architecture student – who acted as the

“child’s hand” without suggesting any solutions. Analysis

of the results revealed a clear predominance of elements

related to user comfort and spatial safety. The most import-

ant elements (as indicated by the children themselves) were

considered to be basic amenities such as benches, soft sur-

faces, a covered area, and tables for parents (Fig. 4). Inter-

estingly, these elements were chosen by the children over

playground equipment (swings, slides, merry-go-rounds,

etc.). Among the “organizational” suggestions regarding the

space were also: an outdoor movie theatre, a games area,

and a cat house. Subsequently, all submitted proposals were

compiled, and their importance was veried in a survey in

which participants again indicated their preferred elements

of the space.

The results indicate that users primarily expect condi-

tions conducive to rest, safety, and the presence of a care-

giver. Recreational elements appear further down the list.

This is consistent with the ndings from EBD research,

which emphasize the importance of opportunities for rest,

a sense of control over the space, and social support in re-

ducing stress among users of medical facilities (Ulrich et

al. 2008). Similarly, Marcus and Sachs (2013) and White-

house et al. (2001) highlighted the important role of seating

areas, shelter from the elements, and spaces that facilitate

recovery within the hospital environment. The workshop

results thus conrm that children’s needs are not limited to

play but also include comfort and passive rest.

• The importance of recreational and social functions

In addition to the basic elements, recreational and social

functions also played a signicant role. Among the most

frequently mentioned were simple play equipment, such as

swings, slides, and merry-go-rounds, as well as more com-

plex features, such as a mini-adventure course, an outdoor

movie theatre, and game areas. Importantly, some of these

suggestions – such as an outdoor movie theatre or food

service areas – go beyond the standard solutions typically

found in healthcare facilities. During the discussion, many

children pointed out the need for a food service option in

the studied space – such as a stand selling ice cream, ke-

babs, or pizza – but because these options were not feasible

within the project constraints, this expectation was not in-

cluded in the list of preferences.

These results are consistent with research on paediatric

environments, which emphasizes the importance of play,

activity, and social interaction for reducing stress and sup-

porting children’s emotional and social development during

hospitalization (Del Nord 2006; Jamrozik-Szatanek 2017;

Bock et al. 2021). From an EBD perspective, these func-

tions can promote positive distraction and social support

(Ulrich et al. 2008). Requests for an outdoor movie theatre

or a dining area thus point to the need to normalize every-

day experiences, although they do not constitute indepen-

dent evidence of the therapeutic impact of these solutions.

• The role of sensory stimuli

An important aspect highlighted by study participants

was the impact of the space on the senses. Respondents

noted the signicance of water features (fountains, pools),

scents (owers, grass, food aromas), and the sounds of na-

ture (birdsong and rustling leaves). At the same time, they

Fig. 4. Children’s preferences

in selecting elements

of the space – summary

(elaborated by N. Przesmycka)

Il. 4. Preferencje dzieci

w wyborze elementów

przestrzeni – zestawienie

(oprac. N. Przesmycka)

Participatory design of healthcare spaces: The case of the University Children’s Hospital in Lublin 95

more dicult to reconcile the types of spaces (enclosed,

open) preferred by children of dierent ages, as interests,

goals, and activities that can be planned in a given envi-

ronment change with age. Children’s prior experiences with

a specic type of space are also particularly important, as

memories of the social and individual activities undertaken

there inuence environmental preferences and the evalua-

tion of a place (Del Nord 2006).

The results obtained are consistent with studies indicating

that children more often choose bright and saturated colours,

although these preferences depend on age, gender, and prior

experiences (Boyatzis, Varghese 1994; Child, Hansen and

Hornbeck 1968; Del Nord 2006). However, the aesthetic

preferences reported cannot be equated with the therapeutic

eects of specic colours. Research in the eld of EBD indi-

cates that the perception of colour also depends on the inten-

sity and hue of light, contrast, the function of the space, and

the overall level of environmental stimulation (Lindahl et al.

2023). The participants’ preferences were therefore treated

as one of several design considerations and were assessed

alongside the need to ensure visual comfort, limit sen-

sory overload, and accommodate children of dierent ages.

