​European Healthcare Design Congress and Exhibition 2016

Colin Porter speaks with Jane Knowles, Head Gardener at Royal College of Physicians

The Landscape, Gardens and Health Network was delighted to take part in the European Healthcare Design Congress and Exhibition this week. Organised by Architects for Health and SALUS Global Knowledge Exchange, the event was held at the Royal College of Physicians – a prestigious venue with an expertly planted Medicinal Garden.

Colin Porter, a founder member of the network, chaired a well-attended afternoon of presentations on the theme ‘Landscape design: nature and the therapeutic environment.’ 

For brief summaries of presentations and points made during Q&A

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​Clare Cooper Marcus
Professor emeritus, University of California, Berkeley

Healing gardens in healthcare – the necessity of nature

Using Roger Ulrich’s 1984 paper, ‘The view from the window,’ as a starting point, Clare Cooper Marcus led us through her own research findings and those of Rachel and Stephen Kaplan (1993). The conclusions underlined the importance of well-designed hospital gardens, not only for patients but also for staff – a point that was enthusiastically followed up by delegates during the concluding Q & A session. 

The Kaplans’ research demonstrated that access to green space helps individuals to restore concentration levels after periods of mental fatigue. As one participant in the presenter’s own research expressed, ‘ sitting here in the sun is like therapy for me’ – a welcome break from the stress of the Intensive Care Unit where she worked.

Although, as the presentation pointed out, it would be difficult to prove, restoring levels of concentration in a well-designed hospital garden could lead to a reduction in the number of deaths attributed to medical errors. Equally, by reducing staff stress levels, such a garden could create a more inviting work environment and thereby help to address recruitment problems.

Delegates were reminded that the gardens patients and staff most enjoy using, rarely contain clever metaphors.  Designs that flatter the designer’s ego should be avoided. The inclusion of shade, accessibility and provision for privacy on the other hand, are essential.  Not only do they increase physical comfort, they also provide choice.

‘Choice’ is one of the prerequisites for optimum living and yet, as the presentation noted, during a typical hospital visit, decisions are made for, rather than by a patient. This is experienced as a lack of control and causes considerable stress. A well-designed garden can provide opportunities for the exercise of patient choice – for example, a choice between sitting in the sun or in the shade.

In conclusion, hospital gardens of the future should be designed to play a part in the treatment regime, rather than as an optional extra. Their impact on the quality of life of hospital staff and on the health of patients and their families makes investment in them very worthwhile.



Catherine Simpson
Urban designer and landscape architect, HLM architects

Designing greenspace for health, the future of cities and hospitals: a case study of Tlemcen University Hospital, Algeria

Catherine Simpson drew attention to the Victorians’ view of cities as a source of corruption.  Their solution was to develop a large number of public parks and to create city hospitals within green spaces.  

As other presentations at the design congress demonstrated, healthcare is moving towards a preventative model.  We now understand that it is better to concentrate resources on keeping a population healthy, rather than wait to treat individuals when they become sick.  

Ensuring that our cities are not ‘grey’ but ‘green’ will help to reduce the health inequalities that blight them.  An essential part of this process is to make use of biophilia – our innate affinity with the natural world.

Using the flagship Tlemcen University Hospital as a case study, the presentation demonstrated the role of hospital grounds in greening our cities.  Surrounded by parkland and built around courtyard gardens, all rooms within the hospital enjoy views over green space.  Patients, staff and the general public in this rapidly growing city will have the access to nature that they need. 

The presentation concluded that, as we move towards a more preventative form of healthcare, so hospitals should once again become an important part of our civic infrastructure, offering city dwellers the potentially life-saving opportunity to live within 5-10 minutes of a green space.



Stefano Capolongo
Associate professor, Politecnico di Milano
Andrea Rebecchi, PhD candidate
Gloria Triboli, student
Monica Botta, architect

Healing gardens in Italian architectures for health: current national panorama’s quali-quantitative evaluation

With a clear understanding of the principles of healing gardens firmly in mind, this evaluation considered the provision of therapeutic green space in Italy.  Of 634 hospitals surveyed, only 4% of them had a therapeutic garden.  This statistic alone demonstrates the importance of the work in which Stefano Capolongo and his team are involved.

The presenters closely studied five hospital gardens in Lombardy and an ‘identity card’ was created for each. Their aim was to qualitatively observe these outdoor spaces in order to determine their effectiveness and to suggest improvements.  The most noticeable weaknesses in these gardens were lack of signage, seating and shading – a fact that linked neatly with the earlier presentation by Clare Cooper Marcus. 

The presenters are aware of the need to engage both staff and patients in any discussion of the development, design and improvement of the hospital gardens they work with. A delegate suggested to the team that including the local community in the process could add an extra layer of inspiration and support to their questioning and garden development.

The researchers concluded that access to nature and green spaces should be better understood in Italian healthcare architecture. The introduction of specific design guidelines based on the principles of healing gardens could have an important impact on the health of patients in Italian hospitals. Attendees at the presentation will watch the progress of this research with interest.

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Points made during Q&A 

-    Green space should not be an ‘add-on’ when designing a hospital.  It should be fundamental. 
-    All hospital staff should have access to a view of green space.  Corridors are often without windows. Kitchens and morgues are sometimes underground. This is detrimental to the health of the staff that works in them.
-    Providing an opportunity for hospital staff to garden alongside each other in the grounds could help to break down the barriers that exist in the rigidly hierarchical hospital structure. 
-    When designing hospital gardens for children, remember to also create spaces or features for siblings who are well. They need the opportunity to let off steam. 
-    Involving end-users and the local community should be an important part of hospital design process
-    If a patient’s compromised immune system makes contact with nature difficult, remember that research indicates the value of green views.