Hospitals are under pressure to improve outcomes while creating environments that support recovery, reduce stress and help staff deliver great care. Biophilic design brings people into closer contact with nature through views of nature, natural light, materials and spatial qualities all have a strong and growing evidence base showing benefits for patients, families and staff.
Key takeaways
- Faster recovery and less pain: Patients with views of nature have been shown to need fewer strong pain medications and are discharged sooner than patients without such views. Shorter stays, lower anxiety and better experience: Recent systematic reviews conclude that biophilic strategies in hospitals can reduce length of stay, lower stress and anxiety and improve perceived quality of care.
- Alignment with UK guidance: NHS Health Building Notes call for therapeutic environments that maximise daylight and provide meaningful views to landscape core biophilic moves.
- Real-world examples: From the UK’s Maggie’s Centres to Singapore’s Khoo Teck Puat Hospital, nature rich healthcare settings report high satisfaction and restorative experiences that complement clinical care.
The evidence in detail
A landmark study that changed hospital design
One of the most cited studies in healthcare design comes from environmental psychologist Roger Ulrich. In a controlled comparison of 46 post-operative patients, those whose rooms overlooked trees left hospital sooner, required fewer potent analgesics and received more positive nursing notes than matched patients facing a brick wall. This work, published in Science, helped establish a measurable link between contact with nature and recovery.
Systematic reviews: a broader picture
Contemporary reviews that synthesise multiple studies reinforce these findings. A 2024 systematic review across 2010 to 2023 reports that biophilic strategies in hospitals are associated with reduced hospitalisation time, lower mortality and pain and reduced stress for staff, alongside improved experiences for patients and families.
Another peer reviewed synthesis proposes a healthcare specific biophilic framework informed by hospital user (patient and staff) experiences, underscoring the importance of tailoring nature based interventions to clinical functions and local context.
UK context: policy alignment and practice
The UK’s NHS design guidance explicitly frames hospitals as therapeutic environments, advising teams to maximise natural daylight, provide views of landscape and sky and ensure bedrooms and communal areas overlook appealing outdoor space all central to biophilic design. These directives appear across general design guidance and specialty notes, signalling policy level support for nature positive environments.
In practice, the UK’s Maggie’s Centres which are non-clinical spaces on hospital campuses for people with cancer offer a well-documented model. Research synthesising user experiences links their nature led architecture to reduced stress, improved mood and a sense of agency and social connection which are factors known to support recovery.
International exemplars
Singapore’s Khoo Teck Puat Hospital integrates gardens, water and views throughout the campus. Post occupancy assessments and national patient satisfaction surveys consistently rank it highly, with biophilic qualities cited as contributors to the overall experience and perceived wellbeing. While many outcomes are experiential rather than clinical metrics, they align with the wider literature on stress reduction and comfort.
Why it works: mechanisms that support healing
Biophilic design isn’t just about adding plants. Evidence points to several mechanisms relevant to recovery:
- Visual connection to nature: Views of trees, sky and water are repeatedly linked with lower stress and pain and more positive affect factors that can support immune and endocrine pathways involved in healing.
- Daylight and circadian support: Access to natural light helps regulate sleep wake cycles, which is associated with improved mood, better sleep and potential reductions in delirium risk especially relevant for inpatients. (This mechanism underpins NHS guidance to maximise daylight.)
- Nature inspired materials and patterns: Natural textures, colours and biomorphic forms can reduce cognitive fatigue and create a calmer baseline in high stress settings. Recent frameworks recommend matching these elements to specific clinical needs and cultural context.
- Restorative landscapes and movement: Gardens and green routes encourage gentle activity and social interaction, supporting psychological wellbeing and rehabilitation goals documented in qualitative healthcare studies.
What this means for hospitals and partners
- Prioritise views and daylight early: Bed placement, window sizing, glazing strategy and sightlines to planting and sky should be decided at concept stage to maximise therapeutic benefit. This is consistent with NHS HBN recommendations.
- Design nature for different clinical moments: Quiet, protected outlooks for wards; engaging, legible routes with planting for outpatient areas and choicerich communal spaces (prospect/refuge) for families and staff. Frameworks suggest aligning biophilic patterns to the clinical function.
- Use evidence-based palettes, not token greenery: Natural materials, colours and patterns, acoustic softening and circadian supportive lighting can all deliver benefits especially where live planting is restricted by infection control.
- Measure what matters: Combine post occupancy evaluation with patient reported outcomes and operational data, for example, length of stay, analgesic use, staff stress markers to demonstrate impact locally, all contributing to the wider evidence base.
Limitations and research needs
Not all studies measure the same outcomes, and some evidence relies on experiential and satisfaction metrics rather than hard clinical endpoints. Causality can be difficult to isolate in complex healthcare settings. Nevertheless, converging findings across decades from controlled studies to modern systematic reviews and national guidance, strongly support incorporating biophilic strategies as part of an evidence based approach to healing environments.
Selected references (some are not open access)
- Ulrich, R.S. “View Through a Window May Influence Recovery from Surgery,” Science (1984). PubMed | Le bonheur est dans le jardin
- Frontiers in Built Environment (2024): Systematic review of therapeutic biophilic design in hospitals (2010–2023). Frontiers
- International Journal of Environmental Research and Public Health (2022): Systematic review and framework for biophilic design in hospitals. PMC
- NHS England – Health Building Notes: General guidance and therapeutic environment principles (daylight, views). NHS England | National Services Scotland
- Case examples: Maggie’s Centres (UK) and Khoo Teck Puat Hospital (Singapore). PMC | ScienceDirect | Living Future – A future worth living in | Human Spaces
