Getting Better

Healing is all about time and space, the ability to seek treatment, be open to therapies,medications and procedures.  As architects, we can create the environments in which healing takes place, whether it be a hospital, ambulatory care center, or a place of respite that someone can seek out like a public garden or urban park.  Because, as evidence increasingly shows, healing is entirely dependent on one's state of mind.

Reducing stress and providing inspirational environments creates a context conducive to healing.  Some facts related to evidence-based design and biophilic research from the work of Roger Ulrich that are good to keep in mind for your next project:

1. Natural light is critical.  Exposure to daylight, especially direct sunlight, increases levels of seratonin, which has been shown to dramatically reduce depression, pain levels, and improve outcomes.  Avoid creating spaces that are cast in perpetual shadow by the building configuration.
2. Views of nature have been found to reduce stress and neuropathic pain.  The view can come from a window, interior landscaped space or artwork, although the most effective views were those that provided grand vistas.  Abstract art was actually shown to increase stress.
3. Effective use of the site is important to provide outdoor areas for patients, families and staff to use.  If possible try to provide access to the outdoors at multiple levels, including roof gardens or sunken gardens at basements.
4. Good acoustic control to mask unpleasant noise (carts rattling, staff talking amongst themselves) and introduce calming sounds like water or birdcalls.

Healing is a process.  Many patients must return again and again to complete a course of treatment.  Aside from not feeling well, just knowing that you have an illness causes stress as one deals with fears regarding the outcome, side effects of medication or testing/procedures to be undergone.  The buildings they approach should be welcoming and regenerative environments, not ones that will reinforce feelings of dread.  Positive environments encourage a positive experience, which also helps patients to lead healthier lifestyles in general.  After all, no path to wellness can succeed if a patient does not embrace and follow it.

Generational Marketing meets Design

Effective design comes from the ability to know your audience and speak their language.  If you don't effectively communicate, you won't effectively define the problem. Different generations of building users have different values, expectations and needs.  Attracting and retaining quality staff and satisfied building occupants requires providing them with quality environments.  Try working with your client to assess the demographics of the building users and look at these tips in the chart below from the Generational Targeted Marketing Corporation to target programmatic elements or design features that might resonate best.  You may discover that providing  amenities like on-site childcare, fitness center or convenience services can make all the difference, or that better break rooms that allow staff to get off-stage and decompress in a stressful work environment keeps them motivated and happy.  There's nothing better than knowing you designed a building that people find enriching to occupy.

DEMOGRAPHIC SEGMENT	MINDSET: ATTITUDES, BELIEFS and VALUES
Generation  9/11 (2001-Present)	Generation 9/11 values fitting in with their peers. Overprotected during their formative years: at home, because of the rash of kidnappings and Amber Alerts; at school, because of school-shooting incidences; and in society, because of terrorism. Will tend to be risk-averse and therefore conformists as adults.
Generation Y (1982-2000)	Influenced by their brand-conscious Boomer parents. Attracted to brands at an early age and remain loyal. Associate brands with companies that stand behind their products. Brand names also important for peer recognition.
Generation X (1961-1981)	Market Savvy Demand an honest, straight-forward approach. Expect you to deliver on your marketing promises. Burn them once, lose them forever.
Baby Boomers(1943-1960)	The busy generation. Often juggle kids, spouses, parents and jobs, so anything that makes their lives easier or more convenient will appeal to them. They do not have time to read lengthy marketing efforts. Capture their attention in seconds, or lose them.
Silent Generation(1925-1942)	Once financially conservative, they are now willing to spend money on themselves. Feel it's now-or-never time to splurge on that big-ticket item.
G.I. Generation(1901-1924)	Avid readers Prefer sales by mail because customer service standards have fallen. May have trouble with transportation, so catalog sales are a natural fit.
Source: Generational-Targeted Marketing Group, 2007

Biophilic Design: More Than a Distraction?

When you first started your architecture education, you were no doubt exposed to concepts tying the built and natural environments such as the chambered nautilus, bi-lateral symmetry, golden section, and of course Le Corbusier's Modular Man.  It seemed like cracking the code of nature would give some kind of magical solution to any design problem.  Then you probably forgot all about that stuff as you began a career and had to deal with real program requirements and code constraints.  Nature-inspired design is back, and this time its about more than just proportion or organic shapes a la Bruce Goff. It's also more than just putting up some twinkly LED lights in the ceiling or an illuminated photograph of a natural scene to simulate an outdoor view.

Incorporating evidence based design principles, biophilic design looks to meld the materials, process and cycles of nature into architecture.  It links our health, job performance and well being directly to the built environment. Design that takes into account natural processes and cycles feels better to inhabit. And now, it has evidence behind it.

In his popular book Biophilia, Edward Wilson, a biologist and social researcher describes a connection that humans innately seek with other living things.  The deep psychological connections that we have formed with nature influence us in primal and subconscious ways.  As behavioral psychologists began to study biophilia in greater detail, the applicability to healing environments became evident. Roger Ulrich has shown direct correlations between connections to nature and reductions in pain and depression, both of which lead to fewer complications and faster recovery. His work in particular seems to indicate that the most beneficial type of stimulation comes from evoking nature, as in artwork, or through actual exposure to nature itself. The growing amount of research into the impact of biophilic concepts on the built environment has included work with actual patients and hospital staff, such as the Ambient Experience created by Phillips, focused on building systems that provide a multi-sensory environment for patients, families and staff.  

This seems intuitive.  However, what exactly to implement in each type of space you are creating is not.  Your game plan:

1. As part of your space program, create a column for what you are trying to promote in each space.  In corridors, you may want to promote wayfinding and reduce noise; in staff work areas, reduce errors; in patient rooms, promote healing; and reduce stress in procedure rooms.  
2. Look at existing research on what will best produce the desired effects in each space.  For example, stress and anxiety contribute strongly to high pain levels.  Views of nature create a  positive diversion that helps to keep people focused on things other than pain or anxiety and promote healing.
3. Brainstorm as a team about ways these effects can manifest themselves in each space- can you provide views to a landscaped area?  Should artwork of natural landscapes be a focal point? What about lighting and acoustics?  What opportunities are there to get natural light, especially sunlight, into the space?  Can the space adapt to the time of day or season?  Are there opportunities to actually bring nature inside through plants or water features?
4. Determine how you can measure the results of your strategies and incorporate them into your evidence-based design plan.

Why does it work?  Some speculate that reducing anxiety is all about distracting people, but I think it goes further than that and taps into a primordial state of balance that helps inhabitants to feel calmer, more focused and invigorated.  Being in a biophilic environment is enriching and by stimulating our senses, we stimulate the soul.