When we are at our most vulnerable, it is reassuring to know that nature is not far away—so much so that one might say it is instinctive to seek out the wild even when institutionalized in some form of long-term care. A hospital, a clinic, or a shelter makes for an attorney’s waiting room, to be sure. But an absence of nature makes it all too easy to picture a world where we’re easy prey for the opportunistic pathogens the built environment can harbor. Biophilic healthcare design is one answer: creating spaces that soothe, heal, and rejuvenate by integrating nature into every aspect of the built environment.
I have found some of the most compelling and effective examples in healthcare settings.
The inherent nature of healthcare settings makes them high-stress environments. Patients, families, and healthcare professionals live in a constant state of anxiety and pressure. For this reason, healthcare systems and spaces should be cultivating a healing atmosphere. They can do this, in part, by incorporating biophilic designs, which is what I am going to write about. I will relate the research that Aaron and I did on this topic during the summer; I will share some of the principles we uncovered, a couple of remarkable models, and some personal insights. Then I will conclude this article with a brief illustration of what a biophilic space might look like and a couple of examples of natural elements that could be incorporated into a healthcare setting.
The Healing Power of Nature: An Ingrained Bond
Biophilic design is a powerful tool for creating healthcare settings, and the reason for this lies in the deep and instinctual connection humans have with nature—a connection that soars to the level of nurturing. This link goes far beyond a mere appreciation of nature as beautiful or even enjoyable. We are hardwired to find not just comfort, but also safety and satisfaction in natural environments, and we are now on solid scientific ground when we say that spending time in these settings can and does improve health. One of the pioneering studies in this area, conducted way back in 1984 by Roger Ulrich, has long-established a clear link between views of nature and post-operative recovery.
It is particularly important in medicine that stress and anxiety not be allowed to disrupt the healing process. From my own observation, I can say that patients seem to relax more in spaces that contain the elements of biophilic design. One project that I worked on specifically for a children’s hospital has a space at the center of the structure, a courtyard that contains actual nature—a mini-ecosystem with plants, flowers, and even a very small water feature. I think that its presence in such a concentration of medical stress is just as beneficial, perhaps even essential, as any prescription might be.
I believe it is insufficient merely to add a handful of plants and a landscape painting or two. The full power of biophilic design in healing spaces can only be realized when the designers of a healthcare built environment curate the entire space. That includes everything from the large structural elements—like bright skylights or sunny window seats—that surely help individuals feel like they are in a living space to the smaller, more subtle choices that lend warmth and texture to what can sometimes be a cold, sterile environment, like the use of natural materials.
Creating with Light and Life: It’s More Than Just an Aesthetic.
One of the most beneficial things biophilic design can do for patient outcomes is to introduce natural light into healthcare spaces. I visited a long-term care facility where the patient rooms were laid out to catch every possible ray of daylight, with ample windows looking out onto a native-plant-filled garden. The delightfully large, airy rooms felt more like well-appointed vacation suites than medical spaces, and it didn’t take a leap of imagination to see how their design directly supported the physical and mental health of the patients who resided in them.
Having a view is not the only thing that is important for good biophilic design in healthcare. The light that enters a room must be used to replicate how natural sunlight changes throughout the day. The best way to do this is to have light that varies in intensity and color, which you can do easily with electric lights. The mimicry of sunlight can make rooms feel open and calm and aligns with the rhythms of our biological clocks. Some hospitals that I’ve visited have gone a step further and used actual architectural genius to get even more sunlight into patient rooms and to give that sunlight a little more oomph.
These are the light shelves I mentioned in my last post—those horizontal surfaces right beneath windows that are situated so that the sunlight can really pour in and bounce around the room.
I had the good fortune to visit a particular rehabilitation facility where the architects had designed and built a “healing garden.” This garden was alive in every sense—birds, butterflies, even tiny mammals like rabbits lived there. What was visual and tactile in the garden was also, in a way, aural and olfactory. Sunshine, the kind that only nature can provide, reached every corner of the garden. And the sound of the breeze rustling the leaves in the trees was the sweetest music any patient could hear. No one could possibly feel anything other than relaxed and happy in that space.
