Creating a healing environment: Rationale and research overview

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The environment of care has been shown to reduce the burden of disease and shorten healing time across multiple medical conditions. Given that many diseases respond to the unexplained regulation of the autonomic nervous system, the mechanism of interplay between the environment and this regulation needs to be explored and addressed as part of health care delivery. Complementary and alternative medical practices can be blended with traditional evidence-based medicine to optimally promote a healing environment and overall patient wellbeing. This review outlines the rationale behinded “blended medicine” and healing-oriented design of health care facilities, featuring examples and lessons learned from the North Hawaii Community Hospital.



It has long been known that the physical environment has important implications for the disease process. One of the first instances where the impact of one’s environmental surroundings on disease was appreciated was the discovery that hand washing and linen changes reduced rates of puerperal fever.1 At the time, it must have seemed strange that the “bad humours” of childbed fever could be removed by bathing the physician’s hands and changing the linens of the mother. Now, however, we routinely accept that infection is a battle between ever-present microbes and the human immune system’s exposure to them via the physical environment.

Traditional medicine is only now recognizing the effect on the disease process of less measurable, nonphysical factors such as stress. Many disease processes have a well-established relationship with stress; examples include the relation between psychosocial stress and more rapid progression of Parkinson disease, as well as the “broken heart syndrome.” Studies of inner city children under stress due to violence or socioeconomic factors show that they have greater disease burdens and worse disease outcomes compared with less-stressed children. Many stressors, such as physical or emotional abuse, lifetime traumas, turmoil in the childhood family, and recent stressful life events, have implications for both disease and healing.2 Similarly, the spiritual component of healing cannot be ignored, nor can the effect of a patient’s environment and aesthetic surroundings.

For these reasons, it makes sense to view health care as a comprehensive approach to combat all factors contributing to the disease process. The integration of all therapies—peaceful and comforting surroundings, stress reducers, caring health care providers, together with evidence-based medicine—creates a healing environment. This article presents an overview of this concept of comprehensively integrated therapies, with a focus on the role of the “healing environment,” or healing-oriented design and architecture, and provides examples and lessons from my institution, the North Hawaii Community Hospital.


Many people refer to traditional medicine as “Western medicine.” Western medicine in the United States is evidence-based and, in most circumstances, validated by clinical trials. These therapies have either stood the test of time or been shown to have superior effectiveness in treating a given disease. Introducing and validating a new treatment, either via the US Food and Drug Administration (as is the case with pharmaceuticals) or within the medical community, can take considerable time and money.3–6

“Blended medicine” involves the use of complementary and alternative medicine together with traditional medicine. Blended medicine techniques are not necessarily validated in large clinical trials, but blended medicine has been found to promote stress reduction, faster healing, decreased infection rates, staff and patient satisfaction, and the economic benefit of lower hospital operating costs.7,8

Blended medicine recognizes the practical reality that healing usually relies on both traditional medicine and other components of care. It has been argued that high-tech treatment (eg, subspecialty care and advanced imaging) accounts for 20% of healing while “high-touch” treatment (complementary and alternative medical therapies) and a healing environment account for the remaining 80% (and that most treatment centers leave out this 80%).9 This third component—the environment—completes the triad of blended medicine.

Potential for improved outcomes

As early as the late 1980s, the treatment of heart disease came to recognize the beneficial effects of stress management, as demonstrated by recognition of the association between heart disease and the “type A” personality and its role in emotional expression.10 Back then, one of the few “alternative therapies” widely known in the West was meditation. Pharmacologic advances in the treatment of heart disease have improved outcomes exponentially. In preliminary studies, alternative therapies such as meditation have been shown to impact blood pressure and may prove effective in the treatment of hypertension and heart disease.11,12 Considering the outcomes of achieving the same treatment targets with blended medicine has provocative implications. For instance, if transcendental meditation results in a blood pressure goal of less than 130/80 mm Hg and a low-density lipoprotein cholesterol level of less than 70 mg/dL, what reason is there to believe that the outcomes would not match those of comparable pharmacologic manipulations of blood pressure and lipid levels?


For many acute illnesses, holistic approaches to healing are being used to augment traditional hospital care; such approaches exemplify the concept of blended medicine. Our experience at the North Hawaii Community Hospital has been that effective treatment of patients must include the ideology of holistic medicine: treating the body, mind, and spirit in the context of the patient’s culture and natural surroundings. We have found that complementary treatments that embody this holistic ideology yield benefits in terms of patient satisfaction. These therapies, some of which are covered by insurance,13 include the following:

Manipulation/massage—pressing, rubbing, and moving muscles and other soft tissues, primarily using the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area. The use of therapeutic massage has demonstrated benefit in both adult and pediatric conditions.14,15

Acupuncture therapy—a family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. It is intended to remove blockages in the flow of qi—a traditional Chinese concept that roughly translates to “energy flow” or “vitality”—and restore and maintain health.

Biofeedback—the use of electronic devices to help people learn to control body functions that are normally not consciously controlled (such as breathing or heart rate). The intent is to promote relaxation and improve health. One particular program, known as HeartMath®, is a systematized program developed for heart patients.

Guided imagery—a gentle but powerful technique that focuses and directs the imagination. Although guided imagery has been called “visualization” and “mental imagery,” these terms are misleading, as the technique involves far more than just visual sense. Guided imagery involves all of the senses, and almost anyone can do it. It involves the whole body, the emotions, and all the senses, and it is precisely this body-based focus that makes for its powerful impact.

Naturopathy—a comprehensive medical system that originated in Europe and aims to support the body’s ability to heal itself through dietary and lifestyle changes together with other therapies such as herbs, massage, and joint manipulation. An example of its application in the hospital would be the use of ginger root for the treatment of nausea.

Healing touch or healing energy—a relaxing, nurturing energy therapy. Gentle touch assists in balancing physical, mental, emotional, and spiritual well-being. Healing touch works with the body’s energy field to support its natural ability to heal. It is safe for all ages and works in harmony with standard medical care.

Aroma therapy—the use of pure and natural essential oils, absolutes, floral waters, resins, carrier oils, infused oils, herbs, and other natural substances. The natural ingredients used in aromatherapy have specific medicinal uses; for example, ginger and peppermint can treat nausea.

Pet therapy. The comforting effects of animals have been noted through the years. For instance, Florence Nightingale recommended “a small pet animal” as an “excellent companion for the sick.” A growing number of studies provide supportive evidence that these “huggable health care workers” truly help the healing process.16

Music therapy—the clinical and evidence-based use of music interventions to accomplish individualized goals (eg, stress management) within a therapeutic relationship. Programs exist for credentialing professional music therapists.

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