Healing gardens aren’t a fad. One of the earliest healing gardens dates back to the 1100s. In a time before pain pills, St. Bernard’s hospice at Clairvaux Abbey in France featured a cloistered garden because he believed being in nature comforted his patients and reduced their suffering.

Do you need more than saintly intuition to answer the question, “Does a healing garden make sense for our facility?” Then consider the research. A 10-year study¹ indicates that surgical patients with a room that looks onto a natural setting—versus a brick wall—had shorter post-operative hospital stays, took fewer doses of pain medication, and didn’t have as many postsurgical complications.

Another study of a healing garden in a pediatric cancer center² showed that patients, family, and staff all experienced lower distress scores for anxiety, sadness, anger, worry, fatigue, and pain while in the garden. According to one of the authors, Roger Ulrich of Texas A&M University’s Department of Architecture, healing gardens can offer four benefits:

•  Clinical—Gardens can help lower blood pressure, reduce pain, and cut a patient’s length of stay.
•  Economic—The clinical benefits just mentioned mean gardens can reduce the cost of treatments and care, and lower the amount or dosages of pain medications used.
•  Patient/staff/family—Gardens can increase the satisfaction with the facility and its care for all of these groups.
•  Safety—When healthcare professionals spend three to five minutes in a natural environment, they emerge less fatigued and anxious, and make fewer medical and treatment errors.

Healing gardens can promote the health of patients and their families—in addition to the wellbeing and satisfaction of the staff. How can you make this work at the facility you design, own, or manage?

Tips for a truly healing garden

If you’re planning to add a garden—or already have one and want it to live up to its full potential—use these ideas to avoid the most frequent mistakes that can limit its benefits.

Provide easy access and circulation. Do your patients and visitors frequently require wheelchairs? If so, make certain 1) people can get into the garden (using ramps instead of stairs) and 2) the paths are wide enough to accommodate two wheelchairs side-by-side. You can’t imagine how often these simple things are forgotten—and reduce the use of a garden.

Offer 24/7/365 views. If you have winter, then your garden can have six months of bare trees. Using evergreens or seasonal evergreen clippings will make it more inspiring—even if people only see it through a window or a doorway. Also consider the view and lighting at night, when patients may be looking out, or staff and family may need an outdoor break.

Ensure the budget includes all key items. Designing and installing a garden shouldn’t require all the money you have. There is furniture to purchase, and regular maintenance and repair. Also, set aside funds for programs to keep it fresh throughout the year and get patients involved. For example, a senior center may want money for residents or guests to plant flowers there on Mother’s Day.

Watch designing by consensus. Often a committee is put in charge of developing a healing garden. Sometimes members can design the garden they think the healthcare organization needs. That leads to the next point.

Understand who uses the garden and what they need. Children want interactive spaces so they can play. Staff members want somewhere they can walk to take a quick break during the day—or a place away from patients so they can recharge. Patients and families want smaller areas for alone time or quiet talks, and larger spaces where everyone can be together. Healing gardens must have solitary and social spots that can accommodate a broad range of ages, abilities, and wishes.

Create a place—don’t just use a space. Sometimes organizations identify an empty space and decide to put a healing garden there. The position of a garden is very important. It needs to be a welcoming place that is integrated into the life of the people who use it, rather than parked in an area where nothing else is happening.

You’re a savvy facility architect, designer, administrator, or manager. Let’s say you have determined that a healing garden will truly benefit the people at a particular building—and you’re thinking about working with a landscape architect to create it. How can you pick the right one?

What to ask your healthcare landscape architect

If I were sitting on your side of the conference room table, interviewing professionals and then working with one, here are the questions I’d be asking.

How much experience do you have in healthcare?An excellent residential landscape architect understands how to design places for small groups. A great commercial landscape architect can develop spaces that are attractive but don’t necessarily invite involvement. Yours is a specialized field. Make certain the professional you select has some experience in creating healing gardens for the groups in your facility.

How will you identify what the people who will use our garden really want?Some groups will be easier to connect with (staff members, for example) than others (such as families visiting patients in a hospital). But the landscape architect should make an effort to interview representative groups or have them participate in questionnaires to gather this information.

How can you best use our budget for this garden?Your facility doesn’t have the unlimited resources you wish it did. A landscape architect should discuss several strategies to maximize them.

•          Developing a master plan that can be implemented in phases.This means you don’t have to spend all of the funds up front. And you can take the next steps as the money becomes available.
•          Designing a garden with lower maintenance costs. One example would be using native perennials in an outdoor garden. Because they literally grew up there, they require less water and care—rather than tropical plants that will die during the winter and need to be replaced each year.
•          Selecting the right hardscapes. These include furniture, pots, walls, etc. Your landscape architect should identify and make recommendations on the most durable and cost-effective—as well as attractive—products for your garden.

How well do you work with groups and deal with feedback?There are talented professionals who would love to sit in their offices and design your landscape but can’t make a compelling presentation to your committee or board. And without this, the effectiveness of their design ultimately will be compromised—and your garden will fall short of everyone’s vision.

There are other
great landscape architects who hand you a master plan along with a “take-it-or-leave-it” approach. Flexibility is called for on both sides. You’ll need someone who can tell you the ramifications of changing a design—and who fights for the elements that are important—but also deals in the realm of “what is possible given our circumstances. ”

How will you work with the team installing the garden?Some firms have their own installation groups and others work with contractors from another company. The last thing you want is to be stuck in the middle—while the clock is ticking and nothing is getting done. Ensure everyone involved in creating your garden has a good working relationship and a method to deal with any issues that arise.

How much will it cost to maintain our garden? Your landscape architect should have a good understanding of the maintenance techniques your garden will require. The annual expense for doing this should be included in your budget cost summary, so everyone knows what’s involved before the garden is installed.

A garden that shares your mission

Here’s something that staff, patients and families already know and you may not: They all equate the quality of your landscaping—in a healing garden or anywhere around your facility—with the quality of the caring they receive there.

If it takes a minimalist approach or looks unkempt, they won’t expect much. But if your landscape provides a welcoming environment, people perceive they will get a better level of treatment. Take a walk around the facility’s grounds and ask yourself what they say about your organization.

As a healthcare leader—or someone who advises them—you evaluate a number of options for increasing safety and improving the quality of care. Working with a landscape architect to develop the right healing garden has benefits for everyone who passes through your facility: the patient who needs less pain medication and has a shorter stay, the family member who wants a cheerful setting, and the busy nurse who could use a quick break while walking between departments.

If St. Bernard were here today, he’d tell you that nature can offer a greater return on your investment than taking a pain pill.

Shannon Mitchell, RLA, is a project landscape architect for Mariani Landscape in Lake Bluff, Illinois. He may be reached at smitchell@marianilandscape.com.

References

¹  Ulrich, Roger. “View Through a Window May Influence Recovery from Surgery,” Science, April 27, 1984.

²   Sherman, Sandra; Varni, James; Ulrich, Roger; Malcarne, Vanessa L. “Post-occupancy Evaluation of Healing Gardens in a Pediatric Cancer Center,” Science Direct, 2004.