Building Design

EBD Boot Camp – Boot Camp for Evidence-Based Design

EBD Boot Camp

It’s back to school! On September 12-14, the Texas A&M Center for Health Systems and Design will hold a two-day work session on evidence-based design. EBD Boot Camp is a practical interactive work session that will give design professionals, developers, researchers, and others the practical experience of applying relevant evidence in their work.

Led by Texas A&M experts, the September Boot Camp is the first of four work sessions sponsored by the Center for Health Systems and Design. Another fall EBD Boot Camp session takes place October 24-26; two more sessions will follow in 2014, February 6-8 and March 20-22. The organizers describe the hands-on workshop in this way:

This is not a superficial conference presentation about theory. It is a unique, no-nonsense, limited attendance and hands-on work session using relevant evidence to develop the real project on your desk.

Want to learn how to incorporate evidence-based design into your work?  Bring a current project and learn how to use and integrate relevant evidence through a hands-on, interactive work session with expert guides.

Texas A&M University, College Station, Texas

September 12-14, 2013 or October 24-26, 2013

$1700 per person, $1450 for each additional person – same firm. Limited to 8 attendees per session.

D. Kirk Hamilton, FAIA, FACHA, EDAC
Mardelle Shepley, D.Arch, AIA, LEED AP, EDAC
James W. Varni, PhD
Susan D. Rodiek, PhD, NCARB, EDAC
Zofia Rybkowski, PhD,LEED AP
Xuemei Zhu, PhD
Zhipeng Lu, PhD

Architects, Landscape Architects, Engineers, Designers, Project Managers, Researchers, Technology Experts, Librarians, Developers, and Building Owners

Attendees who complete the EBD Boot Camp, perform the assigned work and pass the review exam will receive an Advanced Practitioner Certificate from the Center for Health Systems & Design at Texas A&M University.

For more information contact Judy Pruitt at(979) 845-7009 or To register, click here. For more information, read the EBD Boot Camp flier.


“Biophilic Design: The Architecture of Life”

A documentary on the biophilic approach to designing cities, suburbs

A new film takes viewers on a journey from our evolutionary past and architecture’s  origins to the world’s most celebrated buildings in a search for the architecture of life.  The documentary, “Biophilic Design: The Architecture of Life” by Stephen Kellert and Bill Finnegan will be featured October 23 at New York City’s AIA Center for Architecture.

Kellert and Finnegan’s film explores innovative ways of designing the places where we live, work, and learn, and will be introduced by Stephen Kellert. As one reviewer put it: “The film plainly states that bad design is part of the cause of environmental degradation and that good design is part of the solution.”

The producers describe their film in this way:

“Biophilic Design is an innovative way of designing the places where we live, work, and learn. We need nature in a deep and fundamental fashion, but we have often designed our cities and suburbs in ways that both degrade the environment and alienate us from nature. The recent trend in green architecture has decreased the environmental impact of the built environment, but it has accomplished little in the way of reconnecting us to the natural world, the missing piece in the puzzle of sustainable development.”

The film screening, followed by a panel discussion, is co-sponsored by the Yale School of Forestry and Environmental Studies, and the Yale Alumni Association of New York. For a sneak peek of the film, view the trailer now.  If you have questions, please contact Georgia Silvera Seamans or visit this film screening site.

The book, Biophilic Design: The Theory, Science, and Practice of Bringing Buildings to Life, edited by Kellert, Judith Heerwagen, and Martin Mador is also excellent.

What: Documentary, “Biophilic Design: The Architecture of Life”

When: Tuesday, October 23, 2012, 12:15 – 2:45 p.m.

Where:  AIA Center for Architecture, Hines Gallery, 536 LaGuardia Place, NYC


Community Engagement & the Built Environment conference

Head Start Preschool, Seattle, WA                    Photo by Filiz Satir

Head Start Preschool Play Yard, Seattle, WA. Photo by Filiz Satir

Community Built Association Conference: May 30-June 2, 2012

The Community Built Association (CBA) will hold its annual conference in Portland, OR, May 30 – June 2. The interdisciplinary gathering is open to all those interested in community engagement through the lenses of art, play, nature, and the built environment.  The conference features presentations and panel discussions related to play environments, gardens and green spaces, public art, and community-engaged architecture. The conference at Portland’s Tabor Space, 5441 S.E. Belmont Street will  include:

  • Presentations and discussions from leaders in the field of community-based practice;
  • Hands-on workshops that will engage participants’ creativity while they contribute something of lasting value to the local community;
  • Tours of local “place-making” sites around Portland, where volunteers have shaped community spaces with their own hands over time; and
  • Informal networking and sharing sessions with inspirational community builders from Portland and around the country.

