Nature Nurtures

The word “biophilia” is increasingly bruited about in debates on the design of health-care facilities. Although the term sounds like an incurable physical ailment, it actually means “love of life or living systems.” First used by social psychologist Erich Fromm in the mid-1960s, the word was popularized by biologist Edward O. Wilson in his 1984 book of the same name, referring to humans’ innate attraction to nature. Biophilic architecture accordingly embraces nature or natural elements to improve occupants’ physical and mental health, increase productivity, and enhance overall well-being.

Not surprisingly, the study of these therapeutic effects has its own history. The same year that Wilson’s book came out, Roger Ulrich published the first rigorous study of the relationship between health outcomes and physical surroundings. Ulrich, co–founding director of the Center for Health Systems & Design at Texas A&M University, reviewed records for two groups of patients recovering from gallbladder surgery in a suburban-Philadelphia hospital. One set recovered in rooms that overlooked a small stand of deciduous trees, while the other set occupied rooms that looked out onto a brick wall. Ulrich found that the patients with views had shorter postoperative hospital stays, took fewer and less potent analgesics, and were less likely to develop complications.

Since that groundbreaking study, at least 50 others have been published that demonstrate a link between biophilic features—such as daylighting and views of nature—and faster recovery rates, decreased dependency on medication, and reduced stress for both family members and staff, according to Terrapin Bright Green, an environmental-consulting and strategic-planning firm. Terrapin recently published its own study, The Economics of Biophilia. The white paper assigns financial value to productivity and human health benefits garnered by incorporating nature into a variety of building types, including schools, offices, retail spaces, and hospitals. For example, by correlating current data on the average per diem expense of inpatient care with the results of Ulrich’s 1984 study, the paper concludes that deployment of biophilic strategies in health-care facilities nationwide could reduce the average cost of a postsurgery hospital stay by about $2,000 and save Americans more than $93 million each year. The objective was not to pinpoint exact industry savings, says Terrapin partner Bill Browning; “instead, we wanted to provide a sense of their order of magnitude.”

The overarching goal of this analysis is to promote widespread adoption of biophilia in buildings of all types. And there is an indication that health-care providers and the architects who work with them are more receptive than ever to biophilic strategies. Robin Guenther, a Perkins+Will principal, credits this new traction to developments over the past decade like the increased importance of sustainability and the emergence of evidence-based design (a multidisciplinary process that relies on credible research as the basis for design decisions). Hospitals are no longer seen simply as “repositories of machinery,” says Guenther who, with Gail Vittori, was editor of the 2008 book, Sustainable Healthcare Architecture.

Examples of biophilic design tactics include the incorporation of water features, healing gardens, daylight, and views out to nature, as well as the use of natural materials or biomorphic architectural forms. Often such features are discrete elements in a building, but sometimes they serve as a fundamental organizing principle. Such was the case at two health-care facilities in very different settings on opposite coasts: Massachusetts General Hospital’s 535,000-square-foot Lunder Building, completed last year on the institution’s densely developed campus in Boston, and the 736,000-square-foot Palomar Medical Center West, set to open later this month in northern San Diego County. The glass-clad Lunder has two wedges sliced from opposite sides of its 10-story cubelike volume: One void houses an outdoor bamboo garden, and the other is an 80-foot-tall atrium containing hanging vines. The more suburban Palomar’s signature feature is a 1.5-acre, subtly undulating green roof. It covers a two-story diagnosis-and-treatment wing that is an extension of the base of an 11-story patient tower. The roof is visible from many of the facility’s 360 rooms.

The decision to include these biophilic elements is tightly coordinated with the institutions’ broader mission of delivering safe and efficient medical care, maintaining patient comfort, and ensuring staff satisfaction. For example, the steel-framed Lunder is configured so that its five acute-care floors, typically with 32 private rooms each, stack on top of a four-story base containing the lobby, emergency room, and procedural rooms. An intermediary mechanical zone effectively “liberates” the structure of the upper-portion building from that of its base, allowing an unconventional layout for the patient-room floors, explains Jay Siebenmorgen, design lead for NBBJ, Lunder’s architect. The plan features two interlocking C-shaped groups of rooms—all with views of the city, the atrium, or the bamboo garden—and a diagonal circulation spine that connects the two green voids. The arrangement yields the maximum number of beds within Lunder’s tight footprint, yet allows daylight to penetrate into the core of the building, and serves to break the typical central nursing station into two pods, minimizing staff travel distances between rooms and support areas.