That’s what the architects envisioned and what they accomplished.
Crafting Healing Environments That Engage the Senses
Much of the conversation about biophilic design in healthcare focuses on what can be seen—natural illumination, vistas of nature, and natural materials. Biophilic design can manifest in what we hear, smell, and even feel. Sound, scent, and touch can all be key elements in the way a space is experienced, especially in a healthcare environment. There, under high stress, people can be pushed toward sensory overload, and sound, in particular, can be a critical factor in how serene or chaotic a space feels.
A design intervention I’ve witnessed that works particularly well is one where natural sounds are included in the healthcare setting. An example of this would be in a psychiatric ward where an indoor water feature was installed. The sound of the water as it flowed from the top to the bottom of the waterfall created a white noise effect that helped to mask other potentially jarring sounds (such as shouting). The nurse I was speaking with said that the patients, on the whole, behaved better when they could hear the sound of water and that this feature made her job less stressful.
A different story I remember concerns a hospice center I visited that took a distinctive approach to infusing biophilic design with the scents of nature. They used essential oil diffusers in waiting rooms and care areas, with the calming scents of lavender and pine. Staff reported that families often commented on how these scents, redolent of nature, allowed them to feel more at ease. Incorporating scent into biophilic healthcare design is a subtle, yet powerful, way to enhance the overall healing environment. Our sense of smell is closely linked to our emotions and memories.
Equally as important are the elements you can feel with your hands. Many healthcare environments are filled with hard and unyielding surfaces. These are easy to clean and maintain, but they do little for the comfort of patients. Being up close and personal with someone in need is about conveying warmth and a kind of rough-and-tumble comfort that makes it seem like everything will be alright. In my travels to various medical clinics, I have seen the kind of waving-with-your-hand ambiance that the researchers from Harvard have suggested is so essential. These spaces have warm colors; they incorporate natural materials.
My favorite aspect of this kind of radiating warmth is what you can touch: benches, chairs, and other sharing surfaces that are upholstered in wool; countertops that are made from stone; and environments that are made cozy by the use of wood.
Healthcare design informed by biophilic principles: a sustainable approach to the well-being of humans and the environment.
At its foundation, biophilic design is about promoting a closer connection between humans and the natural world. Nowhere is that connection more crucial than in medical settings, where myriad human beings exist under duress. Medical locations can be insufferably stressful, and even the most resolute patient is bound to feel some level of discomfort as they undergo what are often necessary but improvident interventions. Biophilic design portends that the imposition of nature into traditionally unfriendly environments can create a palpable conduit for healthful energies to flow into the individuals occupying those spaces so that they may better endure the trials and tribulations forced upon their bodies and minds.
For ten years, I’ve had the great fortune to see, feel, and take part in the design of healthcare facilities that incorporate biophilia. Nature, I know from these experiences, can be a powerful force in influencing both body and mind. Yet how are we to understand the specific and separate effects of nature on either? How are we to attribute “healing” in either the natural or human-made environment? I want to ponder these questions aloud in this section and offer a few reasons why I think biophilic design matters—especially in healthcare facilities.
An Orchestra of Nature’s Components: Creating Spaces for Patients, Their Families, and Healthcare Workers.
A primary difficulty in constructing healthcare environments is that a multitude of users with an array of needs demands to be served—particularly when it comes to the facilities in which these users interact. The array of needs to be served within this setting seems practically endless: patients who need to relax and recuperate; their families, who expect reassurance and comfort; and healthcare staff, who must achieve the impossible balance between efficiency and sufficiency in the kinds of care they provide. Biophilic design holds tremendous promise for serving these varied constituents in an effective manner, incorporating nature and natural elements in ways that benefit all of those who enter the space in pursuit of the kinds of ends they have in mind.
One of the most notable balances between architecture and nature can be seen at Maggie’s Centres, cancer care facilities founded by Charles Jencks. He and his late wife, Maggie, were deeply involved in the founding and design of these “centres.” Biophilia, the love of life and living systems, informs their design, and manifestations of nature—from a long view of a landscape to a small detail of a plant—occur at every turn. When I visited the Maggie’s Centre in Manchester, I walked through a series of rooms leading to large windows with views of the gardens outside.