Artists, architects, builders, organizers, gardeners, planners, and others are all welcome. To learn more and register for the conference, visit the CBA Web site:


Therapeutic Landscapes with The Patron Saint of Architecture

"The Patron Saint of Architecture" blog image courtesty of Angela Mazzi

This week on the blog, “The Patron Saint of Architecture,” Angela Mazzi features therapeutic landscapes through an interview with me. She asked some excellent, thought-provoking questions that get to the heart of what therapeutic landscapes are, how they function, why they’re necessary, and what designers and healthcare providers can do to make sure that they get incorporated into their projects.

Angela is an architect who specializes in healthcare. Her blog explores all sorts of aspects of healthcare-related design, including (of course) design, as well as business strategies, communication techniques, and “thoughts on how to get and stay inspired as a designer.”

Here are a couple snippets, but I encourage you to read the full post on The Patron Saint of Architecture blog.

How Does your Garden Grow? The Role of Therapeutic Landscapes in Design, by Angela Mazzi

What does landscaping mean to you?  Most likely, not nearly enough.  Too easily, we view it as decorative, a “nice to have” part of a project.  However, as we learn more about salutogenic design and the effects of the environment on wellness (everything from healing to better job performance), landscape starts to become a critical element, one which should form the basis of design.  With this in mind, I asked Naomi Sachs, Founder and Director of the Therapeutic Landscapes Network (TLN) to share some insights on the power of nature.

What is the difference between landscaping and a garden?  Is it only about habitation?

In general, I would say that a “landscape” is any outdoor space, wild or designed, and a “garden” is a designed space. A restorative landscape is simply an outdoor space that makes you feel good when you’re in it. To me, “landscaping” implies decorative elements like a lawn, shrubs, some trees, and is not necessarily intended for interaction.  A therapeutic (or healing) garden is a space designed for a specific population (children, cancer patients, people with Alzheimer’s) and a specific intended outcome (stress reduction, positive distraction, rehabilitation). This is not to say that landscaping isn’t important. Well-designed and maintained landscapes communicate to patients and their families that they will receive a high level of care, and this can happen from the moment you cross the property line.  Even areas such as parking lots can utilize landscape to provide and reinforce the overall image and mission of the facility.

Maintenance is always a concern when it comes to landscaping- I’ve actually worked with healthcare clients who wanted nothing but grass in the areas they “had” to landscape for ease of maintenance.  What kind of recommendations can you make to landscape skeptics about using plantings?

Access to nature just makes good business sense. Studies by Roger Ulrich, confirmed by others, have demonstrated less need for pain medication, improved patient satisfaction, faster recovery rates, and many other examples of improved outcomes for patients and staff. When you really look at the benefits of providing access to nature, the return on investment (ROI) justifies the initial cost and lifetime maintenance.  Hospitals need to see landscaping as a strategic investment in the same manner they would the purchase of a new MRI.

Visit The Patron Saint of Architecture to read the full article. Thank you, Angela, for a great conversation and post!


Gimme Shelter! Shade in the healing garden

Ulfelder rooftop garden, Massachusetts General Hospital. Photo by Naomi Sachs

Ulfelder rooftop garden, Massachusetts General Hospital. Photo by Naomi Sachs

I’ve been meaning to write this post all summer, and of course now it’s fall and here in the northeast, shade doesn’t seem as important anymore. But plenty of the country is still baking (if not on fire), and half of the world is just now headed into summer. I asked the TLN Facebook group to rate the importance of shade, on a scale of 1-10 (10 being the most important). Two people responded “11,” and one member, from TX, responded with 15. So here we go:

The importance of shade in the healing garden

I’m so tired of seeing “healing gardens” with no shade, or too little shade. I’ve seen many designs that are successful except for this one crucial element. I don’t know about you, but on a hot, bright day in August, the last place I want to be is outside in the sun, sweating and squinting. It’s gotten to the point where lack of shade doesn’t just make me sad, it makes me angry. Because while it’s a nice amenity in any public space, in the healthcare setting, shade truly is a matter of health.

