Published: 07/11/2002, Volume II2, No. 5830 Page 22 23

Calbert Douglas and colleagues are to be applauded for the superb study they conducted for NHS Estates, and for the summary article ('A room with a view', 17 October). But without mentioning the more broad context within which sustainable quality healthcare environments must be situated, the progress this work aspires to cannot be meaningfully achieved.

The aspiration that seems to have driven the study appears, from the comments in the closing paragraph, to focus on the formulation of a framework for guidance that '...can be used in assessing development bids to ensure that patient-friendly criteria and good practices are incorporated in all new hospital developments'.

The article neglects to discuss the critical importance of first investing in human-centred organisational development work. The key point is that the environment is an artefact of the organisational culture. A vital link exists between the environment and the organisational culture - the environment represents the cultural values, as well as supporting and reinforcing the desired behaviours of the organisation's work. Necessarily, any bid that does not contain a rigorous long-range training and development programme to vitalise this critical link will more than likely fall shy of its target.

Typically, in today's newer hospital developments where enhanced environments have been developed, the desired aspirations of the organisational leaders are not being realised.

This vital link between environment and culture is too sensitive to be achieved by a tick-box approach. The predictable consequence of this approach finds that the additional investment in the environmental enhancements is squandered after a few short years. This is most unfortunate.

Numerous exemplars have successfully forged this vital link and have achieved ongoing benefits, as well as a fair return on a prudent investment.

These benefits include the environment contributing to desired therapeutic outcomes, staff performance, patient and family satisfaction, and overall institutional financial performance.

Wayne Ruga Architect Manchester