Evidence-Based Design (EBD)

Roger Ulrich keynote at Gardens in Healthcare Conference

The Children's Garden at Legacy Health, Portland, Oregon

The Children’s Garden at Legacy Health, Portland, Oregon

Gardens in Healthcare: Rehabilitation, Recovery, and Restoration
Friday, Sept 21,  8 a.m. – 4 p.m.
Legacy Emanuel Medical Center, Lorenzen Center
Portland, OR

Dr. Roger Ulrich, a behavioral scientist who is widely known for his research on the impacts of healthcare facilities on medical outcomes, will be the keynote speaker for a one-day conference on Friday, September 21, at Legacy Emanuel Medical Center (Portland, OR). Ulrich and others will address the use of gardens in healthcare settings to promote better outcomes for patients, improved effectiveness for staff and a safer care environment for both.

A large and growing body of evidence indicates that the physical environment impacts patient stress, patient and staff safety, staff effectiveness, and the quality of care provided in healthcare settings. Increasingly, healthcare design is guided by rigorous research linking the physical environment of hospitals to patient and staff outcomes. Like “evidence-based medicine,” where clinical choices are informed by research,  healthcare design, too, is being guided by quantitative and qualitative research. Legacy Health System in greater Portland has nearly a dozen healing gardens between its five facilities. These  gardens provide a physical space in which patients, family, and healthcare staff may use  with specific and purposeful ends in mind.

The Portland conference is suited to therapists, physicians, administrators, nurses, facility staff, and design professionals.  By the end of the day, attendees will be able to 1) describe three benefits of gardens for patients, families, visitors, and staff; 2) summarize two research studies to support gardens in healthcare; and 3) outline processes (strategies) to promote interdisciplinary planning, programming, and evaluation of setting-specific gardens

The registration form provides details about conference programming, fees, continuing education credits, and accommodations. For more information, contact Teresia Hazen at thazen@lhs.org or 503-413-6507.

To learn more about the Legacy Health gardens visit, www.legacyhealth.org/gardens.

HEALTHCARE DESIGN Conference – A wealth of sessions related to Access to Nature

Desert Botanic Garden, Phoenix, AZ. Ottosen Entry Garden. Photo courtesy of Desert Botanic Garden

Desert Botanic Garden, Phoenix, AZ. Ottosen Entry Garden. Photo courtesy of DBG, www.dbg.org

HEALTHCARE DESIGN Conference
November 3 – 6, 2012
Phoenix, AZ
Early bird registration ends 7/27
Click HERE to register and for more details

 

HCD12-Conference-logo

The annual HEALTHCARE DESIGN Conference looks great this year, with a plethora of education sessions related to access to nature, including one with me and two awesome colleagues:

Tuesday, 11/6 from 8:00 a.m.  – 9:00 a.m.
Environmental Standards Council—The Case for Access to Nature in the 2014 Guidelines for Design and Construction of Healthcare Facilities

Naomi Sachs, ASLA, EDAC, PhD Student in Texas A&M’s College of Architecture in the Center for Health Systems & Design
Jerry Smith, Owner and Principal, SMITH\GreenHealth Consulting, LLC
Alberto Salvatore, Principal, Salvatore Associates

Through recommendations for the 2014 ‘Guidelines for Design and Construction of Healthcare Facilities,’ The Center for Health Design’s Environmental Standards Council (ESC) proposed language and substantiating evidence for incorporating access to nature as one of the key elements in the Environment of Care. Quantitative and qualitative research indicates access to nature is an essential design component to the health and well-being of patients, visitors, and staff. This presentation will include an overview of the Guidelines and a look at proposed revisions to the Guidelines that will allow regulatory agencies to more strongly support the inclusion of meaningful outdoor spaces in future projects.

Listed below are all of the other sessions, in chronological order, that look like they would be of interest to TLN members. These are just sessions that jumped out at me as I scanned the list. Others may also touch on access to nature, so look at the full program to go into more depth. If you see any I’ve missed, please leave a comment.

