What is a healing environment?

Introduction

What makes a healing environment?

The term healing environment is used to describe
the factors that positively affect (both physically and
psychologically) the community served by the healthcare
facility, including the physical setting as well as the
organisational culture (3).

Traditionally hospitals have been designed to deliver state-ofthe-art medical treatment in the most efficient way possible.
Whilst it is well-documented that stress, depression, and
anxiety have an adverse effect on health; modern hospitals,
with their emphasis on diagnosing, curing, and treating, have
become noisy, cluttered, institutionalised environments with
little regard for the potentially detrimental effects on the
patients physical or psychological wellbeing (1).
Many people have had some of their worst experiences
related to buildings in clinics and hospitals (2). But there are
signs that things are changing. The field of healthcare design
is currently undergoing an exciting transformation that
will significantly change the appearance of our hospitals.
More and more healthcare administrators and medical
professionals are becoming aware of the need to create
healing environments that support the needs of patients,
family and staff. The key factor motivating this awareness
has been growing scientific evidence that the physical
environment in which medical care is provided has an impact
on health and well-being (2).

The positive effects of space and the environment were

well known in the era before science. For many centuries
in ancient Greece, temples to the God Asklepios, such as
the one at Epidaurus, were designed to surround patients
with nature, music, and art to restore harmony and
promote healing in the absence of modern medicine (1). In
the nineteenth century, Florence Nightingale recognised
the negative effects of hospitals by observing differences
in survival rates at various facilities. She attributed this
difference to the hospitals design and construction,
particularly regarding crowding, light and ventilation (1).

In 1984 Roger Ulrich compared the positive effect of views

of natural scenery (trees) on the recovery of patients from
surgery to patients in similar conditions who were exposed
to a view of a brick wall. Ulrich showed that in comparison
with the wall-view group, the patients with the tree-view had
shorter post-operative hospital stays, had fewer negative
evaluative comments from nurses, took less medication,
and had slightly lower scores for minor post-surgical
complications (4, 5).
Since then numerous academic studies have shown links
between health and wellbeing and the built environment.
To enhance wellbeing and facilitate patient recovery
environmental factors identified include reducing noise,
increasing natural light, providing contact with nature and

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What is a healing environment?

What makes a healing environment?

Noise control

the outdoor world, promoting family involvement, increasing

the opportunity for patient control, promoting accessibility
and way-finding, improving safety, improving communication,
maximising potential time with patients and providing a
welcoming environment (3).

Hospitals are noisy places with numerous sources of noise,

and historically they have been designed with soundreflecting surfaces that worsen acoustic conditions and
enable noises to echo and propagate over large areas.
Studies have found that reduced noise levels e.g. by using
noise-reducing finishes such as high-performance sound
absorbing ceiling tiles, improve sleep, reduce annoyance,
improve satisfaction, reduce pain and the use of pain
medications, decrease psychological and physiological stress,
decrease emotional exhaustion, reduce headaches, improve
communication, reduce medical errors, decrease heart and
respiratory rate, decrease blood pressure, shorten recovery
time and hospital stays, and reduce re-hospitalisation (6 - 12).

By using Evidence Based Design (EBD)

principles to help create a healing environment,
the experiences of patients, their families
and staff can all be enhanced infections and
medical errors can be reduced, and patient
outcomes (such as reduced pain and stress,
sleep, privacy, and recovery times) can all be
improved.
Single patient rooms

Overwhelmingly the design intervention that positively

affects the largest number of outcomes in a hospital setting
is the provision of single-bed patient rooms (6). Reported
benefits in studies carried out over double or multi-bed
wards include improved infection control, reduction in
noise, increased privacy and better for family support.
These benefits promote a healing environment and lead to
increased patient satisfaction (6).

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What is a healing environment?

Natural light

Connection to nature

There is no doubt that people prefer daylight to electric

lighting as their primary source of illumination (2). Various
studies around the world have consistently shown that the
majority of survey respondents prefer to work and live in
buildings illuminated by daylight (2, 13-15). People not only
prefer daylight because it is more pleasant than electric
light, they also tend to believe that daylight is beneficial for
personal health (2). A study carried out in 1996 among 174
patients with severe depression found that patients in sunny
rooms had a 2.6 day shorter stay than patients in dull rooms
for example (2, 16).

