You know all about the benefits of nature (whether experienced visually or up close and personal) on patient outcomes. It’s good for the staff, too, not to mention the neighborhood. But now, research is starting to take a closer look at what kind of nature promotes health and well-being the best. Is it smooth, golf-course-like expanses and meticulously arranged annuals? What about prairie-style vistas, with tall grasses waving in the breeze and wildflowers popping up (seemingly) at random?

Past research, not necessarily healthcare-specific, has suggested that we humans prefer our landscapes to be less “messy.” And that might be because wild-looking areas with tangled underbrush—and lots of places for scary things to hide—trigger our evolutionary survival instincts. But that doesn’t mean we always want putting greens, either. As other research shows, a sort of controlled chaos, where it’s clear that a loose interplay of plantings is on purpose and carefully tended, makes people pretty happy, too.

In the July 2013 issue of Healthcare Design, University of Denver adjunct professor Angela Loder and landscape architect Jerry Smith delve deeper into the research, including Loder’s own recent doctoral studies, and offer some thoughtful advice for how to approach natural spaces in healthcare settings. I won’t get into all the details here, but I was taken by Loder’s findings regarding the prairie-style green roofs atop Chicago’s city hall, and what they might mean to incorporating nature within urban facilities.

Her research showed that while some visitors found the space “beautiful,” many others “didn’t like the messy look of the green roofs and associated it with neglect.”As Loder and Smith explain in the article, “This supports work in the social sciences on the social and cultural impact on our values and perceptions of nature in the city … showing that ideas of modernity, progress, and sanitation mean we associate messy in the city with ‘bad,’ ‘unhealthy,’ and ‘poor.’”

Here’s the interesting part, though: The authors say that “participants who had close access to the wilder green roofs over time, and who could watch them change through the seasons, felt calmer; had better concentration, improved creativity for problem-solving, and a heightened sense of hope; and associated it with positive childhood experiences in nature. They also found that the wilder green roofs provided a respite from the fatigue of concrete, steel, and glass of the city.”

That makes a lot of sense to me, and it speaks to how complicated the notion of patient-centered design really is. Are the patients city folk or country folk? Do they need a break from grid-like order, or would they welcome it? How long are they going to be in the facility you’re designing? (Acute care green spaces may call for a different design strategy than those in longer-term facilities.)

So many factors. And so many opportunities. More personalized healthcare is where we’re headed, and I think our hospitals and outpatient centers will have to move further and further away from cookie-cutter aesthetics. The trend toward community building and localization speak to that, as well. The more we think about the patient’s point of view regarding every aspect of their care, the better—and more varied—our healthcare spaces will be. Careful attention to the natural landscape is a perfect place to make a statement everyone can appreciate.