Why provide shade?

1.  Sun protection, from UV exposure and glare
For burn patients; the elderly; people with cancer; AIDS; traumatic brain injuries (TBI); psychiatric illnesses which require medications that increase photosensitivity (sensitivity to the sun); and other conditions where direct sun (UV) exposure is hazardous, shade is paramount. In addition, colored concrete is often recommended for outdoor healthcare environments because it reduces glare. This is one of the reasons why we have embraced Scofield as a Wonderful Sponsor.

Photo by Naomi Sachs

2.  Heat mitigation
Shade provides a cooling effect, thus facilitating use of outdoor space for as much of the year as possible. This is particularly important in regions where high temperatures discourage people from venturing outdoors.


Peru, Here I Come! Healing Gardens for the Yantalo Clinic

Schematic sketch for Yantalo Clinic interior courtyard. Courtesy of Yantalo Foundation and the NewSchool of Architecture and Design

Schematic for Yantalo Clinic interior courtyard. Courtesy of Yantalo Foundation and the NewSchool

In 2005, Dr. Luis Vasquez visited Yantalo, Peru – his mother’s birthplace – for the first time. Though he had grown up in Lima, about 500 miles southwest of Yantalo, he had never seen his mother’s hometown. A retired cardiologist, Luis was struck by the need for medical care in the community. So Luis did what many of us dream of doing: He created the Yantalo Foundation, setting the wheels in motion to build a health clinic that would serve the people of the region.

Ground has now been broken, and work is well underway on the construction of the Adelina Soplin Yantalo Clinic & Diagnostic Center,  the first green clinic in South America. The 16-bed International Clinic will be equipped with telemedicine, solar power and intelligent water use to decrease negative environmental impact and to lower operating costs. The Clinic will serve everyone in the region, regardless of their ability to pay, while also serving as a training center for Peruvian medical students and physicians. International physicians, dentists and other health care professionals will examine and treat patients who otherwise have no access to proper medical attention.

Gina Cangialosi and Lauren Garza designed all work related to the architectural plans of the clinic. Principles of evidence-based design (EBD) were used throughout. The faculty, students and professional friends of the NewSchool of Architecture and Design in San Diego, CA, donated their time and expertise to the Foundation (their renderings are pictured in this post).

And a week from today, I will be in Yantalo, doing the same – donating my time and expertise for landscape design of the clinic and surrounding site.

From a landscape perspective, there are some very exciting things about this project:

  • The clinic has been designed with several interior courtyards as well as exterior spaces for patients, visitors and staff. The opportunity to work on a design where access to nature as a restorative element is a “given” is very exciting.
  • The clinic is on land that was cleared a long time ago – the disappearing Amazon forest is a major problem in Peru, and the government has a strong REforestation program in place. The Yantalo Foundation is proud to be part of that program; they have planted almost 200 trees already, with plans to plant 3,000-4,000 by the end of the project.
  • A local association of retired senior citizens are very active with the project, and many of them have extensive horticultural knowledge – about what grows well where, and also what plants can be used medicinally. I’ll be working closely with them on the design of the healing gardens in and around the building.
  • We will definitely be exploring the use of medicinal plants, something we don’t often get to do in the United States. In Yantalo, one of the goals is to nurture and maintain cultural traditions. Whether medicinal plants are used symbolically or for actual harvesting and use, they will be part of the design.

I leave on Saturday and will be there for a week. Where is Yantalo, exactly? In the Amazon jungle, 648 miles (405 km) south of the Equator. Here’s a map. Bye-bye, winter, hello, summer! I’ll do my best to send updates while I’m there – the best way to keep track of goings-on will be through Twitter and the TLN’s Facebook page, and will go more into detail once I’m back home.

For more information, and to make a donation to the Yantalo Foundation, visit their website:

Rendering of Yantalo Clinic. Courtesy of Yantalo Foundation and the NewSchool of Architecture and Design

Rendering of Yantalo Clinic. Courtesy of Yantalo Foundation and the NewSchool of Architecture and Design

Research Summary: “Investigating Walking Environments In and Around Assisted Living Facilities.”

Photo courtesy of Susan Rodiek

Walking is the most popular form of exercise for elderly people. Photo courtesy of Susan Rodiek.

