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Gardens In Healthcare Facilities: Uses, Therapeutic Benefits, And Design Recommendations
Clare Cooper Marcus, MA, MCP and Marni Barnes, MLA, LCSW
70 pages, with illustrations
The Center for Health Design, 1995

Executive Summary

This study was conducted between January and August 1995, and its goal was to investigate the use and possible benefits of gardens in hospitals by evaluating a number of case studies. Its intent was not to propose theories of how or why certain environments are therapeutic, but to discover which specific elements and qualities in hospital gardens seem to be - in the users' eyes - most related to a change of mood.

This report consists of 12 parts: introduction; literature review; methods; brief historical overview of hospital gardens; a typology of health facility outdoor spaces; four case studies including user-responses; a set of design recommendations based on observations and interviews; and a conclusion.

Our consciousness regarding this topic was raised as we searched for case study sites. Hospital architects we contacted knew of few such examples. When we started to visit hospitals, we were surprised to find few that had outdoor spaces, and where we found some that did, the staff at the information desk frequently had no knowledge of the garden or its location. Thus, early on we sensed that this was a type of space that is considered unimportant in the contemporary medical center.

In all, we looked at 24 hospitals, almost all of them in Northern California. From this admittedly small sample we sensed that public hospitals are more aware of and supportive of gardens in their environment than are private hospitals. Two public hospitals in San Francisco - Laguna Honda and San Francisco General - are housed in 19th-century or early-20th-century pavilion-style buildings where open spaces between wings have been landscaped and developed as gardens. Both of these hospitals also run on low budgets, serving the needy, and seem to make use of everything at their disposal, including the outdoor space. Private hospitals seemed more concerned with cosmetic landscaping to enhance their image but not necessarily to fill the therapeutic needs of patients or staff.

As we conducted interviews, we became aware, too, of the pivotal importance of one person or a few people in creating and making known the benefits of gardens at specific facilities. The gardeners at San Francisco General created the Comfort Garden, a space that eventually became one of our case study sites. The director of the hospice at Laguna Honda Hospital was responsible for promoting the development of a garden in a formerly empty courtyard. (The timing of the installation of this garden precluded our selecting it as a case study.) Nurses at California Pacific Garden Campus were responsible for encouraging long-term care patients and their families to use the garden.

We are convinced that with more persuasive information as to their benefits, many more hospital administrators and medical staff would encourage the use of outdoor spaces for healing and stress reduction. We hope this report will be one tool in raising consciousness in this important area.

Table of Contents

Introduction
Review of Relevant Research
Methods
Historical Overview of the Provision of Outdoor Gardens in Medical Settings
Typology of Outdoor Spaces Provided in Contemporary Healthcare Facilities
Case Study: San Francisco General Hospital, The Comfort Garden
Case Study: Alta Bates Medical Center, Berkeley, The Roof Garden
Case Study: Kaiser Permanente, Walnut Creek, Central Garden
Case Study: CaliforniaPacific Medical Center, Garden Campus, The Garden
Aggregate Data Analysis of the Case Study Sites
Design Recommendations
Conclusion
Appendix: Questionnaire
Bibliography

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Sponsors

Armstrong World Industries, Inc.
Interface Flooring Systems, Inc.
JCM Group
Jain Malkin

A funding contribution was also made by the International Interior Design Association/Healthcare Forum and Carnegie Fabrics to further the pursuit of quality research in the healthcare marketplace.