Hospitals and psychiatric institutions The regional government of Styria explained in a statement of opinion that the increased use and the extension of operating hours after 3.00 p.m. is an important goal. However, the organisational and commercial requirements make the implementation of this goal difficult. Nevertheless, the regional government stated that considerable work is being done to extend the operating hours. The long waiting times for planned heart surgeries are explained by the fact that patients are categorised and, if required, prioritised based on the urgency of their respective procedure. Prioritisation and the sequence in which surgeries are performed are conducted according to medical criteria exclusively. In order to be able to guarantee optimum cardio surgical care, surgery planning is carried out by the acting department head in close cooperation with an experienced senior physician since April 2019. Several improvements were observed in the Department of Child and Adolescent Psychiatry at Hietzing Hospital – Neurological Rehabilitation Centre Rosenhügel. Commission 4 praised the following measures in particular: the active information of patients in regard to any possible restrictions and other planned treatment procedures, the suitability of the recently adapted rooms, the creation of a specially secured terrace for the acute area, the all-day visiting hours and the more sensitive manner in which staff now deals with measures that restrict freedom. Improvements in the Department of Child and Adolescent Psychiatry of Hietzing Hospital There is now a good solution to complaint management in the visited department in the opinion of the NPM. Ward forums were established in which the young patients can address their problems and raise objections. The complaint system was expanded in the current period under review in order to better trace the efficacy of the agreed measures. Complaints letter boxes were installed for anonymous complaints. XX  The number of doctors who can arrange enforced hospitalisation should be increased by amending Section 8 of the Hospitalisation Act. XX  Sufficient financial means shall be provided for hiring more public medical officers. XX  More staff must be made available in psychiatric hospitals and departments in order to enable all patients to go outside regularly accompanied by a member of staff. XX  Measures for the promotion of patient participation shall be further expanded. Only in this way can it be guaranteed that patients can draw attention to their problems. 2.2.2 Spatial conditions - deficits and positive developments Environmental factors (e.g. climate, noise) and architectural conditions (e.g. private space in which to withdraw) have a considerable effect on the behaviour and well-being of people. Structural measures and design elements Structural design essential for care quality 46