Second workshop – evaluation

• Results of the evaluation of design alternatives

Based on the rst workshops (Fig. 6a, b), design con-

cepts were developed that clearly illustrated solutions for

the four selected spaces. Eorts were made to incorporate as

many of the children’s suggestions from the rst workshops

as possible, nding a place for them in various spaces: the

main entrance area (1), the atrium for children and parents

(2), the atrium for sta (3), and the area of tall, undevel-

oped greenery – a park with a playground (4). The design

ferences emerge – girls are more likely to choose pink and purple, while

boys are more likely to avoid pink than to actively prefer blue (LoBue,

DeLoache 2011).

emphasized the role of greenery, art, and the presence of

animals as features perceived by participants as contribut-

ing to well-being.

The results obtained are consistent with research on the

restorative eects of nature and the design of therapeutic

environments. Ulrich et al. (2008) indicated that contact

with nature and positive environmental stimuli can reduce

stress, while Kaplan and Kaplan (1989) emphasized the

restorative potential of natural environments. Marcus and

Sachs (2013) and Whitehouse et al. (2001) also highlighted

the importance of vegetation, water, and multisensory ex-

periences in hospital spaces. The workshop ndings thus

support the call for integrating natural and artistic elements

while maintaining a balance between stimulation and op-

portunities for quiet and rest.

• Formal preferences – colours and shapes

An analysis of aesthetic preferences revealed a clear pre -

ference for bright and vivid colours, such as pink, blue, and

green. None of the children selected brown or black. In terms

of spatial forms, organic and uid shapes dominated, being

preferred signicantly more often than geometric patterns

(Fig. 5). This nding is consistent with broader, earlier stud-

ies showing that children more often choose bright, vivid

colours (blue, red, pink) and are less fond of dark or neu-

tral colours (brown, grey, black) (Boyatzis, Varghese 1994).

However, children’s colour preferences are not xed. Re-

search suggests that younger children prefer more intense

and warmer colours, while interest in cooler and more sub-

dued colours increases with age (Child, Hansen and Horn-

beck 1968). In light of these ndings, greater variation in

colour preferences could be expected within the present

group of children aged 9–17 than in the preschool-age

groups described in some earlier studies

. It proves even

A frequently studied aspect of children’s color preferences con-

cerns gender-related dierences in preferences for pink and blue. The

results show that around the ages of 2–3, more pronounced gender dif-

Fig. 5. Popularity of

selected shapes and colours

(elaborated by N. Przesmycka)

Il. 5. Popularność wybranych

kształtów i kolorów

(oprac. N. Przesmycka)

96 Rafał Strojny, Natalia Przesmycka

concepts were printed on presentation boards, with three

alternatives presented and discussed for each space. The

presentations were followed by a discussion. Each partic-

ipant (patients, parents, sta) could select their preferred

concepts and provide qualitative comments on the pro-

posed solutions (Fig. 6c). As a result of the evaluation stud-

ies, preferred variants were identied for each space. The

concepts presented below received the highest ratings.

The selected design concept for the main entrance area

aimed to emphasize its prominent and welcoming charac-

ter while transforming part of the space into an additional

waiting area. An intimate and contemplative atmosphere

was sought through the introduction of site furnishings and

landscape elements, including benches, a pergola, planters

with ornamental plants, and the restoration of the fountain.

An important element was the variety of surface materials.

The use of colour in this space was limited due to its formal

character.

The concept selected for further development – a large

atrium for children and parents – featured a clear spatial

layout based on preserving the existing tree and introduc-

ing varied surfaces: a covered wooden terrace, exible sur-

faces around the play equipment, and a sunken sandbox.

Seating areas were integrated into the low walls separating

the technical zone and arranged under the canopy. Several

playground structures were proposed (a rocker, a swing),

as well as those that can simultaneously support rehabilita-

tion (climbing frames, balance beams). The terrace canopy

incorporated colourful, translucent elements, allowing the

space to be used even in inclement weather.

Among the presented park development concepts, the

participants selected the version based on minimal interfer-

ence with the site, incorporating natural materials (wood),

and featuring a clear functional layout: an entrance area,

zones for active recreation and passive rest, and play-

grounds. An important element was the variety of seating

options: ranging from classic benches to amphitheatre-style

seating and the option to sit directly on the ground.

