Effects of Healthcare Environmental Design on Medical Outcomes

or challenging images, there is mounting evidence that such content or styles in pictures can increase stress and worsen other outcomes in many patients. (Ulrich, 1991, 1992, 1999). Caution should be exercised before displaying ambiguous, challenging art in patient spaces or high-stress waiting and treatment areas (Ulrich, 1999, 2000bb). A growing but limited amount of research on gardens in healthcare facilities (Marcus and Barnes, 1999) suggests that gardens will tend to alleviate stress effectively if they contain green or relatively verdant foliage, flowers, non-turbulent water, park-like qualities (grassy spaces with scattered trees), and compatible nature sound (birds, water, breezes) (Ulrich, 1999). Apart from providing soothing gardens that can be easily accessed by family, patients, and staff, examples of other design approaches for fostering access to nature include providing: nature window views for patient rooms, waiting areas, and staff spaces; an aquarium in a high-stress waiting area; an atrium with greenery and a fountain; and calming nature art mounted where bedridden patients can readily see it (Ulrich 1992, 2000b). Advantages and costs of evidencebased supportive design One way to summarize the emerging field of evidence-based design is by addressing the question: What advantages can healthcare administrators, medical professionals, designers, and the general public reasonably expect to achieve by including supportive design criteria in the objectives for a new facility? The list of advantages below was identified on the basis of a broad yet reasonably cautious assessment of the available scientific research (Ulrich, 2000a, 2000b). The advantages are stated in terms of improved outcomes that seem realistically attainable assuming that a facility is well designed given current research knowledge (Ulrich, 2000b). • Reduced stress/anxiety for patients and