As part of its ongoing expansion and effort to continue to create outdoor environments that promote healing, Shady Grove Adventist Hospital in Rockville, Md., took one of its open spaces—a rooftop—and transformed it into the Barbara Truland Butz Healing Garden.  

And right from preliminary planning meetings with the hospital, Oasis Design Group (Baltimore) found the project took on a life of its own. 

“Shady Grove Adventist Hospital believes in whole person care and in the healing power of the outdoors,” says Will Smith, chief development officer at Shady Grove Adventist Hospital. “We wanted to create a safe, tranquil, and accessible outdoor environment. Everyone involved in the creation of the garden worked together to create a welcoming sanctuary for patients, their families, and other visitors to the hospital. There are different pockets or areas within the garden that inspire, renew spirits, and bring a sense of peace, serenity, and healing.” 

To accomplish this goal, the landscape architects facilitated the design process and collaborated closely with the building’s original architect, Wilmot Sanz, and structural engineer, Cagley & Associates, to retrofit the existing roof to accommodate the garden.

Use a collaborative design process
During this process, the team discovered that as part of the initial design of the building just five years prior, the architects and Shady Grove had planned for an eventual garden being built in its location, so modifications to the structure were minimal. 

However, roof membrane interfacing, shade structures and water feature detailing, and mechanical and electrical services all required close coordination among the design professionals. Oasis' landscape architects collaborated with the roof provider to recommended modifications to the existing roof details to make provisions for the project, specifically drain locations and structure modifications, vent reconfigurations, and electrical and water source roof penetrations. 

During the design development phase of the project, the design team met with the surgeons and other staff to address concerns about the roof on nearby operating rooms, illustrating how the integrity of the roof membranes would not be negatively impacted but rather strengthened with the addition of the garden’s layers. In addition, the design team assisted the development group with its fundraising efforts.

A garden design promotes healing
The resulting garden today is located adjacent to the hospital’s fourth floor inpatient cancer care unit, where patients, visitors, and hospital staff have convenient access from a central area. The garden is visible from the unit’s patient rooms, a nurses’ station, and many rooms on the second, third, and fourth floors of the patient tower.

The Aquilino Cancer Center, which is scheduled to open in 2013 and be adjacent to the hospital, will also overlook the garden. 

Within the garden, two concentric circles represent the circle of life and include calming and restorative elements to encourage wellness and reduce stress. The outer circle symbolizes life itself and our individual journeys, while the inner circle represents healing and includes a water feature ensconced with earthen mounds planted with medicinal herbs—many of which are fragrant and provide sensory benefits with their scents, colors, and textures. 

The garden was designed to enable patients and visitors to have choices in their surroundings, especially with regard to seating. People may select to sit in the shade under a pergola, near a water feature, at movable tables and chairs, or in a separate meditation area.

Providing a variety of seating types, locations, and orientations gives visitors the chance to claim their own personal territory and develop a sense of ownership to the garden, which makes them feel safe and comfortable in the space. 

Two water features aid in cooling ambient air temperatures, and provide a soothing sound and a visual of water in motion. Within the garden’s inner circle, a central custom-made stainless steel shallow basin fountain serves as a hub to the four axis lines that divide the garden into quadrants.

A second, smaller water feature is a bubbler fountain in the meditation area outside the outer circle. The fountain bubbles from a small rock set in a simulated stream bed, created with repurposed gravel ballast that was removed from the former roof. 

Conclusions
Green roof healing gardens are a smart “green” business investment for hospitals because they contribute to a total healing and wellness experience and are a benefit to hospitals’ patients and their families, staff, visitors, volunteers, and friends.

Concurrently, they can minimize a building’s impact on the environment. With ever-increasing attention on sustainable building practices and people’s impact on the environment, this is one way to reduce a healthcare facility's footprint, while generating a high return on investment.

Scott C. Scarfone, ASLA, is principal at and founder of Oasis Design Group (www.oasisdesigngroup.com), a landscape architecture, urban design, and master planning firm in Baltimore. He can be reached at sscarfone@oasisdesigngroup.com. For more information on Shady Grove Adventist Hospital, please visit www.shadygroveadventisthospital.com.

SIDEBAR: Green building performance for the Barbara Truland Butz Healing Garden 

Green roof/garden stats:

1. 20,250 square feet
2. $1.4 million construction cost, or approximately $69.14/square foot. Financial donors paid for 100% of the Barbara Truland Butz Healing Garden.
3. June 1, 2010: installation completion date
4. Seven-month construction period
5. Fully accessible
6. Both intensive (73%) and extensive (27%) green roof systems utilized
7. 74% green space vs. 26% paving
8. 1,330 square feet shade provided
9. +/- $160,000 design fees 

Architectural elements:

1. Garden directly over operating room
2. Metal decking roof system with 6.25-inch concrete slab
3. Roof drains at the top of the slab/membrane
4. 40 lbs/psi dead load and 60 lbs/psi live load 

Building performance:

1. +/- 5-10% Db noise reduction (estimated)
2. Decrease roof membrane degradation
3. 30 to 40% water retention (with 6-inch media)
4. Aesthetic improvement
5. Decreased stormwater runoff
6. Zero heat island contribution
7. Captured green space