The smallest of the spaces studied – the sta atrium

– was treated as a relaxation area with access restricted

exclusively to this group of users. To reduce the atrium’s

perceived height, elements were designed to partially cov-

er and shade it, while also serving as a support structure

for climbing plants. Due to underground utilities and the

resulting inability to plant directly in the ground, planting

was limited to ornamental vegetation in planters. Despite

the complete exclusion of patients and their families from

using this area, it is visually “accessible” from the general

circulation spaces for all user groups, hence the desire to

incorporate attractive forms of decorative greenery.

The process of selecting design alternatives demonstrat-

ed the usefulness of the research method, enabling a transi-

tion from general preferences to specic design decisions.

The use of design alternatives proved to be not only a de-

sign tool but also an essential element of the research pro-

cess, allowing users to evaluate realistic spatial solutions.

• Implementation

Based on the concepts and following an evaluation con-

ducted during the second participatory workshop, specic

design guidelines were formulated. Based on the presented

concepts, the hospital administration identied two areas

for implementation: the main entrance and the patient atri-

um. Students from the “Architecture of Health” Research

Fig. 6. Selected drawings by children from the workshops: a) one vision of the space, including an outdoor movie theatre, b) another vision

of the space with an area for animals and food service facilities, c) one of the design concepts selected for implementation by the largest group

of patients and parents, created by architecture students G. Kucharska and K. Łęczycki – one of the methods used to select the concept involved

sticking yellow sticky notes with comments onto the design boards (photo by R. Strojny)

Il. 6. Wybrane rysunki dzieci wykonane podczas warsztatów: a) jedna z wizji zagospodarowania przestrzeni, obejmująca kino plenerowe,

b) wizja przestrzeni z miejscem dla zwierząt oraz zapleczem gastronomicznym, c) jeden z projektów wybranych do realizacji przez największą

grupę pacjentów i rodziców, autorstwa studentów architektury G. Kucharskiej i K. Łęczyckiego – jedną z metod wyboru koncepcji

było umieszczanie żółtych karteczek samoprzylepnych z komentarzami na planszach projektowych (fot. R. Strojny)

a b c

Participatory design of healthcare spaces: The case of the University Children’s Hospital in Lublin 97

Fig. 7. Selected design variants for each space – the entrance area, the atrium for children and parents, the atrium for staff, and the park adjacent

to the hospital (elaborated by P. Pasik, N. Łukasiewicz, M. Łęcka, K. Marchewka, W. Moczoł, K. Łęczycki, G. Kucharska, I. Bulavina, M. Kołodziejczyk)

Il. 7. Wybrane warianty projektów dla każdej przestrzeni – strefy wejściowej, atrium dla dzieci i rodziców, atrium dla personelu oraz parku przy

szpitalu (oprac. P. Pasik, N. Łukasiewicz, M. Łęcka, K. Marchewka, W. Moczoł, K. Łęczycki, G. Kucharska, I. Bulavina, M. Kołodziejczyk)

Club at the Faculty of Civil Engineering and Architecture

of the Lublin University of Technology developed detailed

design plans, which were submitted to the hospital. Based

on these plans, tenders will be announced as funding be-

comes available. Regarding the area of tall greenery adjacent

to the hospital – the hospital park zone – the hospital com-

missioned a design, including playground equipment, from

a manufacturer (Stowarzyszenie Przyjaciół USzD 2025)

98 Rafał Strojny, Natalia Przesmycka

parallel with the conceptual work. The presented solution

was not subject to consultation or broader discussion. The

centrepiece of the playground will be a slide shaped like

a lighthouse. The project’s creators explain the idea as fol-

lows: The light of a lighthouse always serves as a guide

to a safe place, despite the turbulence and storms at sea.

And often, the healing process is like a vast ocean of raging

waves, from which a majestic tower with a light emerges –

the child’s return to health (Pop 2024; Szczebiot 2025). The

colours preferred by children are usually bright, saturated

hues with positive emotional associations; however, eec-

tive design of therapeutic spaces requires balancing visual

appeal with the need to limit sensory overload. This latter

condition is quite dicult to meet if the design relies on

the selection of ready-made elements (such as playground

equipment) while limiting the use of natural building ma-

terials. The analysed playground design does not provide

dedicated areas or amenities for passive recreation and rest,

nor does it reference the natural elements present in the

park in any way. Fundraising eorts for the playground’s

construction are currently ongoing.

