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A Systematic Review and Conceptual Framework of Biophilic Design Parameters in Clinical Environments

Bekir huseyin tekin.

1 School of Architecture, University of Liverpool, United Kingdom

Rhiannon Corcoran

2 Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, United Kingdom

Rosa Urbano Gutiérrez

Objectives:.

To provide a live-experience knowledge base about biophilic design parameters and environmental features to inform policy and design in clinical therapeutic environments.

Background:

It is increasingly important to review hospital design to make the best use of the affordances of natural elements in supporting both patients’ and staff’s physical and psychological well-being. The biophilic design theory provides an appropriate design approach. However, current biophilic design frameworks fail to provide efficiently standardized guidance. This systematic review aims to examine the experience of hospital users (patients and staff) with a view to informing a standardized biophilic design framework to improve future design in this context.

This study performed a review and synthesis of nine studies identified using systematic procedures focusing on biophilic design features in healthcare environments.

The study identified a selection of biophilic parameters specifically relevant to this building typology, according to three different user groups: outpatients (fresh air, light-daylight, thermal comfort, welcoming and relaxing), inpatients (feeling relaxed and comfortable, prospect refuge, security and protection, light-daylight, view), and staff (privacy-refuge, quietness).

Conclusions:

The systematically identified studies helped to identify and rank the biophilic design parameters that appear the most critical for promoting and supporting human health and well-being in clinical therapeutic environments from the user’s perspective. It also provides an up-to-date compilation of crucial design interventions related to biophilic parameters and as such provides benchmark information for future research and design guidance in these environments.

Introduction

Considerations about the quality of the environment in which healthcare is delivered can be tracked as early as ancient history. In Western culture, healthcare architecture evolved from the Asclepeions (healing temples) in Ancient Greece ( Sternberg, 2009 ), to the military infirmaries in use during Roman times, Valetudinariums ( Thompson & Goldin, 1975 ), and the hospitals run by the Church (monasteries) in Medieval and Renaissance times, which were later operated by town authorities during early Modernity ( Verderber & Fine, 2000 ). These traditionally developed settings are early examples of biophilic thinking: They were usually built far from the high temperature, noise, dirt, and dust found in towns, and they typically offered a good view of nature and nearby freshwater sources. In the 18th century, hospitals started to diversify and specialize, producing medical research and training, laying the foundations of modern hospital care. The first design principles for hospital wards developed by Florence Nightingale in her 1863 book Notes on Hospitals were a crucial contribution toward establishing sanitation standards, which comprised considerations related to spatial layout, materials, and color, but most importantly to the quality of the environment, where natural elements such as daylight, fresh air ventilation, and heating played a key role ( Nightingale, 1863 ; Verderber & Fine, 2000 ). From the time of this publication up to the Second World War, there was little literature on hospital design, however, soon after the war, the UK government started a proactive initiative for planning and postdesign evaluation of this complex and costly building typology, as part of the new vision for the modern city ( Kenny & Canter, 1979 ; Stone, 1976 ). Post-war hospital planning privileged the building’s circulatory systems and mechanization with the aim of increasing efficiency in the use of human and technical resources, rationalizing and accelerating the delivery of clinical care (reducing inpatient lengths of stay to the minimum clinically necessary, and through increases in day surgery and outpatient treatment; Hughes, 1997 ). Nightingale’s principles were progressively disregarded in this process, which together with the dramatic growth of urbanization, the advent of the germ theory, and rapid changes in medical technology, led to an environmental approach to healthcare exclusively focused on healing through medical interventions ( Murphy & Mansfield, 2017 ). From mid-20th century to today’s “mega hospitals” ( Verderber & Fine, 2000 ), “mall hospitals” ( Sloane & Sloane, 2002 ), or “factory-hospitals” ( Jencks, 2017 ), healthcare environments have focused on the goals and objectives of the organization (fast physical recovery, mass health working like a machine), while neglecting the users (staff, patients) concerns and aspirations and, with this, their emotional, mental, and spiritual health ( Abdelaal & Soebarto, 2019 ; Murphy & Mansfield, 2017 ; Silverstein, 2009 ). This is particularly important for patients who are diagnosed with a chronic condition and are undergoing treatment, as many studies have confirmed that they may experience high levels of psychological discomfort, with many experiencing fatigue, anxiety, or depression ( Blazer et al., 1994 ; Guthrie, 1996 ; Mayou et al., 1991 ; McDaniel et al., 1995 ; Turner & Kelly, 2000 ; Zabora et al., 1997 ). There is research evidence that corroborates that the physical qualities of the setting in which a patient receives healthcare positively influence health outcomes in those mental disorders ( Evans, 2003 ; Galea et al., 2005 ; Laursen et al., 2014 ; Moore et al., 2018 ; Rao et al., 2007 ; Ulrich et al., 1991 ; Yadav et al., 2018 ). In this context, it has become progressively important to review hospital design, and with it the concept of therapeutic environment, as it should not only be a place where patients are treated with the most advanced medicine and technology but also a place that supports their users (staff, and patients and their families), in psychological, emotional, and social terms ( Smith & Watkins, 2016 ; Ulrich, 2008 ). Since the 1950s, research has been increasingly investigating optimal healing environments (e.g., stress recovery theory, attention restoration theory, therapeutic environment theory, salutogenesis, supportive design theory), bringing to the forefront the need to include other parameters in our design briefs, where the role of nature, and with it, the application of biophilic design, proves to be paramount.

