April 28, 2005
Green spaces are good medicine
By ROBERT SHROSBREE
Industry experts, supported by an increasing body of research, now espouse a holistic approach to healing that goes beyond technical, operational or medicinal techniques.
In a recent article on health care trends, Michael Waldholz, a health care and bioscience reporter, wrote, "A growing body of evidence suggests that humans are hard-wired not just to enjoy a pleasant view of nature, but to actually exploit it, much like a drug, to relax and refresh after a stressful experience. Simply viewing a garden or another natural vista can quickly reduce blood pressure and pulse rate and can even increase brain activity that controls mood-lifting feelings."
The emphasis is on a warmer, patient-centered, more personal approach that enriches the physical experience of one's surroundings.
This approach requires a renewed sensitivity to the cultural, social, intellectual, spiritual and creative needs of patients. The environment of a health care campus particularly its outdoor elements such as gardens, courtyards and open space can actually accelerate the healing process.
Health care administrators, planners and investors have also realized the value of providing a healing environment. The principles of therapeutic site and landscape design can also be applied to improve conditions in work environments, senior housing, special education programs, schools and day-care facilities.
The healing landscape can take on many names and varied associations as to its purpose, its form, its location even its philosophy. Whether called a "therapeutic environment," a "restorative garden" or a "wellness garden," the healing landscape addresses physical and psychological comfort and spiritual/emotional renewal.
Within this broad approach, various personal factors such as cultural identity, type of illness, length of stay, and physical/psychological constraints will vary substantially. In response, therapeutic landscapes may have a wide spectrum of experiences where each patient should be able to find his or her own comfort zone. These may include privacy, views to green space, intimate and sensory receptiveness to immediate surroundings, heightened mobility and exploration of common areas, comfortable interaction with others, a sense of community, personal growth and physical or psychological development.
Elements for mild sensory stimulation create an inspirational, often intimate environment and encourage receptiveness to one's surroundings. Water features, special plants, fragrance, color and sound serve to spark the patient's imagination, while cultural symbolism engenders a feeling of community and identity. Equally important is design flexibility to include spaces for gathering, celebration or learning.
Including all users in the design process expands the potential for realizing an environment that touches and affects everyone.
One such project with specific safety features and therapeutic elements is the new Surgery Pavilion at the University of Washington Medical Center. The site design included a garden, courtyard, streetscape and green space. The client and design team recognized that patients, visitors and staff needed to feel secure, comfortable and uplifted by the environment. To that end, we worked to provide areas for non-ambulatory patients and 24-hour access to garden and courtyard areas. Thoughtful use of paving, surfacing, lighting, plants and furnishings complemented the landscape while addressing life-cycle and maintenance realities.
Establishing a set of principles for site development and landscape architectural design integral to the regional context, institutional philosophy and programmed uses are key to a successful therapeutic setting. This planning framework provides a consistent basis for design and organization. In addition, many institutions have an existing philosophical basis for their methods and systems that should influence the design.
Frequently addressed in the site planning process is the physical sequence of spaces, and here, too, the therapeutic environment may be made quite evocative. A "decompression zone" that introduces the participant into the healing landscape can be powerful. Such zones are often situated in site entries and adjacent parking areas, arrival courts and lobbies.
Design principles for the health care campus should include adequate visibility, a positive image and a character that contributes to the fabric and landscape of the broader community. Understanding each level of the organization is critical for developing the direction of individual landscape and campus expansion projects. Program criteria such as adequate parking, separate vehicular and pedestrian routes, universal access, clear way-finding and neighborhood linkages all contribute to the character and quality of the campus.
At Harborview Medical Center in Seattle, a voter-approved $260 million bond program led the way to creating a campus-wide set of design principles addressing seismic, health and public safety improvements based on extensive community involvement. The landscape architectural design elaborated on established principles to create and/or enhance: street life quality, orientation and linkages, green places and healing, and inspirational use of light. We translated these into more permanent open spaces, plazas and green common areas and streetscape improvements that integrate the hospital's diverse buildings.
Artists collaborated in Harborview's architectural and landscape designs to integrate cultural, scientific and regional motifs.
Architects, administrators, landscape architects and planners who specialize in health care are key collaborators in the development, planning and design of therapeutic environments. Their responsibility is to ensure that the meaning of "green" goes beyond the professional jargon, checklists and definitions offered by programs or environmental ratings the opportunity is to create places that will endure and aid in the healing process.
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