Biophili literally translates to “love of life” or “love of living systems” and describes the universally instinctive human attraction to the natural world. It manifests as our reaction to the environment around us. By now, architects do not require evidence-based design to explain the benefits of incorporating nature into projects. It's commonly accepted that the provision of natural views in hospital rooms speeds healing, and abundant daylight in the workplace reduces absenteeism. Correspondingly, views of built environments (parking lots or adjacent structures) heighten anxiety, and a lack of natural light can increase depression.

Using design to comfort is especially significant in healthcare. The new Partners for Urology Health facility in Austintown, Ohio, is a joint venture between two urology practices and the Humility of Mary Health Partners (HMHP) radiation department. Since visiting a doctor can be stressful under the best of circumstances, this collaboration began by envisioning a welcoming environment where a physician can both diagnose and treat a patient, thereby reducing anxiety that can be present before the patient even sees the doctor.

The design was thus initiated with the desire to create a space with a calming, reassuring atmosphere focusing on the experience of the patient throughout the healthcare journey. By referencing biophilic knowledge, the design logically incorporated sustainable attributes. After discussion with the architect early in the process, the owner decided to seek LEED certification.

LEED encourages the use of daylighting. Although ancient Egyptians worshipped the sun, and Roman citizens frequented solariums for health purposes, in this age of high UV sun block, holes in the ozone layer, and skin cancer, the dangers of sun exposure are well known. Enjoying sunlight through glass windows, however, reduces exposure to harmful UV rays while still allowing other health benefits. Historically, sunlight has been used to speed up the healing of wounds; cure acne, jaundice, and rickets; and kill bacteria such as tuberculosis. A 2009 Australian study has linked myopia to a lack of sun exposure. The correlation of sunlight and depression is well-documented; the body responds to daylight by increasing levels of the hormone serotonin (which acts like an antidepressant) and decreasing melatonin (which regulates sleep). Less well known is that this reaction also occurs in people not suffering from depression. Simply put, sunlight makes everyone feel better!

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Therefore, a significant design goal was to provide maximum daylight for interior areas. The resulting 13,600-square-foot design is a light-drenched layout with soothing views from every possible space. Two urology practices share the east side of the building and boast sunny waiting areas, exam rooms, offices, and other auxiliary spaces. The shared staff space is nestled between the two practices and relies on borrowed light streaming through the waiting area windows and corridor clerestory glazing.

Doors leading to interior areas employ translucent glazing, simultaneously allowing daylight and discretion. This detail is successfully repeated at the perimeter exam rooms and interior staff room, providing the necessary combination of diffused light and privacy. The glazing selection has an optimum U value to reduce heat loss, assuring that the plentiful windows do not add prohibitive cost to the HVAC system.

HMHP inhabits the west side with spaces similar to those at the east, as well as a CT scanner room, linear accelerator vault, and the accompanying control areas. The spacious sunny waiting area at this side incorporates an education station for the convenience of the visiting patients. The east and west sides are united by a main corridor spanning from the soaring main south vestibule to a similar employee entrance at the north end. The passage connects all three open waiting areas that are situated around central public facilities and a recycling area. The entire corridor from south to north rises to a 21-foot ceiling and features curtainwall glazing at the vestibules with clerestory windows over the lower roof along the west side. The linear orientation of the corridor invites an unbounded view directly through the building.

Openness of a facility can run contrary to other design parameters. The 1996 Health Insurance Portability and Accountability Act (HIPAA) set rules about the privacy and security of health information. The reduction of sound transmission is especially crucial in healthcare environments, where employees discuss sensitive issues among themselves or with patients. Although the main corridor has a high, hard ceiling, in other spaces the owner chose an acoustic ceiling tile with a good noise reduction coefficient. This tile works in conjunction with partitions that either extend to the deck or rise above the ceiling to attenuate noise, while carpet throughout the semipublic areas helps to dampen sound. Both the ceiling tiles and carpet contain recycled content that contributes towards LEED credits. Even better, both products come with guarantees of reclamation, meaning when they need to be replaced, the respective companies will retrieve and recycle the ceiling tiles or carpet into something new.

Another design opportunity was at the radiation areas. Because of the functional constraints of the CT scanner and linear accelerator room layouts, no exterior glazing is possible. These two rooms (and the flanking spaces that accommodate the monitors) rely on the ability to strictly control the lighting within. To alleviate any restrictive feel in these spaces, both rooms incorporate “sky ceilings” above the procedure beds. These combine light fixtures, ceiling grids, and realistic translucent photos of the sky to create virtual skylights.

In order to provide employees with natural light and an awareness of the passage of time, the CT scanner, linear accelerator, and adjacent control rooms surround an expanded connecting corridor containing a real skylight. This corridor is open to the control rooms and the skylight is close enough to assist the circadian rhythm while remaining separate enough to ensure light levels within the control room are unaffected. It is also a conveniently located area that can be enjoyed between patient appointments. To complement the natural light, a life-sized photo mural of trees covers the entire wall under the skylight.

The arrangement of glazing throughout the facility allows for a unique experience of light and shadow as the sun makes its daily journey. To the delight of the architect, during construction, the foreman mentioned that workers had enjoyed the ever-changing play of light throughout, meaning the project has contributed to a pleasing work environment since the erection of the walls.

