How Views of Nature Can Support Patient Recovery

In 1984, a study appeared in the journal Science that's since been cited as the foundation of evidence-based healthcare design.

‍ ‍

Researcher Roger Ulrich examined the hospital records of patients recovering from gallbladder surgery in a Pennsylvania hospital. Twenty-three patients had been assigned rooms with a window looking onto trees. Twenty-three closely matched patients, similar in age, sex, and other relevant factors, had rooms facing a brick wall instead. Full citation and summary via the Center for Health Design →

‍ ‍

The patients with the natural view had shorter postoperative hospital stays, received fewer negative comments in nurses' notes during recovery, and required fewer strong pain medications than the matched group facing brick. It's a small study by modern standards, forty-six patients in total, but it was the first to measure environment against real clinical outcomes rather than patient preference alone, and it's been cited by thousands of subsequent studies since.

‍ ‍

The research hasn't stood still. A hospital emergency department in southern Sweden, serving around 125,000 people, was later redesigned using evidence-based principles, and a validated before-and-after survey found patients and families reported meaningfully better support from the environment afterward. In 2022, a randomised controlled trial tested evidence-based design directly against two other popular approaches, Golden Ratio proportions and Feng Shui, and a plain control room, using measures of anxiety, sense of control, and perceived support.

‍ ‍

This is the foundation the rest of our thinking sits on. Not every design decision can point to a study this direct, but the underlying principle, that environment is measurable against outcomes rather than simply a matter of taste, is now well established.

Read the full evidence page →