Biophilic design as a discipline refers to an innate human connection to nature and natural processes, and the fulfilment of this connection promotes health and well-being in the environment we inhabit ( Kellert et al., 2011 ; Kellert & Calabrese, 2015 ; Kellert & Wilson, 1993 ). Exposure to nature is associated with multiple health benefits ( Kuo, 2015 ; Mcsweeney, 2014), including pain reduction, less medication, lower blood pressure, faster recoveries, and decreased all-cause mortality in general ( Park & Mattson, 2009 ; Ulrich, 1984 ). Additionally, biophilic design can have a profound impact on supportive care, especially for patients suffering chronic diseases, who often experience psychological distress, fatigue, anxiety, or depression ( Clarke & Currie, 2009 ; DeJean et al., 2013 ; Evans, 2003 ; Laursen et al., 2014 ; Moore et al., 2018 ; Turner & Kelly, 2000 ; Ulrich et al., 1991 ). It has also been shown that contact with nature promotes emotional, mental, and spiritual health; reducing stress; and triggering positive shifts in mood ( Abdelaal & Soebarto, 2019 ; Berman et al., 2008 ; Bratman et al., 2012 , 2021 ; Murphy & Mansfield, 2017 ; Silverstein, 2009 ). Some examples of effective biophilic healthcare environments within hospital settings are Alder Hey Children’s Hospital in Liverpool (designed by BDP in 2015), Circle Hospital in Bath (designed by Foster and Partners in 2009), or the Cancer Centre at Guy’s Hospital in London (designed by RSHP in 2016). There are also outstanding examples of biophilic healthcare environments within nonclinical settings (places where healthcare is delivered but not medical treatment), such as the Maggie’s Centers ( Tekin et al., 2022 ). In all of these examples, the design focuses on human-centered environments, seeking to support physical and psychological well-being through close contact with nature, taking the users’ views into consideration, and showing as much care for humanity as efficiency.

The design parameters that relate to biophilia have been examined and categorized in three established general frameworks: (a) Kellert ( Kellert et al., 2011 ) proposed a framework with 72 design parameters (usually termed as “patterns”) classed into six groups, (b) later on Kellert revised his study ( Kellert & Calabrese, 2015 ) proposing a framework with 24 parameters organized in three groups, and (c) Terrapin Bright Green ( Browning et al., 2014 ) proposed an alternative framework using 14 parameters also organized in three groups as shown in Table 1 .

Biophilic Design Parameters.

The scoping review of the literature by the authors confirms that there are three areas in which biophilic design has been developed: as investigated in research institutions, as used in design practice, and as established in building standards. Examining each of these areas uncovers several issues and disconnections. In scientific academic environments, there is abundant research on many of the different parameters of biophilic design, but this research examining the effects of nature on humans has happened separately for specific aspects of the design parameters and has not been brought together in a holistic and coherent way to support the frameworks. The design recommendations provided by the existing frameworks, the WELL Building Standard and the Living Building Challenge (certification schemes created to support the nourishment of wellness in the built environment; International Living Future Institute, 2019 ; International WELL Building Institute, 2020 ), are too broad and generic and developed from a Western perspective. These biophilic design frameworks don’t differentiate the level of value of each design parameter for each context and therefore, as design instruments, are too vague. Our position is that a biophilic design framework can only be efficient if it is specifically adapted to building function and geographical and cultural context. For instance, these frameworks recommend daylight as a parameter beneficial to humans but don’t specify adjustments regarding the daylighting requirements needed in a hospital of those needed in an educational building, or regarding the biological needs of people who live in extreme climates (e.g., northern latitudes or desert climates), or even regarding cultural dictates that might prioritize some parameters over biological needs (e.g., privacy over daylight in Muslim cultures). Therefore, to be able to provide efficient design guidance, it is necessary to determine a selective hierarchical structure for each context, as specific parameters from within the established general frameworks become especially relevant for the users.

…a biophilic design framework can only be efficient if it is specifically adapted to building function and geographical and cultural context .

…to provide efficient design guidance, it is necessary to determine a selective hierarchical structure for each context, as specific parameters from within the established general frameworks become especially relevant for the users

The goal of this study is to provide an account of the generated knowledge from users’ experiences in order to better inform human-centered policy and design by proposing a biophilic design framework specific to healthcare settings in the UK context. This article specifically discusses a systematic review conducted to identify, compare, and synthesize the published scholarly literature on biophilic design parameters and their impact on human health and well-being within clinical therapeutic environments from the user’s perspective.

This study followed a systematic review methodology with the aim to find all relevant published research that would answer the review question: Which biophilic criteria are most critical in a clinical therapeutic environment and how do they inform design?

The following criteria were decided for inclusion and exclusion of literature. The search was carried out in six different databases, spanning the period between 1973, when Fromm coined the term biophilia, and September 26, 2021. The language was limited exclusively to English. In order to avoid biased or less reliable data, the search was limited to peer-reviewed academic journal publications. The basic search syntax with Boolean operators was (“biophilic design” OR biophil* OR “natural design” OR “restorative design” OR “ecological design”) AND (“therapeutic environment” OR “healing environment” OR hospital OR healthcare OR “care center”) AND (well-being OR depres* OR anxi*). However, depending on the search limits of the used bibliographic databases, these codes showed variations.