Tropism is the instinctive reaction in response to stimuli (phototropism in flowers causes them to turn towards the sun). While some visitors will be drawn toward the interplay of light and shade there are also those with innate reactions to reject this stimuli. For those users, light and glare can be addressed by easily operated visually transparent roller shades at the windows, as well as convenient light switches controllin
g discrete areas of the building.

If selected with care, light and color can create a wonderful rapport, using the progression of sunlight to generate a gently fluctuating mood within a space. For Partners for Urology Health, the design draws on the relationship between the earth and sky. The palette originated with three complementary patterns of carpet tile for back-of-house areas in a muted sage green with supporting accents of darker cerulean. Sheet vinyl in public areas is a more durable material, while the bamboo finish presents a natural look. Bamboo's pale shade translates to a high reflectivity and good overall brightness.

Paints with low volatile organic compounds (VOC) were selected in warm understated buff colors with hints of subtle greens. Varying blue shades from high noon to deepening evening contrast with the more understated tones for a perceptible punch of color, without being garish or overwhelming. The furniture repeats the relaxing color scheme and the fabrics introduce striped and circular patterns for accent.

The theme of trees and skies is also evident in the selection of photographs throughout. The artwork is more vivid, with a wider range of more saturated colors. Because of the type of facility, the designers made the decision to forgo artwork with references to water. Although more difficult to quantify, blue hues were chosen with care to refer to sky more than sea. Cooler grey accents make the facility more business-like than residential, although it does not feel antiseptic.

Users may not enjoy a sterile color palette, but air quality is another matter. Selecting materials that do not negatively affect the indoor air begins with adherence to LEED requirements. Every day it becomes easier to find products that emit no or low VOCs, now that it has been proven that these compounds have been related to types of cancer, eye irritation, compromised immune systems, and other health problems. Paint and carpet as well as the accompanying adhesives and sealants, must comply. Wood or other agrifiber items can contain no urea-formaldehyde resins (linked to fatigue, skin rashes, asthma, and allergies). However, there are always substances such as cleaning products, office supplies, and even the dirt on the bottom of patients' shoes that are impossible to keep out.

When the presence of pollutants can't be prevented, the design of the building can help alleviate the dangers. A good ventilation system goes unnoticed, cooling in the summer and heating in the winter. The best systems also address air quality, preventing employees from inhaling chemicals from a nearby copy room or from an adjacent housekeeping closet. To protect inhabitants, the mechanical engineer and architect must collaborate to identify potential issues and form a design to preclude them. This has become more important as buildings become more air-tight. A sealed building envelope means more energy efficiency, but it also means that sufficient ventilation and filtration are vital to prevent deterioration of the indoor air quality from the buildup of toxicities.

Solutions to these toxicity issues include LEED-acceptable concepts such as calculating adequate air exchanges, calling for partition enclosures around potentially hazardous areas, and providing easily maintained floor grates at vestibules. These methods create an efficient yet healthy indoor environment.

At the exterior of the building, you can see glimpses of soothing interior colors, while repetitive metal panels in a cool matte grey impart a simple, poised façade. Although orderly, the exterior is not tedious or sterile. Overhangs at the roof create shade at the interior, while differing heights allow the introduction of clerestory glazing and create an interesting progression in the overall massing of the building.

The site surrounding the facility is open, with spans of native grasses. The architects coordinated the site selection with the civil engineer to spare three older oak trees that are spaced along the front approach. These trees, with other deciduous ones throughout the site, provide an ever-changing backdrop as the seasons evolve. The existing flora will be augmented with other indigenous species of grass, trees, and foliage that require no irrigation. Besides providing a low-maintenance economical landscape, the site offers interesting, calming views from the building. Studies have shown that patients provided with views of nature had shorter hospital stays and took less pain medication than those given a view of a brick wall. Trees, grass, and flowers simultaneously distract and soothe without overstimulating.

The firm I work with stresses that the initial incorporation of natural elements shaped the project and led to the pursuit of LEED certification, not the other way around. However, once embraced, the LEED principles and parameters challenge designers to investigate methods of utilizing every possible component to contribute toward healing both people and their environment. Instead of not harming the environment, why not try to protect and enrich it? Instead of providing a facility for doctors, why not create a facility to assist doctors in their mission?

HMHP has been presciently responsible in their long-standing, system-wide policies such as regular maintenance plans and a smoking prohibition in all building or grounds. These policies demonstrate the dedication to the health of the members of the community, which is the foundation of their healing ministry. This fundamental HMHP philosophy is expanded and strengthened by the incorporation of LEED principles.

Strollo Architects identified natural elements and LEED requirements as two separate yet parallel philosophies, successfully bringing them together to create an instinctively appealing design that balances practical function with HMHP's overarching commitment to good health. This new facility demonstrates that economical construction can be attractive and quietly conscientious. It is not crucial that visitors are aware of the deliberation spent on every facet of this building; the building succeeds if the people who use it are positively affected. John Burroughs clearly expressed this universal human attraction to the natural world, this biophilia when he stated that he goes “to nature to be soothed and healed …” Now the patients of the Partners for Urology Health have the opportunity do the same. HD

Rebecca Tennant, ASID, IIDA, is an interior designer with Strollo Architects.

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Healthcare Design 2010 June;10(6):16-24