By Geoff Roehll, ASLA, CLARB, Director of Healthcare and Senior Living at RVi Planning + Landscape Architecture

The environments we inhabit shape our health in countless ways. Air quality, access to nature, opportunities for physical activity, noise, stress, and even the views outside our windows all influence our physical and mental well-being.

While many health factors lie beyond our control, our surroundings play a significant role in determining how we feel, how we recover, and how we thrive. It follows, then, that the environments where we receive care should be designed to support healing.

This isn’t just conjecture; decades of research have reinforced this connection. In a landmark 1984 study, environmental psychologist Dr. Roger Ulrich found that patients recovering from surgery who had views of nature experienced shorter hospital stays, fewer minor postoperative complications, and required fewer doses of strong pain medication than patients whose windows overlooked a brick wall.

Simply having a view of nature through the window can measurably influence recovery.

Since that groundbreaking study, a growing body of evidence has continued to demonstrate the relationship between nature, the built environment, and patient outcomes. And isn’t it something we all feel intuitively? As our understanding has evolved, so has the way hospitals approach planning and design. Healthcare campuses are increasingly viewed as holistic healing environments where landscapes, gardens, circulation and wayfinding, outdoor spaces, and everyday interactions with nature all contribute to treatment and recovery.

So, what does that look like in practice? How can a garden heal? Why do decisions about parking, circulation, or wayfinding matter? And how do these investments create value for healthcare organizations? It all begins with understanding how thoughtful design can reduce stress and support healing at every step of the healthcare journey.

Healing gardens and the theory of supportive design  

Understanding how a garden can heal requires understanding the role that stress plays in the healing process. Elevated stress can increase blood pressure, raise cortisol levels, interfere with immune function, heighten the perception of pain, and make recovery more difficult. Patients aren’t the only ones affected. Families coping with uncertainty and clinicians working long shifts experience many of the same physiological responses.

That’s what makes healing gardens so much more than attractive outdoor amenities. They’re carefully designed therapeutic environments intended to buffer against stress and create the conditions that allow healing to happen.

The foundation of Dr. Ulrich’s Theory of Supportive Gardens suggests four key ways by which gardens reduce stress: by helping patients regain a sense of control, fostering social support, encouraging movement, and providing positive distractions through nature. These four principles lay the groundwork for evidence-based healing garden design.

When we design healing gardens, we create opportunities for patients to regain a sense of agency in an environment where so much of their experience is prescribed. That might mean providing multiple destinations instead of a single path, offering choices between sun and shade, or creating quiet spaces where patients and families can spend time together away from the clinical setting.

We’re also thinking about the programming of the space, how the landscape supports care beyond passive enjoyment. The Integrative Medicine Garden at Advocate Good Shepherd Hospital in Barrington, Illinois, illustrates this principle. Designed to complement the hospital’s integrative medicine program, the garden extends care beyond the building itself, creating positive distractions and spaces for yoga, counseling, quiet reflection, walking, and social support that directly support the services offered inside the adjacent treatment center.

Movement is another critical consideration. Gently looping pathways encourage walking without creating dead ends or confusing circulation. Accessible routes, comfortable grades, and intuitive navigation allow people of varying abilities to move confidently through the space while supporting rehabilitation and light physical activity.

Finally, every sensory experience matters. The sound of moving water can soften the mechanical noise of a hospital campus. Native plantings, seasonal color, birds, butterflies, and shifting light provide positive natural distractions that gently draw attention away from pain, anxiety, or uncertainty. Together, these seemingly small interventions help restore a sense of calm—and ultimately support the healing process.

The healthcare campus as a healing journey

While healing gardens are one of the most recognizable expressions of this philosophy, they aren’t the only environments that influence patient outcomes. The same principles that guide the design of a therapeutic landscape can—and should—inform every aspect of a healthcare campus. 