The search was concluded by exporting a total of 1,201 publications to Rayyan QCRI (https://rayyan.ai), a software that supports systematic review processes by expediting the initial screening of abstracts and titles using a semi-automated system ( Ouzzani et al., 2016 ). After eliminating 201 duplicates, the initial screening was completed by reading abstracts and, in some cases, whole texts. To verify that all standards were met carefully, the initial screening was performed five times and peer-reviewed. Finally, 20 studies were included for full-text reading. During the full-text reading period, five more publications were added externally for full-text evaluation ( Figure 1 ). To prevent selection bias, two of the authors read and reviewed the 25 full-text studies separately. Subsequently, nine papers were included in the synthesis ( Abdelaal & Soebarto, 2019 ; Blaschke et al., 2017 , 2018 ; Nejati et al., 2016 ; Peditto et al., 2020 ; Putrino et al., 2020 ; Tanja-Dijkstra & Andrade, 2018 ; Tinner et al., 2018 ; Wiltshire et al., 2020 ).

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Identification of the included articles in the systematic review after applying the inclusion–exclusion criteria.

Table 2 shows the background information about the included studies. All nine studies were published between 2016 and 2020. Four of the studies were conducted in the United States, three in Australia, one in the United Kingdom, with one study co-conducted between the UK and the Netherlands. Five of the studies were published by health and/or medicine related authors, two studies were published by academics in environmental disciplines and two were conducted by academic architects. Additionally, the majority of the publications (seven) were focused on cancer care settings.

Background Information of the Included Studies.

Since all the included studies employed different research methodologies, the analysis of the papers and data extraction for this systematic review followed individual procedures for each subject. Another reason for this was that the obtained data relevant to biophilic design parameters were found in a wide range of expressions. The general overview of the selected studies is shown in Table 3 . Studies 1 and 2 were qualitative studies, and the data were extracted after a second analysis of the statements and facts reported in these studies, using NVivo Version 12 software ( NVIVO, 2012 ). Quantitative data from various groups of participants were represented within Studies 3–6. Studies 7–9 used mixed methods. Data from either patients or staff were collected in all nine studies.

General Overview of the Included Studies.

The quality assessment tool used in this systematic review was adapted from a study by Holloway Cripps ( Holloway Cripps, 2016 ) and modified in accordance with Boland et al.’s ( Boland et al., 2017 ) systematic review guidelines. It assesses reliability through a checklist of 13 questions. Studies 3, 5, and 7 were deemed high quality (highly reliable). A number of questions (one, three, one, and two respectively) were not satisfactorily answered by Studies 1, 2, 4, and 6. Accordingly, these four papers were given a good quality rating. Finally, Studies 8 and 9 were evaluated as poor quality.

Synthesis of the Biophilic Design Parameters

The first clear finding observed in the analysis of these studies was that healthcare environments cannot be evaluated as a single type of environment for all users in terms of their needs or for the significance of the biophilic design parameters. These clinical settings had to work both as therapeutic environments and as working environments for patients and staff respectively. Hence, the analysis examined biophilic design parameters from these two separate perspectives: patient-centered and staff-centered. The studies also revealed some differences in ambient perception between inpatient and outpatient users. Therefore, this distinction was also applied in the analysis. Figure 2 summarizes the classification of the identified biophilic design parameters in a clinical environment based on the review findings. The biophilic design parameters are organized according to the type of user and the level of importance, as certain parameters were reported to be more relevant to the respondents. As a result, up to four distinct groups were used to classify and rank these biophilic design principles: first group, second group, third group, and fourth group, in order of importance. The parameters contained within each group seemed to share the same level of importance and so were simply listed alphabetically. The following sections discuss how biophilic design can provide specific support to each of these users.

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Classification by group of the identified biophilic design parameters in a clinical environment based on the review findings.

Critical Biophilic Design Parameters for Patients

Studies 1–5, 8, and 9 investigated the clinical settings most regularly used by patients. Outpatient studies (Studies 2, 5, 8, and 9) focused mostly on specialist care units (e.g., chemotherapy), waiting rooms, and doctor rooms while the main emphasis of the inpatient investigations (Studies 1, 3, 4, 8, and 9) was wards and hospital rooms, and in some cases, outdoor areas.

Due to the use of different approaches and techniques across the studies, as well as the differences in the contextual environment of the respondents and the different scope in each case, the results were diverse, making the process of extracting general conclusions and ranking the discussed biophilic design parameters more challenging.

The outpatient column in Figure 2 summarizes the synthesized groups of essential biophilic design parameters for a clinical environment for these users. This ranking order reflects those biophilic design parameters that appear to most efficiently support stress-relieving, calming, comforting spaces in settings for outpatients. Five of the studies employed information relevant to inpatient environmental demands, particularly in cancer settings. Although the parameters found important for inpatient-based environments were not markedly different from those for outpatient-based environments, the identified priority differences may have an impact on environmental quality because the function of the spaces and the physical conditions of the patients differ. The inpatient column in Figure 2 summarizes the synthesized findings of what seem to be the most important biophilic design parameters for clinical environments for inpatient users. The most essential parameters for patients who spend most of their time in the wards or hospital rooms on their beds were view, prospect, and daylight through windows. These parameters were usually mentioned with regard to their visual impact as these patients’ mobility was limited. However, Studies 1, 3, and 4 clearly also stated the importance of accessible outdoor spaces, so those patients whose mobility is less restricted can be exposed to a multisensory environment. Refuge, security, and protection were other notable parameters in the top-ranked group, indicating the need to feel safe and secure due to their compromised health, and their high level of dependency on strangers and healthcare workers.