Conclusions

The described process involves pre-design analyses

aimed at developing optimal solutions for the design of

healthcare spaces, in which identifying user preferences, ex-

ploring design alternatives, conducting survey evaluations,

and preparing for implementation formed a single, coherent,

planned research-and-design cycle.

The ndings were consistent with previous research indi

cating that the physical environment can shape patients’ ex-

periences and that paediatric users have specic age-related

and developmental needs. The present study did not assess

clinical or psychological outcomes; rather, it identied us-

ers’ preferences and translated them into design consider-

ations. The participatory process indicated that involving

users can help identify needs that may be dicult to capture

using standard design methods alone. The results indicate

that children expected hospital outdoor spaces to provide,

above all, safety, comfort, and opportunities for rest, while

play-oriented and recreational features were of secondary

importance. Sensory elements, contact with nature, physical

activity, and the creation of environments that facilitate the

normalization of daily experiences during hospitalization

were also important to participants.

The methodology employed – which included identify-

ing user preferences, developing design alternatives, eval-

uating them, and preparing solutions for implementation

– demonstrated the usefulness of the participatory model for

identifying user needs and translating them into design al-

ternatives. The research ndings indicate that design carried

out in collaboration with users can contribute to the devel-

opment of more responsive, user-friendly, and health-sup-

portive hospital environments that meet the actual needs of

children, parents, and medical sta.

Acknowledgments

The authors would like to thank the administration and sta of the Uni-

versity Children’s Hospital in Lublin for enabling this research, as well as

the students of the “Architecture of Health” Research Club for preparing

the graphic materials and providing organizational support for the study.

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Streszczenie

Partycypacyjne projektowanie przestrzeni ochrony zdrowia

na przykładzie Uniwersyteckiego Szpitala Dziecięcego w Lublinie

W artykule przedstawiono proces partycypacyjnego projektowania przestrzeni ochrony zdrowia na przykładzie Uniwersyteckiego Szpitala Dziecię-

cego w Lublinie. Skoncentrowano się na opracowaniu wytycznych projektowych dla przestrzeni zewnętrznych wspierających potrzeby pacjentów pe-

diatrycznych, ich rodzin oraz personelu medycznego. Punktem wyjścia była obserwacja, że istniejące przestrzenie przyszpitalne często nie odpowiadają

współczesnym wymaganiom użytkowników oraz założeniom środowisk terapeutycznych. Celem autorów badania było sprawdzenie, czy zastosowanie

metod partycypacyjnych oraz założeń Evidence-Based Design umożliwia skuteczniejsze rozpoznanie potrzeb użytkowników i prowadzi do opracowania

bardziej trafnych rozwiązań przestrzennych.

Badania przeprowadzono w latach 2024–2025, wykorzystując metodologię action research łączącą diagnozę, współprojektowanie, ewaluację oraz

przygotowanie rozwiązań do wdrożenia. Proces obejmował analizę istniejących przestrzeni, warsztaty projektowe z udziałem dzieci, opracowanie

wariantów projektowych oraz ich ewaluację. W warsztatach uczestniczyli pacjenci oddziału rehabilitacji, rodzice oraz personel medyczny. Zastosowano

wywiady, badania preferencji oraz działania rysunkowe realizowane na przygotowanych wcześniej rzutach i wizualizacjach przestrzeni.

Uzyskane wyniki wskazują, że użytkownicy oczekują przede wszystkim przestrzeni zapewniających bezpieczeństwo, komfort i możliwość odpo-

czynku, a dopiero w dalszej kolejności funkcji rozrywkowych. Szczególne znaczenie miały elementy związane z naturą, zielenią, bodźcami sensorycz-

nymi oraz możliwością aktywności i integracji społecznej. Młodzi pacjenci preferowali jasne kolory, organiczne formy przestrzenne oraz rozwiązania

umożliwiające wielozmysłowe doświadczenie przestrzeni. Na podstawie uzyskanych rezultatów potwierdzono, że partycypacyjne projektowanie śro-

dowisk ochrony zdrowia pozwala lepiej identykować potrzeby użytkowników i może prowadzić do tworzenia bardziej przyjaznych, terapeutycznych

oraz funkcjonalnych przestrzeni szpitalnych.

Słowa kluczowe: projektowanie szpitali dziecięcych, partycypacja dzieci, architektura ochrony zdrowia