Planetree was founded by a patient 25 years ago as a nonprofit organization to advocate for the patient's perspective in healthcare. Planetree's first demonstration site, opened in 1985, was a 13-bed medical-surgical unit in San Francisco, which brought together the design concept of a “healing environment” and a patient-centered approach to delivering care. A study of the unit by the University of Washington showed that patient satisfaction soared, and both nurse and physician satisfaction rates increased significantly.

Because of its success, this small demonstration unit formed the foundations of the Planetree Model, which is currently being implemented and practiced in more than 70 healthcare facilities, ranging in size from 29 to 2,000 beds and varying from rural community hospitals to urban-based tertiary teaching institutions. Many of these sites show similar results: higher patient and staff satisfaction with no significant increase in cost.

Because architectural and interior design is so highly visible, many people during Planetree's 25-year history have mistakenly thought that creating a healing environment was Planetree's primary goal. In fact, physical design is only one of the nine components of the Planetree Model. The other components include human interactions, empowering patients through information and education, recognizing the importance of families and friends, spirituality, use of human touch, employment of the arts, allowing for complementary therapies, and recognizing the importance of the nutritional and nurturing aspects of food.

The design component was never intended to overshadow the other components. Instead, design was seen as vital in how it supported and shaped the other, equally important, aspects of the Planetree Model. While design is important in itself, its greatest power lies in its ability to shape the context for patient-centered care; the built environment can support and influence behaviors and shape the actions, interactions, and activities that are part of a healing experience for patients (photo above).

Nevertheless, the design component is vital because it is so permanent and enduring. It is worth noting that for many Planetree sites, renovation or new construction is still years away, and it is indeed a challenge to deliver 21st-century care in buildings that are more than 100 years old. Yet many sites do provide patient-centered care in facilities where the physical design is not supportive of the human environment. Perhaps the greatest challenge of all, though, is to design today's health-care facilities recognizing that this may shape the context in which 22nd-century care will be delivered. We are designing not only buildings, but also the future of healthcare.

Certainly, healthcare has changed profoundly during Planetree's first 25 years. For example, in 1978—the year Planetree was founded by Angelica Thieriot—the design of most ICUs rarely included a chair to allow a family member to sit near the patient. ICU visiting hours were usually restricted to five minutes every hour, so sitting seemed unnecessary—despite the fact that those five minutes might have been the family's last moments with their loved one. Now, 25 years later, seating for families in ICUs is commonplace, and many critical care areas provide accommodations for a family member to stay overnight.
While design is important in itself, its greatest power lies in its ability to shape the context for patient-centered care.…

The Architectural Roots

The Planetree design concepts were developed at a time (the 1970s) and place (the University of California at Berkeley) that inspired many architecture schools to offer study tracks similar to UC Berkeley's “Social and Behavioral Aspects of Design.” The late Roslyn Lindheim, who was a professor of architecture at UC Berkeley, developed the architectural principles of the Planetree Model, working with colleagues S. Leonard Syme, PhD, an epidemiologist from Berke-ley's School of Public Health, and architect Christopher Al-exander, author of A Pattern Language: Towns, Buildings, Construction.

The Planetree design theory they developed is a synthesis of social-science research findings and information gathered from Lindheim's cross-cultural travels, as well as from later patient focus groups. Lindheim noted that the parameters of a healing environment encompassed the patient's experience of healthcare and included meaningful social connections, participation and control, a sense of being valued, and connection to nature.1 As the Planetree Model evolved, additional parameters focused on comfort, stress reduction, personal growth, and a sense of order.2

Lindheim emphasized that “the first premise of any healthy environment is that it must ‘do no harm’ to individuals, the community, the society, and the ecosystem.” She envisioned the Planetree Model as a response to the “disturbing trend” of having the paramount architectural issue be “not the most caring way to accommodate the needs of the sick, but how to build flexible forms to house constantly changing technology…accommodating mechanical rather than human needs.”1 While technology is vital to healthcare, Planetree design acknowledges human experiences—such as the high emotional con-tent of many life-and-death activities occurring in our hospitals, clin- ics, and medical offices—as they impact patients, families, and staff.

Finally, the importance of the symbolic messages (semiotics) communicated by design has led Planetree facilities to strive to achieve a homelike, familiar, domestic style. Imagery reflecting the culture in which we live may be incorporated into healthcare facilities—for example, as the healthcare industry focuses on patients as “consumers,” some facilities are adopting the look of shopping malls as familiar spaces in which to “shop” for healthcare.

Future Directions

Planetree design will continue to incorporate research findings on the effects of the environment, as well as information from ongoing patient, staff, and physician focus groups. Contributions by organizations—such as The Center for Health Design, whose research and data collection provide valuable resources in advancing the role of design—facilitate the process of expanding and refining the Planetree Model.

As Planetree looks to the future, incorporating the patient's perspective will continue to be at the forefront of its work. Areas for development include:

  • seeking additional opportunities to integrate family presence into ERs, ORs, and other critical-care areas without compromising other patients’ privacy.

  • developing supportive relationships and partnerships between patients, physicians, nurses, and other staff.

  • providing patients and families with access to information and education via computers and other developing technologies.

  • creating more spiritually nurturing spaces both inside and outside the facility.

  • providing access to a wider range of nurturing and nutritionally healthy food choices 24 hours a day.

  • providing spaces to accommodate visits by patients’ companion animals.

  • adding whimsical and playful spaces.

  • making wider use of art, music, poetry, and storytelling.

  • providing greater access to nature and views of nature.

  • integrating massage, acupuncture, aromatherapy, stress reduction, and a range of other complementary therapies into routine care.

  • providing refuges (lounges) that afford staff emotional and spiritual support.

  • emphasizing employee health, wellness, and stress reduction.

  • recognizing the role of architecture as a “complementary therapy,” in that it designs spaces that can be inherently healing.

  • providing greater opportunities for the involvement of volunteers and the community.

  • making use of environmentally friendly (“green”) concepts and materials.

  • incorporating natural light, windows that open, and ventilation systems that circulate fresh air.

  • focusing more on illness as a transformational opportunity.

Conclusion

Planetree was created to challenge each of us, whatever our role in healthcare, to rethink what healthcare facilities can, and should, be in supporting patient-centered care and promoting health and healing. Every time we design a hospital, clinic, physician's office, or long-term care facility, we have an opportunity to shape the future of healthcare. There is still much work to be done in defining that future. HD

Director of the Planetree Alliance, began her affiliation with Planetree 18 years ago as a nurse on the first Planetree Unit. Her most recent book is Putting Patients First: Designing and Practicing Patient-Centered Care (Jossey-Bass, 2003)
A senior architect with The Design Partnership in San Francisco, studied with Roslyn Lindheim, Planetree's founding architect, at the University of California at Berkeley.

  1. Lindheim R. New design parameters for healthy places. Places 1985; 2 ( 4 ): 17–27.
  2. Arneill B., Frasca-Beaulieu K. Healing environments: Architecture and design conducive to health. In: Putting Patients First: Designing and Practicing Patient-Centered Care. Frampton SB, Gilpin L, Charmel PA, eds. San Francisco:Jossey-Bass, 2003.