Critical Biophilic Design Parameters for Staff

The research on staff (Studies 5–7) focused primarily on restorative characteristics of the environment. Studies 6 and 7 gathered information on staff break places, whereas Study 5 evaluated the clinical environment from the perspectives of both patients and staff. The staff column in Figure 2 summarizes the synthesized groups of biophilic design parameters for healthcare workers. The results for staff were synthesized into four different ranked groups, where the most important needs appeared to be Privacy and Refuge, with the need for Quietness mentioned frequently as well. Physical access to the outdoors was noteworthy in the investigations as well. Indoor greenery was unexpectedly low on the priority list. This seemed to be related to the added workload demands associated with their care and the possibility of harmful fungi presenting a risk of infection to patients. On the other hand, outdoor greenery within break areas was emphasized in the same investigations for its visual impact.

Informing Design Practice

The previous section revealed the critical biophilic design parameters for healing environments. This section discusses how Studies 1–7 also informed how to implement these biophilic design parameters taking all the senses into consideration. The recommendations also refer to barriers in relation to the efficacy of biophilic design applications in practice.

According to Study 3, the most important barriers to creating a biophilic healing environment are generated in the decision-making process before designing the healthcare settings. Decision makers did not prioritize nature-based opportunities or “design thinking.” Clinical functionality, efficiency, cost restrictions, or habitual practice were often the main concern of healthcare facilities’ design regardless of the patients’ opinion and the quality of their experience. In order to eliminate these barriers, decision makers, designers, management, and administration must have knowledge about the importance of biophilic design so that decisions regarding site, layout, building orientation, surrounding views, and so on can be considered in the planning stage. Skilled professionals need also to consider the repair and maintenance needs of biophilic features within available maintenance budgets. Furthermore, the lack of knowledge and ability of the designers also leads to inappropriate design choices and executions, such as cold and stark spaces; too much hardscape, glaring materials or materials too hot to the touch; uncomfortable furniture; environments that are too demanding, complex, static, or under-stimulating; insufficient shading or lighting; and structures that cast odd shadows that could raise anxiety.

As the parameters changed to some extent depending on the user group, the suggestions for practice also showed some variations in different spaces. However, some recommendations were applicable to the spaces used by all user groups. For example, for all user groups, indoor design should maximize the use of natural materials, natural colors, fresh airflow, natural light, safety, and security (Study 1, Study 3, and Study 4). Windows in particular should afford views from clinical areas onto landscapes and the outside world, appropriate natural light exposure without glare, natural airflow, and safety (Study 1, Study 3). For all users, it appears crucial to protect them from overstimulation such as overpowering scents, noise, loud sounds, allergy-inducing and toxic plants, adverse comfort conditions, and high-low temperatures coming from overexposure to the sun or shade (Study 1, Study 3).

...for all user groups, indoor design should maximize the use of natural materials, natural colors, fresh airflow, natural light, safety, and security .

Creating a nonclinical feeling was a significant design driver for both patients and staff too. Study 5 recommended that medical equipment should be hidden from the eye where possible, for example, in common spaces and waiting rooms. Although the recommendation for furniture in the studies did not directly refer to biophilic design, furniture choice can support a nonclinical feeling and a homely, comfortable environment.

Physical access to outside and natural settings was another over-arching consideration for its restorative properties (Study 4, Study 7). Outdoor settings should have easy and effortless access for patients and staff. Adequate greenery and comfortable amenities where users can relax were welcomed. Shade and sunny areas should be balanced in order to provide spots for personalized comfort (Study 3) and porches, courtyards, patios, balconies, terraces, and gardens were mentioned as positive design features (Study 7). Physical exercise opportunities for both staff and patients could be offered in outdoor spaces and adapted to patients’ physical abilities. Stroll gardens, walking paths with points of interest and distance markers (plant species, medicinal plants), meandering trails, and resting points were all mentioned. In terms of staff exercise opportunities, nature walks, mindful walking, mobility and balance training, gardening tasks, assisted walking, and labyrinths were recommended (Study 3).

Although the three groups shared similarities in terms of desired parameters, we will see in the following sections that the affordances provided by them for each group should take different approaches.

Applications Specific to Patients

Ease of movement was one of the most important features of the buildings for patients. As such, the maximization of accessibility and the removal of barriers were stressed. This included rapid and easy access between outdoor settings, foyer-waiting rooms, and treatment settings (Study 5) with safety considered as an over-arching priority in relation to movement. For example, the use of nonslip surface materials, smooth paved paths, ramps rather than steps and color contrasting curbing along pathways were mentioned. Barriers to be avoided included mention of heavy doors, narrow doorways and pathways (Study 3). In order to provide physical access to the outside, all barriers and thresholds should be removed for patients with automatic doors suggested improving ease of access (Study 3). Patients also suggested collaborating with volunteer services to provide opportunities for assisted walks outside the hospital building and visits to hospital gardens and courtyards, as well as contact with therapy animals (Study 1).

The material choice and heating system were another concern in terms of thermal comfort of the patients, as it was reported that the environment often tended to be over hot in hospitals. In Study 2, it was suggested that plastic materials be avoided as furniture options as it increases temperature perception. One patient said: “The seats make you very hot. That was one thing that we did [give feedback about] because they’re plastic” (Study 2, p. 4).