Speaking of older adults (see our last post about Environments for Aging), a good article – “Investigating Walking Environments in and Around Assisted Living Facilities: A Facility Visit Study” by Zhipeng Lu – was published in the Summer 2010 issue of Health Environments Research & Design Journal (HERD). I wish I could provide a web link for you to access the free article, but alas, it’s only available to buy. So I’ll summarize the author’s points here.

At issue are the dueling needs of elderly people: The need for safety and the need for exercise and social connection. Lu states that “falls are the most frequent cause of injury-related morbidity and mortality among community-dwelling older people.” Falling is a true risk and needs to be avoided. But as he (and others he cites) argue, exercise and social connection are both critical for maintaining physical and emotional health. Careful consideration of location/neighborhood, as well as design of indoor and outdoor pathways, can both reduce risks and enable elderly people to live active, healthy lives.

Lu first makes a case for the benefits of exercise – in this case, walking – for elderly people (people 65 or older), and asserts that “the physical environment plays a role in promoting physical activity.” Since walking is the most preferred form of exercise among elderly people, it makes good sense to see what types of settings best promote frequent and safe walking.” The design of walkable ALF environments has become more important because frail older people are increasingly averse to nursing homes and seek a higher quality of life and greater independent living in an ALF.” An assisted living facility, or ALF, as defined by the Assisted Living Federation of America is “a long-term care option that combines housing, supportive services, and healthcare for mentally and physically frail individuals.”


Make it Pretty and They Will Come: The Role of Aesthetics in Patient Satisfaction

Woodwinds Health Campus

Garden bench at Woodwinds Health Campus, photo courtesy of Woodwinds Health Campus

Like most people, I’ve had my fair share of unpleasant experiences in doctors offices and hospitals. And looking back, I realize that many of my most worst memories had to do with the way the place looked. The one that took the cake was a doctor’s office in a windowless clinic with one potted plant in the waiting room. And that plant, a Poinsettia from Christmas-time (this was in February) was dead. Even if only on a subliminal level, we perceive that something is wrong with this picture: “If they can’t even take care of one houseplant, how the heck are they going to take care of me?” I have heard many people, when talking about the gardens in a hospital, clinic, or nursing home or other place of healing, express the opposite sentiment: “They take such good care of the gardens, and that reassures me that they will take good care of me, too.”

I’m reading an article from an old (2008) issue of Healthcare Environments Research & Design Journal (HERD), titled “Ambulatory Facility Design and Patients’ Perceptions of Healthcare Quality,” which completely reinforces what we all know in our hearts to be true: That places of healing work better when they look and feel like…places of healing. And I’m talking, of course, about a more holistic idea of healing than just “isolate, sterilize, and medicate.” Squeaky white linoleum floors that reflect buzzing fluorescent lights attached to low ceilings in long, windowless corridors is an old model that has been proven to be anything but good for our health.

So, let me just share a few nuggets from this article. First, its conclusion, as stated in the abstract: “This study is consistent with other studies that examined the relationship among the physical attractiveness of healthcare settings, patient satisfaction, and quality of care.” Patients reported better care, service, and staff and doctor interactions in the more attractive waiting rooms. The authors cite several other related studies about patient satisfaction: Leitner and colleagues (1998) found that “patients in hospital units where nurses felt that their work was meaningful were more satisfied with their hospital stay” and that “…patients on units where nurses felt more tired and more frequently expressed their intention to quit were less satisfied with their care.” Mallak, Lyth, Olsen, Ulshafer, and Sardone (2003) found that “…job satisfaction [among healthcare providers] and patient satisfaction were significantly and positively correlated with culture strength and ratings of the built environment.” They also cite interviews with patients and families about what they want. Douglas and Douglas (2004) “found that patients reported the need for personal space, a homey welcoming atmosphere, areas for visitors, access to external areas, and provision of facilities for recreation and leisure.” Gardens in places of healing can fulfill many of these criteria, and a well-designed garden should address all of them.

I once got an email from someone recommending that his local hospital’s healing gardens (Woodwinds Health Campus, pictured above) be added to the TLN’s list of exemplary gardens in healthcare facilities. The gardens made a strong positive impression on him, and influenced how he felt about the entire hospital. And it probably provided a great incentive for him to visit for regular check-ups rather than waiting for emergencies. Think about how much people’s health would improve if they adhered to the preventative care model!

