During my first year of residency, I once found myself on call in the labor and delivery unit early on Sunday. While walking through the hospital hallway, I heard beautiful music coming from the main lobby. The music, which came from a player piano, was so uplifting it made me feel better about having to be in the hospital on a Sunday morning.
Several years later, I was lying on a hospital gurney awaiting a major surgical procedure. It’s one thing to be in a hospital as a clinician, but becoming a patient is a totally different experience. Facing a major operation can be nerve-wracking, but the calm I experienced when I looked up and noticed a picture of a waterfall hanging on the wall across from me was priceless.
These experiences and others got me thinking about the impact of the environment on health and well-being. In exploring the topic, I learned about the concept of an “Optimal Healing Environment,” which describes health care systems that are intentionally designed to support people’s inherent healing capacity. There are several criteria that need to be considered to create optimal healing environments. I discuss some salient ones below.
The impact of natural light on mood is well known, but it can also impact the healing process. Florence Nightingale was way ahead of her time when she noticed that patients in rooms with natural sunlight recovered more quickly than those in windowless rooms. While we can’t know for sure if the sunlight primarily affected their moods or if it also impacted their physical ailments, these observations presaged current day light therapies.
Research has also shown that light can impact our moods and biological clocks. We now know that there are photosensitive cells in the retina that are connected to the brain centers and are involved with mood regulation. These photosensitive cells are also connected to the centers that regulate the biological clock.
However, in order for these photoreceptors to have a positive impact on the human brain and body, the light has to be much more intense than what is required for normal vision. We can experience these benefits by spending more time outdoors or by allowing natural light into our buildings.
Similarly, in a study of patients recovering from gallbladder surgery, Ulrich found that patients in rooms with views of natural scenes had shorter recovery periods, fewer negative comments in the nursing assessments, and took fewer potent analgesics than those whose rooms faced a brick wall.
Dr. Esther Sternberg, whose research focuses on practical approaches to stress reduction and optimization of well-being through design and lifestyles, has also spoken about the impact of views. An internationally recognized design and health pioneer, Dr. Sternberg is the founding director of the University of Arizona Institute on Place, Well-Being and Performance. In this talk, she explains how beautiful views activate the parahippocampal cortex, an area of the brain that is rich in endorphins.
Dr. Sternberg also notes in her talk that scents can affect brain function and specifically, that the pleasant smell of lavender can induce slow wave sleep in animals.
Additionally, research has shown that odors can influence mood and work performance through learned associations. Pleasant ambient odors have been associated with prosocial behavior and productivity.
4. Floor Design
I recently encountered the work of Diana Anderson, a physician-architect who combines her experience in both fields to design inpatient environments for geriatric patients and ICUs. In this review, Dr. Anderson and colleagues concluded that the built environment was an important part of dementia care, and that prospective studies were needed on this topic. In this podcast interview, she gives an example of a time when doctors assumed that geriatric patients didn’t want to come out of their rooms to walk in the hospital hallway. It was later discovered that the horizontal stripes on the hallway floor were part of the problem. Due to age-related changes in visual processes in the brain, the stripes gave the floor a 3D appearance, impeding mobility and discouraging the patients from venturing out of their rooms. A big problem with a simple solution!
5. Nature-Focused Art
At the end of the aforementioned talk by Dr. Sternberg, she shares how her father, while in a concentration camp during WWII, did not have access to the outdoors and he found solace in reciting words from Psalm 23, his favorite psalm. Listening to this talk, I was reminded of a photograph that I took several years ago. It was a serene scene of a small body of water in a lush green environment. I titled it “He leadeth me by the still waters”, words from the same psalm that Dr. Sternberg’s father had found solace in, by going to that still place in his mind. So, whether it is through a painting, a photograph, or just in our mind, quiet, peaceful scenes from nature can take us to our own healing places, even if our environments are not as conducive to healing.
In addition to these anecdotal reports, such as my own above, a scoping review showed promising evidence that simply viewing artwork may reduce stress.
It may not always be possible to incorporate these features into your hospital or clinic. Perhaps your exam room does not have a window, or your hospital prohibits scents. Even with such limitations, you can create a miniature healing space in your office or workspace. This can be done with decorative plants, artwork, photographs of loved ones, or other personal items that contribute to your personal sense of well-being or that enhance the feeling of connection with your patients.
Ultimately, in order to optimize outcomes, we need to make a deliberate effort to create healing spaces by leveraging what we know about the impact of the environment on health and well-being. We can look to architects for help with this — sometimes things that we clinicians would not normally consider, like the design of the floor, can make a big difference to our patients’ health.
What would your ideal "optimal healing environment" look like? Share your vision in the comments!
Dr. Olapeju Simoyan is the medical director of New Directions Treatment Services and a full professor in the department of psychiatry at Drexel University College of Medicine. She has received several awards, most recently the Arnold Gold Foundation’s National Humanism in Medicine Award for exceptional leadership in placing human interests, values, and dignity at the heart of every health care connection, and Pro-Health International’s Award of Excellence in Humanitarian Services. Dr. Simoyan has combined her interests in writing and photography in several books, including The Amazing World of Butterflies, Living Foolproof, and most recently, Transformation and Recovery, a workbook for patients with addictions and other behavioral disorders. Dr. Simoyan strongly believes in the need to transform education and health care, with a focus on creativity, problem solving and integration of the arts and sciences. She was a 2022–2023 Doximity Op-Med Fellow.
Illustration by April Brust