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Evidence-based Design Accreditation and Certification (EDAC): Why it matters

Rooftop garden, Dublin Methodist Hospital, Dublin, OH

Rooftop garden, Dublin Methodist Hospital, Dublin, OH. Photo by Brad Feinknoph for Karlsberger

In yesterday’s blog post, I discussed my plans to pursue a PhD that would focus on access to nature and evidence-based design in the healthcare setting, and I promised to go into more depth about EBD today. For even more information and resources, please visit the TLN website’s page: www.healinglandscapes.org/resources/ebd.

A large and growing body of evidence attests to the fact that the physical environment impacts patient stress, patient and staff safety, staff effectiveness and quality of care provided in hospitals and other healthcare settings. Basing healthcare facility planning and design decisions on this evidence to achieve the best possible patient, staff and operational outcomes is what evidence-based design (EBD) is all about.
The Center for Health Design

In EBD, research generally refers to empirical research, the systematic investigation of the tangible facts aimed at gaining knowledge, making discoveries, testing and revising theories, and applying new knowledge…What differentiates EBD from the traditional design approach is the emphasis on using research to support design decision making and evaluation of design innovations.
An Introduction to Evidence-Based Design: Exploring Healthcare and Design
(EDAC Study Guide 1), p. 72.

I recently took (and passed) the Evidence-based Design Accreditation and Certification (EDAC) exam, the culmination of the Center for Health Design’s program to educate and certify individuals in using an evidence-based approach for the design and construction of healthcare facilities. (more…)

News from the TLN – A note from the Director

Live oak, College Station, TX. Photo by Naomi Sachs

Live oak, College Station, TX. Photo by Naomi Sachs

I knew it had been a long time since the last TLN Blog post, but I didn’t realize until yesterday that it’s been almost a month. I think we are also overdue for our monthly TLN e-Newsletter (if you’d like to receive the free newsletter, sign up here).

The big news is that I have been accepted into the PhD program in the College of Architecture at Texas A&M University. I will be focusing on – you guessed it – therapeutic landscapes, in the Center for Health Systems & Design. The faculty there is unbelievable, the students are top-notch, and the scholarship that comes out of the Center is excellent. The big draw for me is that several Architecture professors focus on access to nature (see, for example, Susan Rodiek’s Access to Nature DVD series). So it’s a great fit, and I’m excited about pursuing the missing piece of my puzzle: Research on how nature – wild and designed – affects people’s health and well-being. Learning how to conduct original research, write about it, and teach others will, I hope, make a contribution to the growing field of evidence-based design (stay tuned for the next post which focuses on EBD) to not just advocate for therapeutic landscapes but to answer specific questions about how we can best design spaces that benefit even the most vulnerable populations.

The TLN website and community will remain active, but will probably undergo changes as I transition from full-time TLN Director and part-time landscape designer to full-time doctoral student. I am in conversation with our Advisory Board about how to make this happen. Support from TLN members who can donate funds and/or time will be essential (if you would like to donate now, please visit our Support page; no amount is too small…or too big). The conversations we’ve been having on Linked In and Facebook have become so dynamic, fulfilling the “connecting people with people” part of our mission and vision.

I will also be moving from my home of almost 7 years in the verdant Hudson Valley to College Station, in Central Texas. This will be quite the change of scenery. I was fortunate last week to see the Texas Bluebonnets and Indian paintbrush in full bloom together, a breathtaking sight. Above is an image of a noble Live Oak in one of College Station’s parks.

Thanks to all of you for putting the “N” in the TLN. Like a good, well-tended tree, this is truly a strong Network, getting stronger and more vibrant all the time. I look forward to continuing our work, in whatever way takes shape, in the years to come. In the meantime, stay tuned for more blog posts as I pack boxes and prepare to move!

– Naomi Sachs, ASLA, EDAC
Founding Director, Therapeutic Landscapes Network

Call for Papers: The Architecture of the Psychiatric Milieu

Nautilus. Photo by Henry Domke, http://henrydomke.com/index.htm
Photo by Henry Domke, www.henrydomke.com

Thanks to a member of the EDRA (Environmental Design Research Association) group on Linked In for posting this:

Call for Papers: The Architecture of the Psychiatric Milieu

The editorial team of Facilities, a peer reviewed journal, are pleased to announce a call for papers for a special issue dedicated to an exploration of evidence based approaches to establish the most appropriate architecture for the psychiatric milieu.