Study 5 claimed that providing optimum thermal comfort is challenging, often depending on individual differences and preferences. Therefore, a focus on the provision of personal control devices like warmed blankets or heated seating during the cold season and small fans during the hot season was recommended.

As the restrictions of existing building standards sometimes bar natural biophilic design features, the environment can be supported by artificial or electronic scenes and screens, plants or nature-related artworks. It was felt, within Study 2, that even if the artificial elements were not able to enrich a sensory environment, they could bring a visual focus for distraction: “I quite like visual scenes of the environment—mountains and streams that sort of thing. That is pretty commonplace [in this hospital] and it’s quite restful” (Study 2, p. 4). In addition, during clinical procedures, digital devices with interactive nature displays and sounds, such as virtual reality headsets, can be used to distract patients from unpleasant thoughts and reduce anxiety (Study 1). Patients in Study 2 referred to the importance of distraction provided by some artworks, such as a photography exhibition in the setting: “There are ones [artworks] that you just see and you forget what you’re here for” (Study 2, p. 4).

Participants of Study 2 criticized the sensory environment of the hospital environment referring to overall noisiness, noises of medical equipment, “buzzing” of alarms and “bleep” of the drips. The poor auditory experience caused by the machines was explained by a high-grade lymphoma patient:

…By the end of it, I found the whole place really irritating and upsetting. I didn’t really realize how much it was affecting me until on the odd occasion my wife came and met me and I was on edge. And the noise was one of the big things, especially when they’re busy and it’s endless. Bingbong, bing-bong, bing-bong, bing-bong. (Study 2, p. 4)

Patients were sensitive to the smell of the hospital since they commonly experienced anxiety and nausea. A patient claimed: “The last thing you want to be doing when you come in through this—especially when you’re feeling nauseous—is to go into a place that smells” (Study 2, p. 4).

Inpatient environment

Artificial biophilic interventions were more commonly considered in inpatient-related studies, although inauthenticity of nature-based design elements was claimed as a barrier to nature engagement such as fake plants, fake scents and tokenistic, and corporate design. Indoor planting can be incorporated with potted plants and green walls when appropriate and with caution. Nonetheless, plants are strictly prohibited in some clinics due to infection risk. Thus, high-quality artificial plants or scents can be used to incorporate biophilic elements to some extent (Study 1, Study 3). Furthermore, patients reported using technology to listen to natural sounds to help them sleep better. The ability to appropriately scale visual, auditory, and tactile intensities are one advantage of such technology-based interventions (Study 1).

The vast majority of the inpatients’ time during their stay is spent in wards or hospital rooms, usually physically dependent on beds. Therefore, windows should provide uninterrupted views, prospects, and sufficient natural light exposure to the bed, along with natural ventilation (Study 1, Study 3, and Study 4). Windows design should also pay attention to privacy, safety, and refuge by providing one-way views. Indoor seats and inpatient beds that are strategically located to maximize the use of natural window views can motivate patients to take advantage of these opportunities (Study 1, Study 3). In Study 2, the windows were criticized in this regard because they were too high to benefit from a direct line of sight to the outside area. A patient claimed, “you can’t even see a tree moving or anything” (Study 2, p. 4). Another participant expressed the general yearning of cancer patients for pleasant sights: “You just think ‘if only that were a nice garden space that you could wheel your drip out to and get a glimpse of cloud” (Study 2, p. 4).

Additionally, Study 4 recommended some environmental characteristics in indoor spaces that contribute to refuge, welcoming-relaxing feelings, and a sense of homeliness. Private bathrooms, private rooms, visitor beds in the patient rooms, family-patient or patient-only lounge, personal desks, closet spaces, and access to a kitchen were seen as important characteristics in this regard.

Outpatient environment

The entrance to the facility is an important space as arriving people often face high levels of stress and anxiety. It was felt that creating a welcoming atmosphere with biophilic touches can relax people. The use of natural materials such as timber, natural wall colors, fish tanks, and natural objects, that were kept at the reception and hospital foyer in Study 2, was well-received by patients, “because it’s very relaxing” (p. 4). As always, safety was emphasized, avoiding the inclusion of allergy-inducing elements, and slippery or otherwise challenging surfaces (Study 1, Study 2).

Spaciousness and calmness were sought in the clinical environment by patients, particularly in diagnosis rooms. Doors were especially mentioned in Study 2: sliding doors of a warm natural material as the best option. Furniture and materials should be comfortable and relaxing. High ceilings were recommended to create a spacious and well-lit environment, along with light accessible fittings which do not overwhelm patients. A participant shared her experience of receiving the diagnosis in Study 2 (p. 6):

The room is absolutely tiny. There’s not really anywhere to sit. And you have to actually sit on the bed. I sat on the bed, yeah. If you’ve got a visitor. Your visitor sits on the chair and then the doctor stands and talks to you. The image you get of being told you’ve got cancer is, you know, sitting in front of the desk, you know, the doctor sitting in a chair. He’s got reference books, you know. Whereas, you sort of feel like you’re sat in this little poky room because you’re not important enough. And you just feel that you…it’s just really awkward to be told you’ve got cancer sitting on a bed, tiny little room with two doctors standing there—because mine was two doctors standing—talking to you. So, for them to now tell me I am terminal, standing there in this tiny little room, no window at all…I wasn’t sitting comfortably, as I was sitting on the bed. They need to make you feel that they are talking to you and you alone, they’re not standing waiting to go out the door to talk to someone else.

