Americans believe when they become sick, diseased or injured, they need medical attention to be cured. We have long associated curing with healing, believing that to be cured is to be healed. Thus, it is the expectation that medical facilities are healing environments. However, are they? Can a place heal? What’s the proof?

Healing environments continue to be defined with new qualities including safety, security, accessibility, sustainability, and now evidence-based design. Using evidence to validate the use of a particular design has become the tool of choice. Evidence shows how to mitigate barriers; evidence shows that better lighting, art programs and even water features improve patient outcomes—and reduce operating costs.

“Healing Environments – What’s the Proof”, new book by Barbara Huelat, defines the characteristics of a healing environment, listing ten essential components that make a difference in health outcomes: place, change, people, comfort, senses, knowledge, empowerment, biophilia, spirit and experience. Readers are challenged to look differently at humanity’s natural ability to heal and to integrate supporting evidence.

When trying to describe places called “Healing Environments” we typically look to where healthcare providers treat patients. People use phrases like “patient-friendly”, “family-centered”, “home-like”, “hospitality-like” and “patient-first” to describe healing environments. But these buzzwords provide ill-defined philosophies that don’t quite reach the heart of the matter.

Designers, consumers and healthcare providers might try to create healing environments, and intuitively, the phrase “healing environment” sounds reassuring. Often healthcare organizations believe they have a healing environment, even if they can’t quite define it. If they feel they don’t have one, they want one—it will improve business, benefit their community and their patients.

The most basic definition of a healing environment is our oldest and most common conception: a place where doctors practice medicine—a hospital. Since healthcare reform requires that existing facilities perform in a “patient-friendly” manner and facility mission statements often include promises of patient services, care-giving and high-quality care, people have become increasingly willing to accept the idea that modern-day medical facilities provide healing environments.

Furthermore, many Americans believe when they become sick, diseased or injured, they need medical attention to be cured. This belief nurtures the idea that a healing environment involves a hospital, doctors and nurses. We have long associated curing with healing, believing that to be cured is to be healed.

By examining the association between healing and curing, the flaws in this definition become apparent. Though medical facilities may help cure, they do not, in and of themselves, constitute a total healing environment.

Confusing a healthcare facility with a healing environment is made easier by the fact that we tend to think of “healing” and “curing” as synonymous; they are not. A patient who is cured is not necessarily healed. For instance, if a facility resuscitates a patient during cardiac arrest, that patient is cured—saved from death. That patient is not healed; the cause of the cardiac arrest remains untreated.

Since people die everyday, we know that medical facilities cannot always provide a cure. However, as hospice patients attest, healing is frequently possible, even in the face of death.

A cure involves the repair of physical damage. Healing balances the body, mind and spirit. Traditional medical institutions seek to provide cures, while healing environments support both healing and curing. Curing and healing are both important aspects of health care, and health-care facilities can support both.

The Evidence

Evidence-Based design has surged over the past five years. For designers striving to validate the reasoning behind their work, this trend has been very beneficial. Hospital administrators have challenged the design profession with “prove it” regarding the value of patient amenities.

In the late 1980’s the Center for Health Design published it’s first list of a literature search of research documenting studies where design had a positive impact on the patient’s ability to heal. This occurred before the term “evidence-based design” was used. This list numbered less than 60 examples. Today I googled “evidence-based design” and found more than 55,100,000 entries. Evidence-based design is growing exponentially, and not a minute too soon. What is behind this phenomenal growth?

Evidence-based design has become the new design tool of choice. Armed with this new tool we can now mitigate environmental barriers to healing and specify elements such as better lighting, art programs and even water features with evidence that these amenities can actually improve patient outcomes, and even reduce operating costs. Evidence-based design proves the value of healing environments as well as contributing to the continued growth of these new thought processes.

Evidence-based design is analogous to evidence-based medicine. Simply put, it is the process of making design decisions based on the best available research. Evidence-based design provides indicators which illustrate improvements in healthcare environments. Areas such as clinical outcomes, financial improvements and human behavior provide some of the strongest validity for success.

Evidence-based design for healing environments is primarily related to three strategic areas including; environmental psychology, clinical science and economical context.

Environmental Psychology links people with healing space. The focus is on the experience and the emotion that place elicits. This discipline further addresses evidence which support healing by the reduction of stress. Clinical Sciences focus on the medical and scientific components of the environments.

This links science to the prediction of improved patient outcomes. Economic Context refers to management, cost and operations of medical facilities wit respect to how evidence can forecast improved financial outcomes.

Healing environments extends far beyond the walls of medical facilities. While medical facilities continue to provide treatment, healing can occur in many places that may or may not be medical facilities. A healing environment envelops the experience.

It is our experience of place that creates the lasting memory and becomes one with our body, mind and spirit. It is the experience of place, not the place itself that provides the sense of pleasurable memories. Positive experiences can contribute to healing. It is the experience—good or bad—that we remember, and it is our memories that provide meaning in our lives.

As Hypocrites said, “The natural healing force within each one of us is the greatest force in getting well.” To maximize a facility’s ability to provide a healing environment, we must not only ensure that it provides safety and comfort for the physical body, but we must also ensure that it provides avoids emotional stress.
Healing environment as a concept and hypothesis continue to grow and define itself.

Well-known scientists, whose work is specifically linked to the healing environments such as Roger Ulrich, and Craig Zimring, continue to contribute to this growing body of evidence. However, we also need to look at other diverse disciplines, such as anthropology, biophilia, chemistry, neurosciences, religion, and sociology to integrate their research. CDC, The Center for Disease Control, is also a valuable evidence-based resource to integrate into healing environments.

There is ample evidence behind the concept of healing environments. We are challenged to look differently at humanity’s natural ability to heal as well as integrate supporting evidence. And finally, we must “think outside the box” and engage in the transformational model of healing through experiences.
Barbara J. Huelat, AAHID, ASID, IIDA, 2008

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