Facilities for psychiatric care have a tradition of standardization in design and treatment dating back to the moral treatment paradigm of the 1850s. As normative approaches to psychiatric care have changed, so too do the facilities used to house, treat and manage patients. The shift to evidence-based design (EBD) in hospital
architecture means that the psychiatric milieu must follow suit. The search for evidence to model psychiatric facilities is an important endeavour. But psychiatric illness is not like orthopaedics or cardiology, where the needs and satisfaction of staff and patients can be relatively easy to assess and evidence can be easily measured. Mental illnesses are a heterogeneous group of disorders, and there is a risk in categorizing all psychiatric illnesses together and treating them alike. Environmental influences that exacerbate one condition frequently assist with another. As such, Facilities is soliciting approaches that are specific to:

  • geriatric psychiatry
  • mood disorders
  • the non-affective psychotic spectrum
  • psychiatric emergencies
  • substance-related disorders
  • facilities for forensic psychiatry

This list is not exhaustive… and interested authors are encouraged to contact the Guest Editor with alternative proposals. Please kindly take note of the following requirements if you wish to have your paper
considered for this special issue:

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Effect of Garden Walking on Elders with Depression

Photo by Naomi Sachs

One of our members, a hospice RN, sent me this interview with Dr. Ruth McCaffrey, DNP, Sharon B. Raddock Distinguished Professor in Holistic Nursing at Florida Atlantic University. It was originally published in the digest of the American Holistic Nurses Association.

How have you come to study garden walking for older adults with depression?
I have been working over the last three years on developing an evidence-based program using reflection during garden walking to increase life satisfaction and reduce depression. The work began as collaboration between the Morikami Japanese Museum and Gardens and myself. The Morikami has had many people write letters and tell them that the gardens had a healing quality and helped them in a time of great sadness or in a time when strength was needed. The garden designer has created several gardens in the Japanese healing traditions and uses the idea of nine healing elements in nature. We were able to apply for and receive a grant from the Institute for Museum and Library Services to create a research study with three different interventions, individual reflective walking, guided imagery walking and a comparison group who had art therapy. From that work we developed a book for use in an individual reflective walking program through the garden with a group session at the beginning of the walks, after three weeks and again after six weeks. This program has proved to be very successful and popular…

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HealthcareDesign10 – A Healthy Dose of Evidence-Based Design

HealthcareDesign10 begins a week from tomorrow, and this post highlights some events that I’m looking forward to.

HealthcareDesign, a joint effort of the Center for Health Design, Healthcare Design magazine, and Healthcare Building Ideas, is “the premier conference on advancing the future of healthcare facilities, offering attendees incredible learning and networking experiences,” and it’s taking place this year from November 13-16 in Las Vegas, NV. Vegas! But seriously, it’s THE conference for designers and healthcare providers to talk, network, and learn about all sorts of issues related to the design of healing environments, indoors and out.

I mentioned evidence-based design (EBD) in my recent Garden Designers Roundtable post. In a nutshell, EBD uses quantitative, and sometimes qualitative, research to design environments that facilitate health and improve outcomes. It’s a big part of what the Therapeutic Landscapes Network advocates for. We encourage research, and we urge designers and healthcare providers to use that research to create the best possible environments.

This is by no means a comprehensive list; these are just a few sessions that look especially germane to the subject of therapeutic landscapes. Honestly, there are so many interesting-looking education sessions and roundtable discussions that choosing is going to be a real challenge. Click here for the full schedule.

Sunday, 11/14, 9:00-10:00 a.m.
Toss-up between “Light Health and Human Efficiency–Evidence-Based Design for the Human Animal,” Deborah Burnett and James Benya or “Impact of Art on the ED Patient Wating Experience,” Upali Nanda, Kathy Hathorn, Michael Nelson, Pam Kleba and Robyn Bajema.

