The Future of Healing Gardens.

Healing gardens have come of age. Due in part to a growing body of evidence on the health benefits to patients, staff, and visitors, they are appearing in hospitals, senior facilities, cancer facilities, and memory care units nationwide. They are featured in architecture trade magazines, in marketing literature, and even in the popular press. That is the good news. So what is the bad news?Despite available research and studies of excellent examples, in many cases, there is little understanding of the essential elements of a successful garden. Two chaise longues and potted plants on a rooftop are labeled a "healing garden." A stark courtyard with minimal greenery, few places of privacy, and uncomfortable seating is designated a healing garden. Labyrinths have become fashionable with little understanding of their purpose, the need for privacy, or the physical ability of potential users. Yes, designers and their healthcare clients want to be seen as up to date with the current trend. Yet, sadly, many of the new gardens appearing in healthcare facilities do not meet even minimal standards as restorative outdoor spaces. Why is this happening when there are many research studies and sets of evidence-based guidelines that provide accessible information for design professionals?This situation reminds me of a much earlier period of design research. In the late 1960s when the organization Environmental Design Research Association was founded, a recurring discussion at its annual conferences was "How do we build the essential bridge between researchers and designers?" Practitioners of each discipline seemed to have different mind-sets, thought on different timescales, and even used different vocabulary. Researchers were frustrated that their work was frequently ignored. Many designers seemed to have little inclination or time to read, complained (often justifiably) of researcher jargon, or needed to move on quickly to the next job.A wise voice in that debate was that of Sandra Howell (then a professor at Massachusetts Institute of Technology (MIT)), who argued that researchers would never be more than partially successful communicating with designers. A better tack was, she argued, to educate and convince the fee-paying clients who would then--hopefully--tell designers: "This is what we want." To some extent that has happened. Speakers at annual conferences such as Healthcare Design and the International Academy for Design and Health's World Congress are now presenting case studies of successful gardens or sets of evidence-informed guidelines to audiences that comprise not just designers but the healthcare administrators--CEOs and chief financial officers--who will (or may) hire them.Other positive changes have occurred. Leadership in Energy & Environmental Design (LEED) for Healthcare, the Sustainable Sites Initiative, and the Environment of Care Section of the 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities all now include a requirement or credit pertaining to access to nature. The Joint Commission for the Accreditation of Hospital Organizations--an influential body--also now requires that there be access to nature in the facilities that they evaluate. These are all good signs. But "access to nature" can be interpreted in a multitude of ways, and not all of these directives spell out exactly what access to nature means, nor do all of them draw on available research to guide the design of a successful healing or restorative garden.Today, no hospital architect would attempt to design a new neonatal intensive care unit, or an operating theater, without accessing the latest research. Few would be hired unless someone in the firm was Evidence-Based Design Accreditation and Certification (EDAC) certified. Yet problems remain. EDAC has little to say about outdoor space. The professionals hired to design gardens rarely have training in that particular field (e. …