The waiting rooms should allow sufficient daylight exposure, view, and fresh air and generate a quiet environment to reduce patients’ stress levels and the need to leave the room for relaxation (Study 2, Study 5). Easy and rapid access to the outdoor environment where the patients are able to hear when their name is announced or see a board showing the list of announced people was recommended (Study 2, p. 6):

From the patient perspective, being spatially confined to the waiting room prevents patients from accessing their preferred places within the hospital site. Participants talked of being “stuck there” for fear of missing their name being called and therefore being unable to “go outside to the courtyard” for its “scenery” and “fresh air.”

An efficient healthcare design should provide privacy as well as socializing opportunities (Study 3). Socializing opportunities can be created through spatial arrangement of seating and gathering options (Study 2), the inclusion of communal spaces, children’s play areas, semiprivate enclosures for personal conversations, and even BBQ areas (Study 3). However, socializing should not be enforced by the environment. Rather the environment should be flexible to accommodate socializing and withdrawal spaces (Study 2).

According to Study 5, as the most commonly preferred location within the treatment rooms, seats near to windows should be maximized, and the spatial arrangement should be designed to deliver optimum daylight and provide uninterrupted views for a larger portion of the room. In practice, an open-plan layout provides the highest exposure to daylight and socializing opportunities, but it also creates a noisier environment and impacts the provision of withdrawal spaces. Therefore, the inclusion of open-plan spaces needs more thought in order to create a balance of socializing and privacy and tranquility (Study 5).

Privacy can be provided through zoning or screening or by providing solitary spaces for rest or contemplation. A patient explained her experience after being diagnosed with cancer, in Study 2:

I remember going out and crying in the waiting room with my daughter. I was just hugging her. She was crying. She was crying and I was crying. And it was in front of everybody. We had nowhere to go that was a private space. (p. 5)

The spatial arrangement between waiting rooms and chemotherapy rooms should consider privacy, and patients mentioned that waiting areas in front of the toilets should be planned to also offer more privacy (Study 2).

Applications for Staff

Views through windows were a frequently desired feature within staff indoor break areas (Study 7). Study 7 also revealed that visual or physical contact with the outside world and biophilic elements (i.e., view, prospect, daylight) played a critical role in staff’s restoration. The importance of this connection was stated by participants as follows:

When I had a window it made all the difference in the quality of my day, being able to look at out and see what was going on, I think the access to a view or to daylight and to the changing of the time of the day and the seasons is critical to the mental health and well-being of the staff. (Study 7, p. 22)

In terms of staff needs, easy access to private and quiet spaces, such as break rooms or outdoor settings shielded from inside views where they should also be able to enjoy adequate daylight and thermal comfort, were the most desired environmental features (Study 2, Study 5). Staff break areas should be located in ways that provide easy and rapid access back to patients and also to outdoor spaces which appears to be one of the most critical applications of biophilic design for staff well-being (Study 7). It was reported in Study 7 that participants should have access to rooftop gardens where they could have direct access to the nursing unit, and a patio garden directly accessible to the staff break rooms and cafeteria. The general idea of desirable indoor break area location followed the same concern, easy and rapid access to patients:

If they’re not able to have immediate access back to the unit, like if the break room is not on the unit, then oftentimes they won’t take breaks, You need to get away from the unit, at least behind a door so that the noise is not crazy and you’re not hearing everything. But that being said, you also can’t go very far away because your patients are sick and if you’re their nurse, it’s really difficult to not be right there. (Study 7, p. 29)

In fact, Study 7’s interview results reported that the most powerful stress reliever was the provision of direct access to the outdoors, because of the opportunities to direct contact with natural elements: “to walk in a garden, to be around diverse plants and flowers, to listen to the sound of water, and to receive direct sunlight” (p. 23). A participant described the ideal break area features for staff: “they had a beautiful staff lounge and it had a door that opens to a balcony, an outside balcony…just the ability to get fresh air, I think they would just love that” (p. 23).

Staff break areas should be located in ways that provide easy and rapid access back to patients and also to outdoor spaces which appears to be one of the most critical applications of biophilic design for staff well-being .

Staff specifically demanded a nonclinical homely environment in break areas where a sensorial connection with nature could provide a relaxing environment to reduce stress (Study 6). The furniture in break areas should be easily rearrangeable, and comfortable, for individual and group activities, with sofas and recliners, explicitly mentioned (Study 7).

Staff participants also recommended private outdoor break areas free from patients and their companions. Also, these outdoor areas should be enriched with greenery, trees, shade, tables, flowers, and water features:

In my perfect world, there would be plants—not anything too crazy that requires a lot of maintenance. There would be a water feature that just gave that noise, that waterfall noise, and then benches to sit on. It doesn’t have to be a big walking path because I just don’t have time…Trees, bushes, or flowers that have aroma to them; perhaps access to nature sounds [such as] running water or birds. I mean all of those elements of nature that we know nourish us as individuals. (Study 7, p. 23)

Privacy and being away from nonstaff sight were frequently emphasized:

If you’re going to have outdoor access, then I think it does need to be a quiet environment; again, private—it would be a private garden, not a garden like with families and kids running around, It has to be segregated because if families see staff members sitting outside…the family members are going to find them. (Study 7, p. 22)

Figure 3 shows a summary of the main recommendations for each user group.

