Biophilic Design in Modern Medical Spaces

Margaret Daniel

Disclosures

October 12, 2021

All of your patients have been there — blindly following a nurse in turquoise scrubs as she leads them further into a labyrinthine mess of exam rooms and Formica-topped nurses' stations with no destination in sight. Sensory overload is in full effect — the air smells of disinfectant and bagged lunches; fluorescent lights buzz and crackle like dying campfires. Alone, in a windowless room, they hear the occasional, disembodied voice over the crinkle of their thin paper gown.

How relaxing, right?

According to the American Institute of Stress, in the United States 70%-90% of doctor's office visits are the result of stress-related issues and illnesses. And, until a few years ago, the design of these care facilities showed no interest in mitigating the problem. With direct links to the six leading causes of death in America, stress, though abundant in our interior environment, should not be an expected inconvenience in our healthcare experience.

Enter Alda Ly Architecture. Alda Ly, principal architect of the New York City–based firm, and her team of architects and designers are leading the charge to change healthcare design for the better. They're flipping the concept on its head by embracing a user-centric approach that's filtered through a hospitality design lens.

Understanding Biophilic Design

Before floor plans are drafted and furnishings are selected, Ly and her team thoroughly interview their clients — doctors, nurses, and their patients — to expose the pain points of the healthcare experience, seeking to fix them with all manner of clever design tricks. Her main guiding principle? Biophilic design.

Biophilia, defined in Edward O. Wilson's seminal 1984 work by the same name, is "the tendency of humans to focus on and to affiliate with nature and other life-forms." This idea has been scientifically expanded to include 14 elements of design, all seeking to connect humans to nature through the built environment, activating the parasympathetic nervous system, and jump-starting the body's healing process.

"For us, it is not just about adding plants everywhere; that is a common misconception," says Ly, regarding her firm's science-based approach to healthcare design. "It is about connection to nature and the physiologic reactions people can have to their environment." Tangible visuals, such as access to natural light through large windows, plant life, and water sources, as well as more abstract considerations, such as biomorphic forms, concepts of mystery, risk, and peril, all play a part in the body's response to spaces.

This psychological approach led Robin Berzin, CEO of Parsley Health, a functional medicine clinic promoting testing and customized lifestyle plans, to trust Ly with the design of her bi-coastal offices. "The doctor's office of the past was a lifeless, stressful environment — which is counterproductive to the healing process," says Berzin.

Figure 1. The entryway at ‍Parsley‍ Health features a wall installation of living rubber fig plants, Art Deco–inspired overhead lights, and modern finishes.

Eager to help her patients not just survive but truly thrive in all aspects of their lives, Berzin asked Ly to create a clinic that "supports our patients' health top to tail."

In the New York City center, this holistic approach starts in the waiting room, an airy space with floor-to-ceiling windows intended to regulate circadian rhythms. It features a mix of elegantly stripped hardwoods and swaths of brilliant shades of white and gray across the walls.

Patients feel cozy curling up on the living room–inspired furnishings upholstered in soft woven fabrics and velvets. The comfortable communal tables invite conversation while a variety of shapely light fixtures, each surface finished in a soothing palette of blond wood and pink, blue, and green pastels — shades known to lower cortisol levels — bathe them in warm light, a welcome replacement to the typical harsh fluorescence.

Figure 2. In the lounge, an abundance of natural light helps to soothe and inspire, evoking a sense of relaxation for patients while they wait.

On one wall, an inviting kitchen features canisters of tea and a refrigerator full of kombucha so that guests feel refreshed as they relax in an armchair, work at a table, read in a corner nook, or peruse a wall of delightfully packaged supplements — everyone has a space to suit their needs.

Figure 3. The open concept kitchen flows seamlessly into the waiting area, ensuring that guests can refresh themselves with a health-conscious beverage or snack.

Eliminating wayfinding woes, the architects forwent a maze of rooms, opting instead for a central hallway lined with comfortable exam rooms painted shades of baby blue and pink, featuring plush banquettes and café tables with medical equipment cleverly hidden in chic rolling carts. "That was really important to us," says Ly of their efforts to hide all examination gear. "We were doing everything we could to make sure it felt like you were just having a conversation about your health, so you don't feel like a medical specimen when you walk in the room."

Figure 4. Soft tones and plush accessories transform this exam room into a chic and comfortable space for conversation.