Neatly trimmed hedges, a grinder for a “compost”-like mound of dirt, decorative wood chips, and plants with large leaves alluded to the hidden (and in some cases, very close by) entrances to the animals and microorganisms that are part of a healthy ecosystem.
I was especially intrigued by the way Maggie’s Centres designs for not just the patient, but the whole family and the surrounding healthcare workers. There are cozy, sunlit nooks for them that are almost like the private rooms we give patients in hospitals. These rooms and spaces are filled with nature. I was irresistibly drawn to a nook in the wall of the waiting room, which is filled with light and has a view of the lovely garden at the entrance to the Centre. I figured, hey, I might not be a patient, but I would wait to see an oncologist in a space like this.
Including Green Spaces to Reap Psychological and Physiological Benefits
Biophilic design powerfully impacts healthcare when it creates green spaces—indoors and outdoors. These can take many forms, such as rooftop gardens and indoor atriums pulsing with plants and natural light, but they always share the same prerequisite: a tranquil atmosphere amid what can otherwise be a tumultuous environment.
I participated in a project to convert a hospital rooftop into a garden dedicated to healing. We wanted to make it possible for patients, visitors, and staff to suspect, even for a brief moment, that they were out of the hospital and in a natural space. Our design, executed with the help of talented landscape architects, included a number of features intended to soothe the senses, including, we hoped, the eyes and ears of those who wandered the paths of the garden. Water—its sight and sound—was the principal feature of the space. It was important to us that in this walkable space, which was in full sun for much of the day, there also be places where one could sit in the shade.
The effect of this space was tremendous. There was one patient, in particular, who had been bedridden for weeks. One day, a nurse wheeled her up to the garden. The woman hadn’t been outdoors in almost a month. The second she felt the sun on her face and heard the leaves rustling, the shift in her presence was remarkable. The nurse told me later that the patient seemed to have turned a corner after that garden visit. We often talk about nature’s role in our health, but the woman’s story is a good reminder of just how potent an outdoors experience can be.
I have encountered biophilic design principles in an urban context as well—most impressively in an indoor space designed for a hospital. The designers in this case went so far as to create a tall, living wall that spanned several stories. Verdant vertical in the lobby, it served as the hospital’s centerpiece, of sorts, and its installation brought that stuffy indoor space strikingly close to something you might find in the great indoors. Quality-of-air improvements and energy savings aside, the wall’s life was beneficial for more reasons than I can count: the impressive sight, the calming sound of water trickling down, and the sharp, pleasant smell immediately elevated your mood upon entering.
When discussing biophilic healthcare design, it is natural to focus on patients and their families as the primary beneficiaries. But the principles this design style embodies also bring benefits to healthcare workers, who, as a group, spend many long, high-stress hours working in environments where they are called to deal with life-or-death situations. Such environments should be designed to help all who work and heal within them to feel and function at their best.
My memories of visiting a hospital redesigned with biophilic principles are quite vivid. One of the most appreciated aspects of the renovation was the addition of break rooms and lounges with large windows that afforded views of a green courtyard. The staff I spoke with told me that these spaces had become their go-to spots for between-shift unwind time. They didn’t need long—just a few minutes in the lounge with a look toward the trees and some bird sounds to help reset their mental state after whatever tough case or long procedure they’d just endured.
Though simple in nature, these spaces were doing heavy lifting in terms of preventing burnout and promoting a connection to the natural world.
More sophisticated adaptations of biophilic design have supported an even more important aspect of healthcare: the well-being of the dedicated workers who staff the facilities. One prime example took place at a facility that installed a state-of-the-art system in all its operating rooms and other areas that staff commonly occupied for long periods and needed to be more alert in. This was a dynamic lighting system that mimicked the natural progression of daylight. Using artificial light in the same way that the body would use light from the sun through the natural day was, apparently, a real win for the staff.