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Summary of recommendations for informing design practice in clinical environments.

In the context of the modern healthcare environments, it was confirmed that emotional, mental, and spiritual health issues are typically disregarded, while the main foci are physical treatment and cost. The environment has an influence on patients, particularly those affected by chronic illnesses as they visit hospitals regularly, as well as staff where under-resourced environments can give rise to health and well-being issues such as stress, depression, anxiety, and fatigue. The studies reviewed here focus on how the provision of biophilic design can mitigate these problems and promote a more welcoming and relaxing environment.

The synthesis of findings helped to identify and rank the biophilic design parameters that appear the most critical for promoting and supporting human health and well-being in clinical therapeutic environments, within and across three different user categories: outpatients (fresh air, light-daylight, thermal comfort, welcoming and relaxing), inpatients (feeling relaxed and comfortable, prospect refuge, security and protection, light-daylight, view), and staff (privacy-refuge, quietness). This review also showed that inpatient, outpatient, and staff users had similar desires but sometimes divergent priorities and requirements and that the provision of the same or similar biophilic elements to different groups could support distinct affordances. Therefore, future research should investigate the different building typologies and programs based on their specific user groups and contexts to provide efficient and rigorous biophilic design frameworks. This analysis also provides an up-to-date compilation of crucial design interventions related to biophilic parameters (summarized in Figure 3 ) and as such provides benchmark information for future research and design guidance in these environments.

The main limitation of this review was that not all the examined studies had as their main aim to produce data directly related to the assessment of biophilic design but rather to general hospital design environments. However, this could also be a benefit allowing a better understanding of the value of nature-based design where it fits within general healthcare design. It was also noticed that the available case studies were limited in number, however, they were systematically selected based on our criteria. This stringent selection is actually very important, because it frames the research to meet our specific goals and provides the necessary rigor to produce a substantive contribution to this early literature by revising it within this specific frame. The selected studies were localized in industrialized Western countries and typically of less than high methodological quality. Studies 8 and 9, showing the lowest level of reliability, proved not to contradict the high-quality studies but did not offer any further evidence to the synthesis, having no input into the design recommendations. Climate and culture influence human perceptions of nature, so as more research is conducted in various regions, climates, and cultures, a wider range of data will contribute toward more effective biophilic design frameworks.

A previous study by the authors focused on nonclinical therapeutic environments in the United Kingdom ( Tekin et al., 2021 , 2022 ), and identified other key biophilic design parameters, such as curiosity and sense of belonging, which were expected to be encountered in this review too. However, the discussed papers did not include any reference to them in the design of clinical environments. We suggest this should be further explored. Lastly, a rigorous design framework should be benchmarked against objective scientific data and qualitative primary data about the impact of biophilic design on humans. This analysis of each of the biophilic design parameters is currently being researched by the authors through a thorough literature review and a mix of qualitative methods, which will provide a holistic discussion and further complement guidance.

Implications for Practice

  • The provision of a clear, specific, and contextual use of biophilic design can more effectively inform design and research of therapeutic environments.
  • The research shows that the effective use of biophilic design parameters and their corresponding design interventions depends on the needs of the user (inpatients, outpatients, and staff).
  • The identification and ranking of biophilic design parameters relevant to healing environments in accordance with each type of user is a crucial step toward the effective use of natural elements for therapeutic purposes.
  • A compilation of up-to-date design interventions and environmental features connected to biophilic design parameters is needed to inform a revised theoretical framework, policy and design guidelines.

Authors’ Note: The work presented in this article is part of a PhD study, funded by the Turkish Ministry of National Education, at the University of Liverpool.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Turkish Ministry of National Education.

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Biophilic Design in the Built Environment to Improve Well-Being: A Systematic Review of Practices

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2018, Journal of Urban Research

The built environment is the man-made space including our cities, neighbourhoods, offices, and homes where people live, work, and recreate daily. Several recent research studies have devoted considerable attention to how our built environment affects our health, well-being, and quality of life. The idea of this paper stemmed from a conversation with architecture students after a lecture on healing landscapes. They have been asked to take a photo of the view out of the windows of their rooms for the following week discussion. The discussion mainly focused on why viewing nature is more favourable and advantageous than viewing buildings. The answer to this question is 'biophilia', defined as the inherent human inclination to affiliate with nature. Biophilic design-an extension of biophilia-is an innovative way of design that strives to foster a deep connection with nature in places where we live, work, and learn to induce well-being effects. The present paper seeks to systematically review and address the current practices of biophilic design in interior spaces where people spend most of their time. This paper situates the emerging concept of biophilic interior design and concludes by reflecting upon a conceptual model that enriches and sustains the human-nature connection.

