Nature’s Cure: How Biophilic Design Can Enhance Healing

By Laura Kazmierczak

The typical approach to architectural design tends to silo building and landscape architecture, treating the two as separate entities. Over time, this dissociation in design has negatively impacted both humans and the natural environment. In the healthcare field, the latest technological advances in medicine are often the innovations which receive the greatest amount of attention. However, incorporation of much more basic human needs—ones found deeply embedded in our genetic code—carry valuable weight in the design of healthcare facilities.

When asked to describe a healthcare setting, words like “sterile,” “hygienic” and “antimicrobial” tend to come to mind; there is good reason doctors wear pristine white lab coats. Some of the most commonly contaminated surfaces in healthcare settings include bed privacy curtains, computer keyboards, blood pressure cuffs and furniture. While these factors are important to environments that successfully heal patients, many other highly beneficial assets are overlooked. These assets are not hard to find; they are an inherent part of each and every human on the planet.

What is biophilic design?

Biophilic design is defined as “an innovative approach that emphasizes the necessity of maintaining, enhancing and restoring the beneficial experience of nature in the built environment.” This definition, from professor and author Dr. Stephen R. Kellert, describes a design tactic which stems from the term biophilia, meaning life loving. In 1984, biologist and Harvard University professor Edward O. Wilson published his book “Biophilia” that coined the title term meaning, “the innate tendency to focus on life and the lifelike processes.”

How does it impact patients?

An interior courtyard garden on Kootenai Health’s campus, located in Coeur d’Alene, Idaho, provides an attractive space for patients and staff to utilize for exercise, breaks and exercise. Image credit: Ben Benschneider.

While every population demographic—from early childhood education settings to the corporate workforce—can benefit from biophilic design, another specific user group experiences significant added benefit from this intrinsic design methodology. Healthcare patients, particularly those in hospitals, have been found to have substantial healing benefits when exposed to environments that incorporate principles of biophilia into their design. Exposure to natural elements, whether directly from nature or interpretations of it, aid in the healing process of patients.

Reducing Stress
Within the realm of healthcare design, stress is a major determining factor of healing rates. Research supports that when patient rooms have views of nature, postoperative stays are generally shorter, less pain medication is dispensed and overall condition improves. Evidence shows that representational images of natural features such as landscapes, gardens and waterscapes can reduce stress and improve results like pain relief. One study by researchers Katcher, Segal and Beck found that patients waiting to undergo dental surgery exhibited lower anxiety levels when an aquarium of fish was present in the waiting area as opposed to when the aquarium was absent. Another experiment conducted with blood donors found that those who viewed a wall-mounted television showing a tape of nature had lower blood pressure and pulse rates than those donors who watched a tape of an urban setting or even a talk or game show. These examples illustrate that even when a direct connection to nature is not available, imagery of nature has positive benefits on patient health and well-being.

Mitigating Pain
The gate control theory of pain states that neural mechanisms in the spinal cord act as a gateway in the broadcast of pain impulses from the spinal cord to the brain. When this gate is opened, pain is experienced due to impulses flowing to the brain; when closed, these impulses are prevented from flowing and pain is lessened or not felt. A key element of this theory is that the gate can be closed via communications from the brain that are often swayed by psychological or emotional factors. As previously noted, numerous studies have shown that when patients are provided with a connection to nature, pain is often mitigated without, or with decreased, administration of drugs. When positive feelings such as relaxation are experienced via a view of the natural environment, the patient’s focus on injury becomes distracted, and it is theorized that the gate is closed and pain is reduced.

How does it affect economics?

For most major building project types, cost factors heavily into the design decision-making process. With healthcare funding becoming scarcer as capital dollars disappear and insurance reimbursements shrink, facility administrators are often obliged to forecast a future which is seemingly uncertain. As such, outcome studies are particularly important in evaluating the success of certain design initiatives. The availability of concrete evidence regarding the benefits of biophilic design in healthcare settings is the only way to effectively promote implementation.

Patient recovery outcomes are an obvious economic benefit that hospitals and other health facilities consider when making design decisions. Another critical piece is the effect of biophilic design elements on doctors, nurses and other staff members. While studies relating to healthcare staff are limited, it is important to consider this population when making design decisions. For example, providing an outdoor garden at a healthcare facility can help reduce turnover rates and improve overall job satisfaction. Numerous studies show that feeling a lack of control contributes heavily to healthcare staff stress levels. Being given the opportunity to change their environment intermittently by stepping outside can help reduce staff stress, one of the leading causes of workplace absence.

Impact on facilities management

When it comes to how biophilic design principles impact the management of facilities, there tends to be some skepticism about how easily buildings can be maintained. However, unlike the incorporation of typical “green” products—think solar panels, automated building management systems, sophisticated ventilation systems—biophilic design is more about exploring and implementing existing strategies in a savvier way. Innovation is key during the earliest design phases when incorporating biophilic design elements. For example, a wall treatment may already be part of a project, but choosing to use a wall covering that features large imagery of an outdoor scene may be selected instead. It might take a little bit longer to research and coordinate this particular wall covering, but it is merely enhancing a design element that already exists, not creating a new one that requires more cost to implement and maintain. Another example would be the way in which a space is organized. Is the building oriented on the site to take advantage of daylighting strategies? Are the interior spaces arranged in ways that best capture outdoor views for users? Biophilic design is much more about thinking smarter, not working harder.

The myriad research available on biophilic design in healthcare settings makes it clear that connecting with nature during treatment and recovery is of great benefit to patients. Allowing for a more holistic healing process, incorporation of these design elements cannot be discounted. As we continue to make advances in medical technology, we must concurrently look to our basic human roots to improve healthcare environments as a whole.

Huisman, E., Morales, E., Hoof, J. V., & Kort, H. (2012). Healing environment: A review of the impact of physical environmental factors on users. Building and Environment, 58, 70-80. doi:10.1016/j.buildenv.2012.06.016.
Stephen R. Kellert, Biophilic Design: The Theory, Science, and Practice of Bringing Buildings to Life (Hoboken, NJ: Wiley, 2008): vii.
Edward O. Wilson, Biophilia (Cambridge, MA: Harvard UP, 1984): 1.
Fabris, P. (2012, April 05). 7 keys to Highest value, lowest cost for healthcare construction. Retrieved February 28, 2018, from
Ulrich, R.s. 1999. “Effects of Gardens on Health Outcomes: Theory and Research.” In Healing Gardens, edited by C.C. Marcus and M. Barnes, 27-86. New York: John Wiley.
Wellness Council of America. “The Benefits of Stress Management for Employees.” WELCOA. February 06, 2018. Accessed February 28, 2018. benefits- stress-management-employees/.

Author: Laura Kazmierczak
Laura Kazmierczak, Associate AIA, NAC Architecture, brings a user-centric design approach to her projects, focusing on an individual’s interaction with a building and how those spaces can support wellness. Kazmierczak continually looks for ways to incorporate biophilic principles into her projects to strengthen the connection between the natural and built environments.

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Posted April 18, 2018

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