Monday, 11/15, 8:00-9:00 a.m.
RIPP to the Rescue–How Researchers in Professional Practice Lead the Way to Better Design,” Mardelle Shepley and Erin Peavey.

9:15-10:15 a.m.
Researching Restorative Landscapes in Healthcare–Evaluative Case Studies and Design Recommendations,” Clare Cooper Marcus.

2:15-3:15 p.m.
Natural Images–The Effects of Patients Undergoing Surgery,” Ellen Vincent and Dina Battisto.

3:30-4:30 p.m.
Nature and Human Nature,” David Kamp, with moderator Mardelle Shepley.

4:45-5:45 p.m.
Evidence-Based Design Boot Camp,” D. Kirk Hamilton, Mardelle Shepley, and Roger Ulrich OR “Data as Proof–Links Between Healthcare Design Strategies and Staff Stress and Productivity,” John Goins and Whitney Austin.

Tuesday, 11/16, 9:15-10:15 a.m.
Regenerative Hospitals,” David Burson, Peter Syrett, Deborah Rivers and Michelle Halle Stern (“Through three primary lenses–resources, materials, and connection to nature–participants will explore the meaning of regenerative design on the delivery of healthcare services at academic-based medical centers and see how the regenerative design framework can inform the design and operations of healthcare facilities.”)

10:30-11:30 a.m.
It’s Not an Accident – How Integrated Stakeholders Make Successful Design Happen,” Jerry Smith, Peter Bardwell, Cheryl Herbert, Janet Beck and Carol Cosler

3:15-4:30 p.m.
Closing Keynote Speaker
Esther Sternberg, author of Healing Spaces: The Science and Place of Well-Being. Click here to read the Therapeutic Landscapes Network Blog’s interview with Dr. Sternberg.

See what I mean? Spoiled for choice. No time for slot machines!

Garden Designers Roundtable: Thoughts and Evidence on Therapy and Healing in the Garden

I go to nature to be soothed and healed, and to have my senses put in order.
~ John Burroughs

Autumn crocus, The High Line, New York City. Photo by Naomi Sachs

This blog post comes courtesy of the Garden Designers Roundtable, who invited me to be their first-ever guest blogger. I’m honored and excited to be participating in today’s roundtable discussion, the theme of which is “Therapy and healing in the garden.” All photos are by Naomi Sachs.

Some Thoughts and Evidence on Therapy and Healing in the Garden

The idea that gardens and landscapes foster good health seems like a no-brainer, especially to gardeners and garden/landscape designers/architects. It’s like telling Newton that apples really do fall down. Sadly, though I’m preaching to the choir here today, many people still haven’t grasped this concept, and we can find all too many examples of landscapes that are anything but healing (picture, if you will, a parking lot at the mall…). At the Therapeutic Landscape Network, we focus a lot of our attention on the design of hospitals and other healthcare environments because – oddly enough – they tend to be so far behind as places that facilitate health and well-being on a holistic level. We’re getting there, but we still have a long way to go.

For today, since a big part of the TLN’s mission is to connect designers and health and human service providers with the research they need to design beautiful, nurturing, successfully restorative spaces, I thought I’d highlight some of the evidence that we’ve blogged about over the years. In this case, research that “proves” that being in and interacting with nature is, indeed, restorative for body and soul. This research is important because it’s positive ammunition. It’s what makes CEOs, and policy makers, and grant funders and our clients sit up and take notice (and change the laws and sign the checks!). I’ve provided a one-sentence summary of the research, with the title of each related blog post that you can link to for more information and full citations.

But first, for background, the seminal ‘View Through a Window’ study:
In 1984, Roger Ulrich studied two sets of patients, both in the same hospital, both recovering from the same surgery. The key difference: One group’s view from their window was of nature – grass, trees and sky; the other’s was of a brick wall. Ulrich found that the patients with the nature view complained less, required less pain medication, and made a faster recovery. Here, finally, was empirical proof of the salutary benefits of nature. Ulrich’s paper, published in the journal Science, got the attention of the medical community and legitimized the field of evidence-based design. Evidence-based design being the use of quantitative, and sometimes qualitative, research to design environments that facilitate health and improve outcomes. Since then, hundreds of studies have been published. Some, like those cited below, continue to demonstrate that contact with nature is good for people; some explore how people benefit, and what conditions are best for specific groups, needs, and situations (e.g., children; seniors with dementia; gardens for people who are immuno-compromised).

