The Healing Qualities of Biophilic Design for Healthcare

The Healing Qualities of Biophilic Design for Healthcare
Interiors that connect us to nature is proven to inspire us, boost our productivity and even contribute to a stronger sense of well-being.
Our approach to mental and physical wellbeing is based on biophilia, the innate human attraction to nature and all that is alive.
Now more than ever, it’s necessary to bring the outdoors in and create indoor environments – biophilic interiors, that reference nature in both obvious and subtle ways.
The reflection on the principles of biophilic design is particularly interesting when it is applied to healthcare facilities. This is not only due to the high rate of critical and stress factors in hospitals for patients, their families as well as healthcare professionals, but also because the hospital and the city are two separate but interconnected systems, which are visited and used by the same individuals.
Nowhere is it more important than our healthcare facilities to incorporate the healing qualities of Biophilic design principles.
Let’s understand why.

       How does it work?

The word biophilia translates as ‘love of life’ from the Greek words bio (life) and philia (love). It was coined in 1964 by German-born American psychoanalyst Erich Fromm in The Anatomy of Human Destructiveness when he described it as ‘the passionate love of life and all that is alive.’

While the phrase was coined by Fromm, it was Harvard biologist Edward O. Wilson who wrote the book Biophilia twenty years later, exploring how evolution has impacted our biophilic tendencies today. He noted that frequent contact with nature is essential for brain development and that the value we give to living things and other species is something that has been influenced throughout evolution. 

Research suggests that biophilia can have a positive impact on well-being by affecting three of our mind-body systems:

  1. Physiological, it reduces anxiety.
  2. Psychological, it reduces anger and fear.
  3. Cognitive functions, it improves creativity and boosts mood.

   Evidence Based - The Ulrich 1981 Study


It’s been over 30 years since Roger Ulrich’s trailblazing study on the effect of window views to nature on patient recovery. Between 1972 and 1981 a cross-section of 46 patients were observed whilst recovering from cholecystectomy (Gall Bladder Surgery). Professor Roger Ulrich of Chalmers University of Technology in Sweden of post-surgery gall bladder patients proved faster recovery rates, needed fewer pain killers, and had fewer post-operative complications launched the field of evidence-based design.                                               

The patients were all assigned to similar rooms with a window. However, one group had a view out to some deciduous trees, whilst the other group’s window offered a view of a brick wall. Comparisons were made between pairs of patients with similar traits (gender, age, weight etc) one of the pair had the tree view whilst the other the wall view.

Different aspects of their recovery were measured, and the results speak for themselves:

  • Patients with the tree view spent fewer days in hospital – an average of 7.96 days in hospital compared with 8.70 days for those with the wall view.
  • The ‘tree view’ patients took fewer moderate and strong analgesics per day.
  • The nurses notes on patients’ conditions and recovery had less negatives evaluations eg ‘upset and crying’, than positive evaluations (eg ‘in good spirits’) for those patients with tree views -an average of 1.13/patient compared with 3.96/patient with wall views.
  • Those with a tree view also had slightly less minor post-surgical complications.

A similar study in 2005 (Walch et al­­­) looked at the significance of sunlight levels in hospital recovery spaces and its impact on patient wellbeing. Again, the figures demonstrate significant improvements in those exposed to greater levels of sunlight:

  • Patients felt less pain
  • 22% reduction in analgesic medications were taken per hour
  • 21% less pain medication costs were achieved 

These findings indicate that the design of hospitals can have an impact on patients’ recovery time, highlighting why biophilic principles should be considered within the design of healthcare spaces to incorporate natural elements. The difference in individual patients’ recovery time when multiplied by the number of healthcare users over a year adds up to a huge amount of time and resources and this has implications regarding the financial savings that improved design could have on hospital budgets, let alone individual wellbeing satisfaction with their care. 

Hospital Entrance – a healthy dose of light and nature!

 Biophilic Interior Principles

– spaces that reconnect us with nature - 
  1. Visual Connection with Nature– Stimulating views to elements of nature, living systems and natural processes, such as a window with a garden or sea view, flower beds, courtyard gardens, inside potted plants, green walls and green roofs.

Khoo Teck Puat Hospital Singapore – The Earthbound Report

 2.  Nature Art: Images as representative symbols - Ulrich’s findings extended to representational nature imagery, finding that patients reacted favourably to nature art, reporting less anxiety, stress, and even pain perception (Ulrich et al. 1993). Since then, the incorporation of nature art in healthcare settings has become known as evidence-based “positive distraction,” a term that’s defined as “an environmental feature that elicits positive feelings and holds attention without taxing or stressing the individual, thereby blocking worrisome thoughts” (Ulrich 1999).

3. Natural Analogues. The representational presence of natural materials, patterns, objects, colours, and shapes incorporated into building design, facade ornamentation, decor, and furniture.

- Art imitating nature - 

    4. Nature in the Space. The incorporation of spatial elements commonly found in nature such as expansive views, places of sensory refuge (such as a quiet and dark room that simulates a cave), and a mild sense of risk (like steppingstones over a shallow pond).

 Modifying hospitals’ design by humanising spaces and especially through reconnecting with nature offers a therapeutic support that can positively impact on the patients’ psychological and physical well-being; it can also improve their ability to recover, with varying results depending on the different levels of treatment (diagnosis, therapy, recovery) and on the disease in question.

At the same time, space design can improve the efficiency levels of an organisation and contribute to economic benefits, both because the staff’s well-being increases, and because it reduces health-related costs. Rooms with plants natural ventilation and light, the sight of, and contact with, nature increase the staff’s productivity and organisational capability.

These biophilic design choices also boost the activity of the parasympathetic nervous system, thereby decreasing stress levels and encouraging a general sense of well-being. By promoting staff’s health, biophilic design helps to reduce sick leave, while improving satisfaction and attention levels.

Biophilic design recognises the perceived benefits of bringing nature indoors, as it has been proven time and time again to help humans, especially in all aspects of health and wellbeing.

In the words of Dr. Richard Jackson from the University of California Los Angeles School of Public Health, “We now know that developers and architects can be more effective in achieving public health goals than doctors in white coats.”

On average, one-third of a workday outside of the home is spent at the office. Therefore, in order to achieve public health goals and employee wellbeing and productivity in the workplace, Biophilic natural elements, eclectic spaces and creative thinking are essential factors to consider and adopt now into the design of all our healthcare spaces.

Khoo Teck Puat Hospital Singapore – The Earthbound Report


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