Biophilic design has a profound influence on the emotional and physical well-being of its users, and it also plays an essential role in sustainable architecture. By integrating aspects of nature—such as natural light, plant life, and good old-fashioned fresh air—healthcare facilities can lessen their energy consumption and overall environmental impact. In this sense, biophilic design is not just a “nice to have”; it is a key necessity for making future-proof healthcare environments that contribute to a sustainable society.
An excellent example of the marriage between biophilia and sustainability is a certain hospital—a singular structure, really—that was built with nature in mind. Green roofs topped the building; rainwater harvesting and solar energy supply systems were cleverly positioned. The building itself was oriented for optimum exposure to natural light, which meant that most of the people inside would never know what it felt like to be in a windowless room; it would be far cheaper and easier to fill the space with light from lamps. The green roof delivered firewood, as it were, to the hospital fireplace: the only place where firewood was allowed.
The extensive plant installations in the hospital, where I worked, made it feel less like a clinical institution and more like a sanctuary. The plants created a biophilic space, and when patients commented on the greenery in the hospital, it made me feel good because the design intention was for them to feel calm and connected. I saw the idea of biophilia many times during my research. It’s an interesting concept and makes for great design.
Biophilic healthcare design is not just about imbuing a space with the essence of nature. It is about creating directions, alive and in motion, that serve their inhabitants. These spaces can harness light in creative ways, for instance, or can incorporate plants, water, and other natural elements—in deliberate, watched-over ways, that is: we are reminded in biophilic design that “natural” does not mean “unconscious.” And when we’re moved through those spaces—when we’re not just looking at the contours of our hospital room but also experiencing the contours of our hospital room—they are touching something deeper within us.
Biophilic healthcare design — creating built environments that reflect a connection to nature — can bring healing benefits to patients and staff. Although the concept is relatively new, it is already expanding from hospitals into clinics, outpatient facilities, and even medical office buildings. One of the primary researchers and biggest proponents of biophilic design in healthcare settings is Dr. Roger Ulrich, Ph.D. His ground-breaking work is helping to illuminate how the built environment can profoundly affect a person’s ability to get well or to stay well.
Looking ahead, we can see that biophilic design in healthcare is more than just a trend—it’s a shift in the way we’re thinking about healing environments. And while the core concept behind biophilic design isn’t new, what excites me most about this framework is the potential it has within the innovative biophilic healthcare ecosystem—an environment where the value of nature in the built environment is paramount to improving health and well-being. Healthcare spaces can and should occupy the leading edge of biophilic design—because nothing is more vital than our collective health. Biophilic design can mean a lot of things—some of which I’ve touched on in previous installments of this series, and others I’ll expand upon here.
But to get started, let’s look at some emerging trends that clarify the direction in which biophilic design is headed within the healthcare context.
One of the most fascinating developments of late has been the blending of technology with biophilia—that is, the love of nature—to create immersive, natural experiences in spaces where access to the real thing is limited. Virtual reality (VR) and augmented reality (AR) are becoming popular tools in healthcare design, allowing patients to enjoy nature—even in windowless rooms or urban hospitals where outdoor space is scarce. In one pilot program, patients in an intensive care unit who were unable to leave their beds were given VR headsets that transported them to serene, virtual natural environments.
Some patients found themselves in a forest, listening to birds and the rustling of leaves. Others were taken to a peaceful beach, with the sound of waves crashing against the shore. Despite being in a clinical setting, these virtual experiences reduced patients’ anxiety and discomfort in a way that’s hard to explain.
A tool that can bolster biophilic healthcare design is augmented reality, or AR. Imagine being in a hospital room where, with the flick of a switch, your temporary walls transform into a simulated forest, complete with the sounds of nature and the illusion of sunlight filtering through the trees. AR can’t replace real natural elements, but it might be able to approximate the experience in spaces where biophilic design is limited by other factors. Yet, AR is still a nascent technology that will take time to develop and test in these environments. The next instance where technological advancement might augment biophilia is in systems that make buildings responsive to the needs of occupants and the environment.
