Based on “Design With Nature: An Integrated Design Approach to the Environment of Care”, a presentation at HEALTHCARE DESIGN.06, November 5, 2006, in Chicago by Jerry Smith, ASLA, LEED AP, Senior Associate, The HOK Planning Group, Chicago; Geoffrey Roehll, ASLA, Vice-President, Hitchcock Design Group, Naperville, Illinois; and Laurel Macdonald Bonnell, ASLA, Principal, Macdonald Environmental Planning PC, Portland, Oregon

The phrase “design with nature” was first coined by the late Ian McHarg in his 1969 book of the same name on the environmental effects of site design and land use planning. The concept has been resonating throughout the design community since its inception and has become integrated into the basic tenets of healthcare design.

Over the past 25 years, environmental and social researchers, behavioral psychologists, and design professionals have published hundreds of research documents detailing their metrics and observations on health/nature-related outcomes. This work has been supported largely by philanthropic foundations such as the Robert Wood Johnson Foundation and the Merck Family Fund and sponsored by nonprofit organizations like The Center for Health Design. This growing body of work has provided a platform for site-design concepts and therapeutic principles of nature to become an integral part of the healthcare design process.

Recent Guidelines

Recently, two significant design guidelines have been released that provide the latest and foremost recommendations for design and construction within the healthcare design industry. These documents provide new sections and language that support incorporating direct access to nature as a recommended best practices design parameter. During the presentation at HEALTHCARE DESIGN.06, Jerry Smith, ASLA, LEED AP, of The HOK Planning Group—who is also on the Environmental Standards Council of The Center for Health Design and the Steering Committee of the Green Guide for Health Care (GGHC)—presented a brief review of these guidelines:

Defining the Healing Environment

“Therapeutic garden design” is helping shape future development for many healthcare facilities and retirement communities, yet very few understand what this phrase really means. According to Geoffrey Roehll, ASLA, of Hitchcock Design Group, “therapeutic or healing environments expand upon a holistic approach to healthcare that addresses one's physical, psychological, and emotional well-being through a commitment to the overall healing experience”. This holistic approach goes beyond the traditional method of patient-centered care and responds not only to the patient and residents, but to staff, families, and visitors. This commitment can be carried out in many forms.

“Therapeutic”, “enabling”, “restorative”, “rehabilitative”, or “spiritual” are terms often associated with these spaces, but these terms do not clearly define for whom or for what these spaces are intended. Simply stated, a healing environment is intended to elicit a positive or healthy outcome upon the user. The design and the elements incorporated will depend upon the users and how they are to interact with the space. Whatever the case, a responsible mix of elements that responds to a variety of users and program opportunities is vital to success.

Establishing the elements of a healing environment and the promotion of physical, psychological, and emotional well-being requires a basic understanding of the users and the surrounding facility. Offering amenities that provide choices and challenges within a garden may be appropriate at a rehabilitation hospital in the form of stairs and ramps that can be used for physical therapy and the restoration of body functions. The psychological health of the user is important in settings such as an ICU or skilled care where the patients, families, and staff are often subject to high levels of stress.