Contact with nature can have beneficial health effects (3, 17).
This was first demonstrated by Ulrich in 1984 with his
pioneering study described earlier (4). Ulrichs findings are
supported by a Swedish study which demonstrated that
patients who had a view of vegetation from their beds had
shorter convalescences, fewer complications and took less
pain-killing or sleep-inducing medications. Normal blood
pressure was also more prevalent in the experimental group
than in the control group (3).

Patients in sunny rooms had a 2.6 day shorter

stay than patients in dull rooms

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Conclusion
Conventional healthcare facilities are rarely therapeutic and
frequently increase levels of stress in patients, family and staff (2).
By using Evidence Based Design (EBD) principles to consider for
example reducing noise, increasing natural light, and providing
contact with nature the designer can help to create a healing
environment that will benefit all of the buildings occupants.

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What is a healing environment?

References
(1) M Schweitzer, Gilpin L, Frampton S. Healing Spaces: Elements of Environmental Design that make an impact on Health. The Journal of Alternative and Complementary
Medicine. 2004, Vol 10, Supplement 1, 71-83
(2) A van den Berg, F Jaspers, C Wagenaar (2005). Health Impacts of Healing Environments: A review of evidence of nature, daylight, fresh air, and quiet in healthcare
settings. Foundation 200 years University Hospital Groningen
(3) Ampt A, Harris P and Maxwell M. The health impacts of the design of hospital facilities on patient recovery and wellbeing: A review of the literature. 2008 Centre for
Primary Healthcare and Equity, University of New South Wales, Sydney
(4) Ulrich RS. View through a window may influence recovery from surgery. Science. 1984, 224(4647):420e1.
(5) Huisman E R C M, Morales E, van Hoof J, Kort H S M. Healing environment: A review of the impact of physical environmental factors on users. Building and
Environment. 2012, 58, 70 - 80
(6) Ulrich R, Zimring C, Xuemei Zhu, DuBose J, Hyun-Bo Seo, Young-Seon Choi, Xiaobo Quan, and Anjali Joseph. A Review of the Research Literature on Evidence based
Healthcare Design. Health Environments Research & Design, 1(3), 2008.
(7) H Salonen , L Morawska. Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities: A review. Intelligent Buildings
International, 2013
(8) Bayo, M.V., Garcia, A.M. and Garcia, A., 1995, Noise levels in an urban hospital and workers subjective responses, Archives of Environmental Health, 50 247-251.
(9) Beyea, S.C., 2007, Noise: a distraction, interruption, and safety hazard. AORN Journal.
(10) Biley, F.C., 1994, Effects of noise in hospitals, British Journal of Community Nursing, 3 (3), 110-113.
(11) Joseph, A., 2010, Hospitals that heal. Hospital design for the 21st century. Asian hospital and healthcare management.
(12) Hagerman I., Rasmanis G., Blomkvist V., Ulrich R., Eriksen C. A. ,& Theorell T. (2005). Influence of intensive coronary care acoustics on the quality of care and
physiological state of patients. International Journal of Cardiology, 98 (2), 267270.
(13) Heerwagen, J.H. & Heerwagen, D.R. (1986). Lighting and psychological comfort. Lighting Design + Application, 16 (4), 47-51.
(14) Veitch, J.A., Hine, D.W., & Gifford, R. (1993). End-users knowledge, beliefs, and preferences for lighting. Journal of Interior Design, 19 (2), 15-26
(15) Cuttle, C. (2002). Identifying the human values associated with window. International Daylighting, 5, 3-6.
(16) Beauchemin, K.M., & Hays, P. (1996). Sunny hospital rooms expedite recovery from severe and refractory depressions. Journal of Affective Disorders, 40 (1), 49-51.
(17) Young-Mason, J. (2005). Nature and well-being. Clinical Nurse Specialist CNS 19(4): 218-219.

2015 Saint-Gobain Construction Products UK Ltd trading as British Gypsum (734396).

Registered: Saint-Gobain House, Binley Business Park, Coventry, CV3 2TT

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October 2015