The article mentioned above explores the role of the built environment in influencing patient (consumer) satisfaction. Another article, which I’ll blog about soon, discusses the role of the built environment in influencing patient health and safety. There are so many reasons for healthcare providers to focus not just on the medicines and the machines, but on the places that house what all that stuff is there for: The patients and their families. All of those places have outdoor space – be it a parking lot and drop-off area or a designed “healing garden,” and all of those outdoor spaces could and should be considered as part of the aesthetic package that influences patient satisfaction, health, and well-being.

Full citations:

Becker, Franklin, Bridget Sweeney, and Kelley Parsons (2008). “Ambulatory Facility Design and Patients’ Perceptions of Healthcare Quality.” Healthcare Environments Research & Design Journal (HERD), Vol. 1, No. 4, pp. 35-54.

Douglas, C. H., and M. R. Douglas (2004). “Patient-friendly Hospital Environments: Exploring the Patient’s Perspective.” Health Expectations, Vol. 7, No. 1, pp. 61-73.

Leiter, M. P., P. Harvey, and C. Frizzell (1998). “The Correspondence of Patient Satisfaction and Nurse Burnout,” Social Science Medicine, Vol. 47, No. 10, pp. 1611-1617.

Mallak, L. A., D. M. Lyth, S. D. Olsen, S. M. Ulshafer, and F. F. Sardone (2003). “Culture, the Built Environment and Healthcare Organizational Performance.” Managing Service Quality, Vol. 13, No. 1, pp. 27-38.

A New Way to Improve Quality of Life for Seniors: Excellent DVD Series (with a discount for us!)

Five years ago, Susan Rodiek embarked on a project to create a series of DVDs about providing better access to nature for older adults. Rodiek, a professor at Texas A & M University’s Center for Health Systems & Design, specializes in senior populations, and access to nature has long been a focus for her research and teaching.

Those years of hard work have paid off. I received my “Access to Nature for Older Adults” DVDs last week and I’m truly impressed. The three-DVD series is not just instructional – it’s downright inspiring. With beautiful imagery, compelling research and interviews, easily digestible information, and a lot of real, practical solutions to common problems, it’s a must-watch and a must-have for architects, landscape architects, planners, educators, and any care provider who works with seniors in continuing care retirement communities, assisted living facilities, nursing homes, hospices, as well as acute care general hospitals.

Session One, The Value of Nature, describes how access to nature may benefit the health of seniors, from the perspective of experts and available research – addressing the role of programs, policies, and design issues.

Session Two, Improving Outdoor Access, explores how the layout of the building itself can either encourage or discourage outdoor access, and how specific areas – such as indoor-outdoor connections – can be successfully developed.

Session Three, Safe and Usable Outdoor Spaces, highlights the main outdoor features that are reported by residents to impact their outdoor usage, and how these can be improved. Seating, shade, and walkways are among the outdoor elements illustrated.

The Access to Nature website is also chock-full of good information. Some of it is accessible to everyone, and some of it is only accessible if you have the DVDs. So go ahead and buy them! You won’t be sorry.

Receive a 10% discount: Between now and the end of January 2010, Therapeutic Landscapes Network members and readers of this blog will receive a 10% a discount when you buy any or all of the Access to Nature DVDs. Just enter this promotional code in the checkout section on the Access to Nature website: TLNA2N.

The need for natural light, part III

Let’s see, which hospital room would you rather stay in? This one (A)?

Or this one (B)?

Carson Tahoe Regional Medical Center, Carson City, NV
As for me, I’d choose B. There are lots of reasons why I think B is better than the A, but high on the list is that B has lots of windows that not only look out onto a view that even homebuyers would pay good money for, but that let in copious natural light as well. 

And so we come to the Part III of “The need for natural light.” 

The benefits of natural light – at home, at work and school, and in the healthcare setting – have been well documented. People fare better when they have access to natural light. For example, a 1998 study found that sun exposure in the workplace environment increased worker satisfaction and performance, including lowering intention to quit and reducing fatigue (that same study, by Leather et al., found that providing views of nature also increased satisfaction, particularly in high-stress environments). A landmark “Daylighting in Schools” study found that students in classrooms with more natural light scored as much as 25% higher on standardized tests than other students in the same school district (see references below for full citation and to link to the condensed study). 