At Palomar, similarly practical considerations prompted the decision to locate the equipment-intensive diagnostic and treatment functions in a dedicated wing: Designers wanted to accommodate expected advances in medical technology and control retrofitting costs. The wing’s structure—with its rolling roof supported by a series of trusses more than 100 feet long, without intermediary columns—is intended to facilitate the replacement of outmoded equipment and permit changes to room layouts, explains Frances Moore, an associate principal at CO Architects, the project’s designers. The space directly below the waveform roof provides a zone for the wing’s copious mechanical infrastructure.

To bring daylight into the interior of the diagnosis-and-treatment wing’s vast volume, CO has provided “skywells.” These planted courtyards, defined by ground-to-roof glazing, provide a link between the outdoor environment and surgery-prep areas, operating rooms, and recovery spaces. As part of its participation in the Pebble Project—a research initiative administered by the Center for Health Design—Palomar plans to document the effect of the skywells on staff productivity and medical errors.

On top of the two-story wing, the green carpet of native herbs and grasses, chosen by landscape-architecture firm Spurlock Poirier for their ability to thrive in the roof’s hills and valleys, provides environmental benefits such as creating habitat for birds, helping control storm-water runoff, and mitigating heat-island effect. It is a so-called “extensive” green roof—a lightweight system with only a few inches of growing medium appropriate for plants with shallow roots (those with deeper soil designed for a wider variety of vegetation are described as “intensive”).

Unlike the rolling roof, which was designed to be viewed but not occupied, gardens included in the patients’ tower at Palomar were conceived as planted terraces where family members and other visitors can sit surrounded by ferns, shrubs, and flowers, and take in the view of surrounding hills and mountains. The design team staggered the floor plates to create double-height spaces tall enough for trees, and provided planting beds with sufficient soil depth for the trees’ root systems. The sensory stimulation—the sound of rustling leaves, the textures and aromas of the different plants, and changes in light levels—should prove therapeutic. “A connection with nature can provide a distraction from one’s immediate problems,” says landscape architect Andrew Spurlock.

In contrast, the goal for the bamboo garden at Mass General’s Lunder, which can be seen from adjacent patient rooms and circulation areas but is not accessible, was to create a composition that would provide visual interest in all seasons, explains Herb Sweeney, a senior associate at Michael Van Valkenburgh Associates (MVVA), the project’s landscape architect. Designers chose a type of evergreen bamboo that will eventually grow as tall as 40 feet, flowers such as daffodils and hellebores, and a species of dogwood with red branches that are especially noticeable when it is leafless in the winter.

For Lunder’s skylit atrium, MVVA selected a robust vine species with 20-foot-long tendrils to emphasize the space’s verticality and developed an integrated irrigation system. But before the facility’s opening, the owner replaced the live vines with silk facsimiles, citing maintenance and infection-control concerns.

Both hospitals have exterior envelopes detailed so that the occupants can derive maximum benefit from the buildings’ natural (or natural-looking) features. For instance, Palomar’s unitized curtain wall system includes fixed exterior shading louvers that prevent uncomfortable glare conditions, allowing patients to keep the operable interior shades open, except when complete darkness is desired. The louvers also mitigate heat gain, making them an important part of the building’s energy conservation strategy—a strategy expected to enable Palomar to perform about 10 percent better than California’s energy code, Title 24. Hospitals, which are often notorious energy consumers, are exempt from Title 24 and therefore are not required to comply, points out Moore.

At Lunder, the patient-room levels are clad in full-height insulated glazing units. These units’ lower lites include a frit that provides a perceptual edge, while allowing light to bounce off the floor. At the top edge of the room the ceiling tapers, with the glazing extending above the typical 9-foot room height. This detail ensures the maximum view of the exterior environment, even for bed-bound patients, explains Siebenmorgen.

Straightforward but thoughtful details, like the Lunder patient-room soffits or the Palomar sunscreens, belie the complexity of the buildings’ programs, mechanical and structural infrastructure, and architecture. Both project teams credit their successful coordination of these overlapping systems to their use of building information modeling (BIM). “Now this is pretty standard stuff,” says Siebenmorgen. But in 2005, when design work at Lunder and Palomar kicked off, use of BIM was not yet widespread.

The teams depended on BIM for tasks such as exploring program alternatives, better understanding site constraints, virtually simulating construction, and coordinating trades. They also used it to help design challenging geometric conditions, like the staggered garden terraces in Palomar’s patient tower, dictated by the projects’ biophilic goals.

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