The Impact of Healthcare Interior Design

In most pre-project interviews with patients and staff, the word "sterile" comes up a lot, remembers Marissa Feddema, an architect on the Parsley Health projects. "It's funny, because you want a healthcare space to be sterile because that builds trust. You want the space to be clean." But, aiming for more than just cleanliness, Berzin says, "Our centers were created to be the design embodiment of medicine meets wellness."

This approach to well-being goes beyond the patient experience. As Ly's research has uncovered, and the public has become aware of due to the COVID-19 pandemic, the healthcare profession can be immensely stressful for practitioners who spend 8-12 hours each day in these cold environments.

"While we focus on the function of the staff spaces, we also want to give them an equal experience," says Tania Chau, an interior designer at Alda Ly who specializes in tailored back-of-house spaces ranging from private outdoor areas to break rooms and private spaces that nurses can duck into for some solitude, take phone calls, and catch their breath.

These spaces have become even more essential in light of the past 18 months. With the COVID-19 pandemic pushing healthcare providers to their limits, hospital beds overflowing, employee shifts extending around the clock, and stress at an all-time high, the importance of these spaces has been highlighted and cemented their importance moving forward. In many ways, the pandemic has propelled and emphasized the need for biophilic design in the healthcare space.

Although many healthcare providers and hospitals have been hesitant to implement these design changes for a variety of reasons — upfront cost, perceived ineffectiveness, and delayed return on investment — the science swings the other way, in favor of Berzin and Ly's customer service–oriented approach to patient care, with data showing that hospital amenities play a large role in patient retention.

A visiting professor at the Centre for Healthcare Architecture at Chalmers University of Technology in Sweden, Roger Ulrich has conducted studies on the impact of healthcare interior design for over 30 years. His research affirms the positive impact of biophilic design and consistently shows that patients who have access to natural light and plant life, who are treated and recover in facilities following the principles of biophilic design, have shorter hospital stays (7.9 days vs 8.7 days), require fewer analgesics within 2-5 days of surgery, and acquire fewer infections, increasing profits for hospitals and patient quality of life.

"The combined impact of protocol and space design was a game changer," found Ulrich. "One of the most effective ways to impact outcomes is to design an integrated cluster of architecture changes and care process changes."

According to internal research, over 80% of patients at Parsley Health reported feeling better within their first year of care and were using 30% fewer prescription drugs, no doubt a result of the clinic's comprehensive approach to health that extends into their office interiors.

A New Wave

These positive design changes are not exclusive to hospitals and traditional outpatient clinics. In New York City, BHDM Design recently completed the flagship for a membership-based mental health provider, Real, emphasizing communal interaction and healing throughout the design.

Group therapy spaces feature comfortable arrangements of chairs and sofas in buttery blond leathers, punctuated with shocks of burnt orange and cobalt blue to energize the space. Playful wallpapers adorned with abstract breast motifs emphasize a more fun, engaging approach to the mental health conversation, making the drab psychologist's office a thing of the past. "Projects like this are about synergy and listening," BHDM Design President, Dan Mazzarini, told Hospitality Design. "The therapy experience was ripe for disruption."

In Nashville, Tennessee, Pencil & Paper Co. founders Gen and Benjamin Sohr created a luxurious experience for patients at the Nashville Dentistry Co. Focused on the overall experience of tailored service, the design firm imagined everything from the interiors to the brand's logo — even the appointment reminder cards. A bold mix of black-and-white graphics, paint, and tile, paired with abstract art and plush upholstery, the office feels more like a show house than a dentist's office. This Gesamtkunstwerk approach, which sees each aspect of design as essential to the whole, garnered praise from the press and professional organizations alike, winning the American Dental Association's prestigious Dental Office Design of the Year award in 2018.

For Mount Sinai's state-of-the-art patient center, Healthquarters, Alda Ly Architects brought their signature flair for hospitality to the high-tech office, choosing to do more than just "plaster television screens on the walls." Staff tote iPads, ensuring that patient information is always handy, and the desktops in exam rooms are more reminiscent of co-working spaces than laboratories. "It feels more like a collaboration or conversation instead of an interview about what is wrong with you," explains Feddema.

Figure 5. High ceilings, a curved reception desk, and royal blue accents create a modern environment where patients check in.

This conversation enables designers to adequately meet the needs of all users — ensuring the health of patients and equipping healthcare providers with the tools and mental clarity needed to provide the best care possible. For Parsley Health, the feedback has only been positive. "Our space creates community, both for our team members and for our patients," says Berzin. "The results are beyond our wildest dreams."

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