As for healthcare: Roger Ulrich and colleagues have found exposure to natural light to be an important factor in environments for healing. Exposure to sunlight can reduce depression, alleviate stress, and even reduce pain. In addition to providing essential dosages of Vitamin D, sunlight increases our levels of serotonin, which in turn inhibits pain. In their recent literature review of evidence-based healthcare design, Ulrich et al. cite a study by Walch and colleagues of post-operative spinal surgery patients. Patients with sunnier rooms reported less stress and took 22% less analgesic pain relief medication (see Ulrich et al, 2008, below). 

In her new, excellent book A Visual Reference for Evidence-Based Design, Jain Malkin lists daylight as one of the key ingredients in creating a successful Environment of Care: “There is a major focus on the importance of natural light and views, access to gardens, and clarity of wayfinding.” In Chapter 4, “Incorporating Research into Design Features,” lighting is first on the list: “Lighting–both natural and electric–is the most important component of an interior environment. Adequate exposure to natural light is essential for biological health and entrainment of circadian rhythm. Research indicates that patients in rooms that receive more sunlight are less depressed and have reduced length of stay.” Malkin also mentions benefits to staff members (pp. 63-65; see full citation below). 
So what does all of this have to do with therapeutic landscapes? 

Simple: Windows that let in natural light… 

The waiting room at Santa Fe Cancer Center at St. Vincent Hospital 
looks out onto the healing garden (Santa Fe, New Mexico)

…can also offer views to the outside world (even skylights can sometimes give us views of blue sky and/or clouds). As Ulrich et al. state in their most recent (2008) literature review, “Larger windows in patient rooms not only provide natural light, but they also have the potential benefit of offering views of nature and should be considered in the design process.” 

Healing garden at St. Vincent Hospital, Santa Fe, NM 
(note the mirrored windows – they provide privacy for those inside 
while also reflecting the garden to make it appear larger).

And as we know from Ulrich’s and other studies, window views to something more interesting than a brick wall, or the building’s air conditioning system, elicit better outcomes. And the research also suggests that more naturalistic the setting, the better the outcome (again, see Ulrich et al, 2008, below).

Lobby at Carson Tahoe Regional Medical Center, Carson City, NV

All of this research notwithstanding, there are times when natural light can be too much of or not enough of a good thing.

Too much of a good thing

1. When light = sun = heat. In hot climates, keeping light out is one important way of regulating the temperature. Whether inside the building or out, people seek shade when temperatures rise above the human comfort zone. Though it’s beautiful and exemplary in many ways, I’m actually not sure how I’d feel in the above Carson City lobby on a hot day in August…but maybe they’ve got it all figured out with awnings, blinds, or some other technology (besides just more AC). 

2. When light = glare. For example, as I write this, the sun is starting to stream into my office, which would be lovely if it didn’t glance off of my computer screen. Time to draw the curtain. And glare can truly be a problem, especially for people like the elderly who are glare-sensitive. 

3. This last point isn’t so much to do with light as with privacy. The one drawback of a window, especially on a ground floor looking out onto a garden, is that if users inside can see out, then people outside can usually see in. Designers of hospitals with interior courtyards often grapple with the double challenge of the “fishbowl effect” (feeling like everyone can see you when you’re in the garden) and not wanting to violate the privacy of those indoors. Designers have found all sorts of clever ways to address this issue, including at St. Vincent Hospital, above, where mirrored windows allow users inside to see the garden whilst keeping their privacy intact, and users outside get the sense of an even larger and more verdant garden (yep, the old mirror trick can work in the landscape as well).

Window coverings: That 1998 workplace study I mentioned earlier also suggested providing users with ways to control the amount of light (curtains, etc.). As we also know from research, providing people with choices is another way to reduce stress and bolster a feeling of control over one’s environment. Whether those operable window coverings are used to control light for temperature regulation, glare, privacy, or just personal preference, they should be provided whenever possible.
Not enough of a good thing: Seasonal Affective Disorder and Sundowners Syndrome. Sometimes natural light has to be augmented or adjusted, as in these two examples below.

