Creating a healing environment: Rationale and research overview

THE ROLE OF THE HEALING ENVIRONMENT

As noted above, part of holistic healing and blended medicine is the environment of care. Stress is an inherent part of the hospital experience and can serve to complicate a patient’s disease. The general appearance of a hospital’s rooms, grounds, and environment has important effects on patients.

Creating a patient-friendly environment is a challenge, especially since patients come in all sizes and from all cultures. A patient-friendly therapeutic environment for children arguably will be different from one designed for seniors. One unifying concept, however, is low-stress, high-comfort design. Research from the Center for Health Design has shown that the more attractive the environment, the higher the perceived quality of care and the lower the anxiety of patients. For example, there is a significant relationship between perceived wait times (which are affected by the pleasantness and aesthetics of waiting areas) and perceived quality/perceived anxiety.¹⁷ Patients underestimated longer (≥ 30 minutes) actual wait times and overestimated short (0 to 5 minutes) actual wait times. There was no significant relationship between actual wait times and perceived quality or perceived anxiety,¹⁷ suggesting that perceived wait times, which are influenced strongly by the physical design of the environment of care, are a more important determinant of patient satisfaction.

Research on the healing environment is proliferating

Research and industry efforts to promote healing through design are ongoing in a number of centers. The Pebble Project is a joint research effort between the Center for Health Design, a nonprofit research and advocacy organization, and selected health care providers.¹⁷ The project, launched in 2000, is charged with creating a ripple effect in the health care community to provide research and documented examples of health care facilities whose design has made a difference in the quality of care. Such design-related improvements in care also can translate into improved financial performance of the institution.¹⁷

The North Hawaii Community Hospital experience

The North Hawaii Community Hospital, built in 1996, has incorporated the healing environment into many aspects of its design. We had the advantage of being able to build the hospital with a therapeutic design that includes elements such as wide corridors that deliberately do not trigger the “fight or flight” response. The use of natural lighting, floor-to-ceiling windows, and skylights throughout the hospital helps to keep the patient in sync with respect to chronobiologic principles. Against the backdrop of architectural and design elements like these, care is delivered in a restorative, therapeutic environment based on holistic principles and cultural wisdom to create a total healing environment.¹⁸

Hospital building boom presents an opportunity

As our nation’s population ages, the US health care system is anticipating a hospital construction boom worth $200 billion over the next decade.¹⁹ In California alone, new spending for hospital buildings was projected to exceed $14 billion between 2002 and 2010.⁸ This represents a great opportunity: at this pivotal moment, hospitals leaders are discovering the role of complementary medicine and healing design in improving patient and community health. Evidence suggests that hospital adoption of design approaches that minimize ecological harm and maximize patient healing and staff satisfaction leads to measurable outcomes such as reductions in length of stay, use of pain medication, medical mistakes, and cost of care.^7,20,21

These findings should remind us that patient satisfaction is defined not only by clinical outcomes but also by the aesthetics of the hospital experience. Patients want a healthful, healing environment. It is not hard to predict patients’ preferences. They are similar to those that all of us share—for a comfortable environment and respect for our preferences and culture together with evidenced-based, high-tech diagnostics.

REMAINING QUESTIONS AND CONCLUSIONS

As the study of blended medicine and the healing environment advances, a number of questions loom before us:

• Will we find that hospitals are just warehouses for sick bodies and that the ideal healing environment may in fact be a spa, the patient’s home, or some yet-to-be discovered variation on the current hospital system?

• Are there some disease processes that are solely caused by stress, or rather by an exaggerated process of normal injury?

• Why do we not study the biochemical makeup of healthy individuals involved in the complementary and alternative medicine practices mentioned above?
• What are the mechanisms of recovery in stress-induced injury?

The answers to these questions will unquestionably be complex, but as the study of heart-brain medicine grows more widespread, research to provide insight into the intricacies of alternative therapies will increase. No doubt there will be evidence against some accepted modalities, as well as discovery of new ones. The key lies in the heart-brain relationship.

Given that many diseases respond to the unexplained regulation of the autonomic nervous system, the mechanism of interplay between environment and this regulation needs to be explored and addressed as part of health care delivery. Systematic documentation of findings and clinical trials on the supposed mechanisms are needed.²² Once complementary and alternative therapies are validated, they must be implemented into treatment in much the same way as we now use as-needed medications. Instruction in the role and implementation of blended medicine and the healing environment should be part of the curriculum in medical and nursing schools.