Innisfree, Millbrook, NY

The evidence since ‘View Through a Window.’ A few good examples:

Trees, greenery, and other vegetation make neighborhoods safer and more desirable. They even play a role in boosting students’ grades and reducing the risk of domestic violence.
See “Healing the Neighborhood: The Power of Gardens.”

Plants in an office setting improve worker satisfaction, creativity, and productivity.
See “I Demand Satisfaction! The Role of Nature in Job Satisfaction.”

As little as 10 minutes spent outside improves attention in children with ADHD; neighborhoods with more green space improve body mass index of children and youth.
See “Nature Deficit Disorder: Getting Kids Outdoors.” For many more resources on nature-based learning and play for kids, visit our Get Out and Play! page.

Uma, picking serviceberries. Photo by Naomi Sachs

Gardening improves health and happiness, including reducing heart rate and blood pressure.
See “Horticultural Therapy in the Wall Street Journal.” Horticultural Therapy is “a professional practice that uses the cultivation of plants and gardening activities to improve the mental and physical health of its participants,” (definition courtesy of the Horticultural Therapy Institute). Hort therapists often work with occupational and physical therapists in a garden setting; gardens that are designed specifically for this kind of therapy are called rehabilitation gardens. For more information, see the horticultural therapy page on our website and for a really inspiring post about the power of horticultural therapy, see A Life Worth Living: The Garden as Healer.

Exposure to nature makes people more altruistic and generous.
It’s true, Nature Makes Us Nicer!

Autumn leaves. Photo by Naomi Sachs

I hope that now that you’ve been introduced to the Therapeutic Landscapes Network Blog, you’ll stay awhile and read some of our older posts, and that you’ll visit us again for new ones (you can also sign up to have posts emailed to you). I welcome your comments, which can often lead to great dialog on the TLN Blog.

Many thanks again to the Garden Designers Roundtable for the invitation and warm welcome as a guest blogger. Visit the GDRT website (gdrt.wordpress.com), or click on the links below, to read other bloggers’ posts (and to see some great pictures) – it’s an excellent group, and each blogger has something interesting to say on the topic.

Genevieve Schmidt, North Coast Gardening: Designing a Landscape for Colorblind People
Ivette Soler, The Germinatrix: Plant a Garden, The Life You Save Might Be Your Own
Jenny Petersen, J Petersen Garden Design: Therapeutic Spaces
Lesley Hegarty & Robert Webber, Hegarty Webber Partnership: Homage to Ariadne: Labyrinthine Therapy
Rochelle Greayer, Studio “G”: A Tale About What Makes a Garden Healing

Center for Health Design Store Sale!

We’re interrupting our series on upcoming events to announce that the Center for Health Design is having a summer sale  – 20% off everything in their store.

Jain Malkin Visual Reference for Evidence-Based DesignItems from the CHD Store include Jain Malkins’ A Visual Reference for Evidence-Based Design; Debra Harris et. al.’s book A Practitioner’s Guide to Evidence-Based Design; The EDAC (Evidence-Based Design Accreditation and Certification) study guides; the Access to Nature DVDs; and more.

Enter the code SUMMER2010 to get your summer bargains.

What is evidence-based design, or EBD, you may ask?
“Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.” – The Center for Health Design
Or in our own words, it’s the process of using quantitative, and sometimes qualitative, research to design environments that facilitate health and improve outcomes. In some settings, design based on intuition or common sense is fine. But when it comes to creating spaces for specific groups of people with specific needs (and where the space is designed for a specific outcome or result), such as in the healthcare setting, design must be based on sound research. See the TLN website’s page on Evidence-Based Design for more information and resources.

For more on the Center for Health Design and the great work that they do, visit their website: www.healthdesign.org.

Access to Nature