Throughout the master planning process, we evaluate every decision through the perspective of the people using the campus every day—patients, families, visitors, clinicians, and staff. From the moment someone arrives, each interaction with the environment has the potential to either increase stress or alleviate it. 

Healing begins long before a patient enters an exam room. Before treatment even begins, the arrival experience shapes how people feel about a healthcare campus. Finding parking, navigating unfamiliar surroundings, and locating the right entrance may seem like operational concerns, but they have meaningful human impacts. Every unnecessary detour or confusing decision point adds cognitive and emotional burden during an already difficult moment. 

Accessibility is equally important. For hospitals and especially senior living communities, thoughtful planning minimizes walking distances, reduces grade changes, provides frequent opportunities to rest, and creates routes that feel safe, comfortable, and intuitive for people of all ages and abilities. These decisions may appear small in isolation, but together they help reduce stress, improve confidence, and create a more supportive experience for everyone who uses the campus. 

That same philosophy extends to staff. Outdoor courtyards, rooftop gardens, walking paths, and other spaces for respite give clinicians opportunities to decompress during demanding shifts. Supporting the well-being of caregivers ultimately supports better care for patients, reinforcing the idea that a healing environment serves everyone—not just those receiving treatment. 

That philosophy takes many forms depending on the needs of a campus. At the Lynn and Jerry Flaherty Family Respite Garden at OSF Saint Francis Medical Center, for instance, we transformed an underutilized rooftop into a restorative retreat for patients, families, and healthcare staff. Inspired by a journey through the woods, the garden weaves together intimate seating areas, gathering spaces, water features, and views of the Illinois River. While the space serves those who can access it directly, it also provides restorative views from surrounding patient rooms, reinforcing the idea that healing can occur through both experience and observation.

The business case for healing environments 

The value of healing gardens and thoughtfully planned healthcare campuses is more than just added amenities. Shorter hospital stays, improved treatment responses, and lower rates of complications can contribute to more efficient care delivery. Intuitive campus circulation can improve patient satisfaction and strengthen community perception, helping organizations to differentiate themselves in an increasingly competitive landscape.  

The benefits extend to the people delivering care as well. Physicians, nurses, and hospital staff work in environments defined by long hours, emotional demands, and high rates of burnout. Access to outdoor respite areas and restorative landscapes can contribute to greater job satisfaction and support employee retention.  

Taken together, these benefits reinforce an important reality: investing in healing environments isn’t just about creating beautiful places. It’s about creating healthcare campuses that function better for everyone who depends on them—patients, families, clinicians, staff, and the organizations that serve them. The same evidence-based principles that improve the human experience also support stronger operational outcomes

The role we play

Everything discussed—from healing gardens and intuitive circulation to evidence-based campus planning—requires collaboration across disciplines. As planners and landscape architects, we don’t design healthcare facilities in isolation. We work alongside architects, engineers, clinicians, administrators, and operations teams to understand how people use a campus today and how it can better support care tomorrow. 

Our role is to translate research into places that work. That means balancing clinical needs with human experience, coordinating complex site constraints, and identifying opportunities where the landscape can improve outcomes. Whether we’re developing a campus master plan, designing a healing garden, or reimagining outdoor spaces, every decision is guided by the same question: How can this environment better support the people who rely on it? 

Because healing doesn’t happen in just one room, and great healthcare doesn’t begin or end at the front door. It happens throughout the entire journey. And if something as simple as a view through a window can influence recovery, imagine what’s possible when nature becomes an integrative part of the healing process. 

Author Bio: As RVi’s Director of Healthcare and Senior Living, Geoff Roehll has led the planning and design of healthcare and senior living landscapes for more than three decades. Coming from a family of healthcare professionals, Geoff has long been passionate about creating environments that support healing through thoughtful planning and evidence-based landscape architecture. In addition to his work with RVi, Geoff was an instructor at the Chicago Botanic Garden’s Therapeutic Garden Certificate Program and regularly shares his expertise at regional and national healthcare conferences.