The responsive biophilic design is still in its infancy but has the potential to offer ambient healthcare spaces. Responsive biophilic design in ambient healthcare is the idea that, as with a living organism, a healthcare environment dynamically adjusts to meet the needs of its inhabitants. I imagine that a responsive biophilic model could define not just the anatomy of an outpatient setting but also the physiology of its experiential interfaces, such that in the presence of living people, every room, hallway, and waiting area naturally synchronizes its lighting and temperature and mindfully modulates its ambient sound and scent (as well as the appearance of physical elements) to ensure a calming effect and enhance the total patient experience.
The next frontier for this expansion could well be in mental health facilities. There’s already plenty of research demonstrating how the presence of nature can enhance mental health outcomes, and biophilic design can play a crucial part in crafting environments that encourage recovery from conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD). I recently paid a visit to a mental health clinic that had been designed with these principles in mind, and it was, quite frankly, unlike any clinic I had ever encountered. The waiting room felt more like a living room, with ample windows that offered expansive views of a peaceful garden filled with lavender, a plant known for its calming presence.
(Cincinnati is home to a pretty terrific botanical garden, by the way.) Patients were positively encouraged to spend time in the Mood Garden before and after their appointments.
Biophilic design can be impactful even in smaller healthcare settings, such as dental and pediatric offices. I’ve seen pediatric clinics where exam rooms resemble treehouses, with murals of forests and playful wooden elements that make being in a doctor’s office less frightening. I’ve also seen less dramatic instances of biophilic design in a children’s hospital where the use of color and light was the focus. Both experiences challenge the conventional notion that a clinic or hospital must be a sterile environment filled with intimidating sight gags. Yet, despite the well-documented physiological and psychological payoffs, biophilic design in healthcare is limited by several challenges.
Cost is the most frequently cited barrier, but there are also issues of knowledge and the interplay of materials, light, and color.
Nonetheless, I’ve come to realize that the secret to not meeting this predicament is in seeing biophilic design not as an “extra” or “luxury,” but as an essential component of modern hospitals. When we consider the payoffs to biophilic design in patient recovery, stress reduction of patients and staff, and even energy efficiency (thanks to the natural light and ventilation that are far more appealing than fluorescent lights and air conditioning), it’s crystal clear that these investments yield dividends. In fact, some studies posit that the money put into biophilic attributes can be recouped in as few as five years.
Yet another obstacle to overcome is the healthcare industry’s own mindset. Many healthcare decision-makers are still inclined to doubt that design—especially nature-inspired design—can have a real impact on clinicians and, ultimately, patient outcomes. More and more, however, this perception is changing. The most successful design projects I know about are those in which the design team includes healthcare providers right from the start. “Involve the clinicians, involve the nurses, involve the administrators,” I would advise. When those with direct experience of a clinical environment are on board, the use of biophilic principles tends to be advocated for much more robustly than when the decision-makers are relying solely on anecdote or the authority of the designer.
Using Biophilic Design to Spark Transformational Change
In the final analysis, the design of biophilic healthcare is about much more than simple beauty or comfort. It is about transforming the healthcare paradigm itself, changing the medici-spaces of today into environments conducive to restorative, holistic healing. The way I see it, this is our moment, as designers and architects, to fully embrace our responsibility as the makers of the Medici spaces of the today and tomorrow, recognizing that our human, emotional, and physical well-being is inextricably linked to that of nature.
I think that biophilic design will soon emerge from the fringe and occupy a mainstream place in American healthcare. Its transition to the forefront is already assured; the more we recognize its various benefits, the more we will harness it to beautify and deepen our urban spaces as a means of enhancing our lives. Healthcare will increasingly be configured as a natural experience. Patients will hear — with the help of technology — the wind in the trees, the rustling leaves, and the chirping birds. They will feel the warmth of the sun and the coolness of shade. They will see artful representations of the natural world and hear realistic sounds that will lead them to a “natural” state of mind.
I have worked for years at the intersection of design and healthcare, and the intersection of both with sustainability. Biophilic healthcare design is about much more than just looking good. It’s about true, holistic healing. And in that regard, the future is as bright as can be, as green as it can get, and as full of life as anything ever could.
