Marberry: Your landmark study, “View through a Window May Influence Recovery from Surgery,” that was published in the journal Science in 1984 is still referenced today by many in the industry. What was the impact of that study on your career?
Ulrich: Over time, it has been considerable. The Science article got a great deal of media coverage-it was covered worldwide and in all major wire services, and was the medical news of the week.
One of the gratifying things about the study is that in recent years, several medical researchers working independently have reproduced the main results. In other words, the findings hold up when tested by others. There is quite an active area of medical research today that uses nature distraction to reduce pain. Most of these studies are rigorous; virtually all have reported significant pain-reduction effects; and all cite the window view study as a starting point. But the study could not exactly be duplicated today because the same type of patient-gall bladder surgery patients who spent seven days in the hospital-doesn't exist anymore because the procedure has become less invasive and stays are much shorter.
Marberry: So that study has had not only an impact on you and your career, but also on the healthcare and design industry as a whole?
Ulrich: There were early adopters, such as Derek Parker at Anshen+Allen, who implemented design ideas around nature in the Lucile Packard Children's Hospital at Stanford. By the late 1980s and early 1990s, other architects had begun to implement the research, but it was still more the exception than the rule.
Beginning about 1990, The Center for Health Design's activities encouraged adoption of ideas in the study, as did growth of the healing environments movement, which evolved later into the evidence-based design movement. The research gained more momentum from the fact that mind-body medical science was developing rapidly and confirming that patient stress and emotional states affect clinical outcomes.
Initially, medical audiences I spoke to in the 1980s listened politely, though probably some were dubious and did not really accept the findings. But today, after so much progress in mind-body medical research, few would seriously question the notion that if an environmental design intervention is shown to reduce patient stress, then it could also foster better clinical outcomes. The idea that stress-reducing interventions improve clinical outcomes has become mainstream knowledge that medical students learn.
Marberry: Let's talk about the term “evidence-based design.” I've always believed that the first time it was ever in print was when Colin Martin, a reporter at The Lancet, interviewed you in 2000. So, did you coin the term?
Ulrich: I did mention it during the interview, but don't believe that sole credit should go to me for its origin. Some of my colleagues on the board at The Center for Health Design at the time deserve part of the credit. I do recall thinking during the interview, though, that “evidence-based design” might resonate more with that reporter and the audience of a world-class medical journal than a more subjective-sounding term, such as “healing environments.”
Marberry: In the 1990s, you were talking and writing a lot about supportive design or psychologically supportive design. That's the same thing as evidence-based design, isn't it?
Ulrich: Yes, it was an early attempt to define this concept. At that time, there was very little rigorous published science, so I wrote a paper in 1991 called “A Theory of Supportive Design.” It began with the premise that it would be desirable to have evidence-informed design guidelines flexible enough to be adapted to the specifics of individual design projects. Because there was an absence of directly relevant research at that time to underpin such guidelines, I searched through research literature in health-related fields-such as health psychology, environmental psychology, and so on-and from this, identified three broad principles that were supported by a large body of scientific knowledge.