1. Another issue with natural light is that in the winter, there just isn’t enough of it. We’ve all heard of SAD – Seasonal Affective Disorder, and this is a real thing. Just as plants need grow-lights in the winter because even sitting in a sunny windowsill isn’t enough, some people need additional light, too. Full spectrum light therapy, at doses of 2500 – 10,000 lux, has been found to be as or even more effective than anti-depressants for some SAD sufferers. 

2. For people with Alzheimer’s and other forms of dementia, exposure to light and the color of light should be controlled and regulated to avoid mood changes and disruptive behaviors, particularly those brought on by “sundowners syndrome.” In two studies by Melinda La Garce, the effects of “Sundowner’s Syndrome” and other light-related problems were reduced by adding “full spectrum lighting to simulate daylight, shading devices to reduce sun angle change and shadows, and light monitors to keep the light intensity the same throughout the day and evening.” In the 2004 study, La Garce noted that the sun’s altitude, which changes over the course of the year, affects the color, intensity, and angle of daylight. She also found that the color of light seemed to play a stronger role than shadows and light intensity. 

As I’ve mentioned in the past (see, for example, “When the Weather Outside is Frightful”),  indoor atria are another great way to provide access to natural light and nature, even on days when going outside is not an option. This image is of the Fourth Floor Atrium at the University of Alberta Hospital in Canada. To see more examples, link to Shane Pliska’s article in Interiorscape Magazine.


Crockett, Jim (2004). “Healthy Daylight and Healthy Darkness: What our Bodies Need.” Consulting-Specifying Engineer. Click HERE to link to the article.

Darling, Tammy (1993). “Seeing the light: why your body needs regular doses of natural light.” American Fitness, Nov-Dec. Click HERE to link to the article.

Gross, Raz, Yehuda Sasson, Moshe Zarhy, and Joseph Zohar (1998). “Healing Environment in Psychiatric Hospital Design.” General Hospital Psychiatry, Vol. 20, No. 2, pp. 108-114. Read the summary by InformeDesign.

Heschong, Lisa and Heschong Mahone Group (1999). “Daylighting in Schools: An Investigation into the Relationships Between Daylighting and Human Performance.” Commissioned by California Pacific Gas and Electric Company. Click HERE to link to the condensed report.

Horowitz, Steven G., M.D. (1998). “Design Trends: Designing for Advanced Therapeutic Outcomes – Acute Care.” Journal of Healthcare Design, Vol. 7. Read the summary by InformeDesign.

La Garce, Melinda. (2004). “Daylight Interventions and Alzheimer’s Behaviors – A Twelve-Month Study.” Journal of Architectural and Planning Research, Volume 23, Issue 3, pp. 257-269. Read the summary by InformeDesign.

La Garce, Melinda. (2002). “Lighting Affects Behavior of Alzheimer’s Patients.” Journal of Interior Design, Volume 28, Issue 2, pp. 15-25. Read the summary by InformeDesign.

Leather, Phil, Mike Pyrgas, Di Beale, and Claire Lawrence (1998). “Windows in the Workplace: Sunlight, View, and Occupational Stress.” Environment and Behavior, Vol. 30, No. 6, pp. 739-762. Read the summary by InformeDesign.

Malkin, Jain (2008). A Visual Reference for Evidence-Based Design. The Center for Health Design

van Bommel, W. J. M. and G. J. van den Beld (2004). “Lighting for Work: A Review of Visual and Biological Effects.” Lighting Research and Technology, Volume 36, No. 4, pp. 255-269. Read the summary by InformeDesign. 

Ulrich, R. S., Craig Zimring, Xuemei Zhu, Jennifer DuBose, and Hyun-Bo Seo, Young-Seon Choi, Xiaobo Quan, and Anjali Joseph. (2008). A Review of the Research Literature on Evidence-Based Healthcare Design. Published in Health Environments Research & Design Journal, Vol. 1, No. 3, Spring, pp. 61-125. Click HERE to read the abstract. 

Ulrich, R. S., C. Zimring, A. Joseph, X. Quan, and R. Choudhary. (2004). The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. Concord, CA: Center for Health Design. Read the summary and access the full report at the Center for Health Design.

Walch, J. M., B. S. Rabin, R. Day, J. N. Williams, K. Choi, and J. D. Kang. (2004). “The effect of sunlight on post-operative analgesic medication usage: A prospective study of patients undergoing spinal surgery.” Psychosomatic Medicine, Vol. 67, pp. 156-163.