Related Papers

Bettina Bolten

Biophilic Design is an applied science that takes into account the most recent findings on the relationship between Man and Nature to render artificial spaces more coherent with innate human biophilia. It is well known that the application of Biophilic Design reduces stress, stimulates creativity and clear thinking, improves physical and psychological well-being and accelerates healing. Considering the relentless process of global urbanization, these benefits will become increasingly important in the design of our urban spaces, architecture and interiors. The aim of the present study is to develop a conceptual framework for Biophilic Design, reducing the gap between scientific research and its translation into functional applications.

biophilic design research paper pdf

International Journal for Research in Applied Science & Engineering Technology (IJRASET)

IJRASET Publication

When building a structure, physical well-being, comfort, and emotional well-being are all important factors to consider. We typically neglect nature throughout the design process. For nature, there is no other option. As a result, it's crucial to think about while building a structure. In reaction to external stimuli, humans have evolved behavioral processes and problem-solving mechanisms. In this situation, architecture has complete influence over a location's character and stimulus production. The Biophilic Hypothesis argues that physical, mental, and intellectual stimulation is well-planned and delivered to the environment. The impact of biophilic design on employee health and well-being in the workplace is investigated in this study, which presents a unified paradigm for biophilic space design implementation.

Ana Karinna Hidalgo

Well-being in cities can be addressed from the perspective of multiple disciplines. Urban design can contribute to creating built environments within nature with tangible elements to provide psychological restoration that releases stress and mental fatigue. To do so, many design approaches, such as biophilic design, biomimicry, and eco-cities can make a contribution to this topic. This paper is focused on biophilic design as an urban design approach aimed at understanding connections between natural and built environments in relation to psychological restoration. Important inputs from environmental psychology and public health are also considered to understand people’s responses to different natural and built environments. This paper consists of an extensive literature review of these disciplines and approaches in order to provide designers with elements to be considered for the design of restorative environments. These elements may include natural water features, natural light and colors, vegetation, and well-designed buildings to improve people’s well-being.

EVELYN GYASI

Evelyn Gyasi

There are various biophilic strategies that can be used by designers who have dedicated themselves to creating spaces for health and well-being. However, out of these numerous strategies, this essay discusses just 14 evidence-based strategies that can easily be used in any small or big project. This research has helped with understanding the need to take design strategies to another level by specializing in creating spaces for psychological and physiological well-being. Out of these 14 strategies, I have settled on and summarised six biophilic concepts shared by Sami Meira (2022) I have named 6 biophilic ‘pocket’ strategies that can be used in creating public/client awareness. These six biophilic strategies are. Environmental elements: Natural forms: Natural Patterns: Light and space: Space relationship: Evolved human-nature relationship

IRJET Journal

Physical wellness, comfort and mental wellbeing are important factor in designing a built-form. We often neglect nature in process of design. Nature has no substitute. So, it is very important to consider while designing a building. Humans have evolved their behavioural mechanism & problem-solving tactics responding to the stimulus from the surrounding spaces. Architecture, here, has an infinite power to dictate the character and stimuli generation of a space. This stimulus to be positively conceived and delivered physically, psychologically and intellectually to the surroundings, is the core of the Biophilic Hypothesis. This paper discusses the impact of biophilic design on human health and well-being and presents a unified framework for its application in the design of biophilic spaces.

International Transaction Journal of Engineering, Management, & Applied Sciences & Technologies

Assistant Professor Dr. Chro Hama Radha

Biophilic design has contributed to creating built environments within a taste of nature. The tangible features offer the occupants psychological restoration, releasing stress and mental fatigue. To achieve this, previous researchers have found biophilic design amongst a list of many other design approaches to have the potential to contribute to this topic. This research aimed to examine the biophilic design practices in the current built environment in public buildings, homes, and workplaces. The study, therefore, employed a systematic review method alongside a narrative synthesis approach. In this regard, essential inputs from a body of research on the impact of biophilic design on psychology and public health were considered. The research found that elements such as natural daylight, ventilation, and living architecture have been used to develop well-designed buildings capable of improving users' health and well-being. To achieve the status of a restorative-built environment, the study suggests that designers must provide natural elements such as forest-like landscapes, natural water features, and natural light.

Weijie Zhong

In Brebbia, C. (Ed), Sustainable Development IV, WIT Press.

Maibritt Pedersen Zari

A growing amount of architectural discourse explores analogies between ecosystems and living organisms, and architectural design that increases the capacity for regeneration. This is referred to here as bio-inspired design. This paper examines the relationship between biophilic and biomimetic approaches to architectural design as two aspects of bio-inspired design. The theory that bio-inspired design is inherently linked in the creation of regenerative architecture, able to increase capacity for self repair in both living ecosystems and the human psyche is examined. Intersections, or mutualisms between design to improve the wellbeing of ecosystems and design to improve human wellbeing, such as biomimicry and biophilia, are analysed and may illustrate the key aspects of bio-inspired design that could contribute to regenerative design. The implications of such an approach are discussed, and the scientific basis of such a process is investigated.

Margherita Pasini

This brief communication wants to draw greater attention to the role of physical environment in the psychological restoration process. Given the benefits deriving from contact with Nature, urban designers should also attend the human need for psychological restoration. According to the Attention Restoration Theory, performance, mood and wellbeing benefit from exposure to environments attracting effortless involuntary attention and demanding little voluntary attention; this process called fascination, mostly occurs in natural environments though our exploratory studies showed that also urban settings/buildings can be high on fascination. Using knowledge of our affinity for Nature, experiences of wellbeing can also be generated through the environments we create (biophilic architecture). Fascination with Nature is derived not only from natural elements, but also from the qualities and attributes of Nature people find appealing and aesthetically pleasing when reproduced in the built en...

International Journal for Research in Applied Science & Engineering Technology (IJRASET)

Nature' and biophilic design have drawn a lot of attention in architecture over the past 10 years, particularly in reaction to the mounting environmental problems. Regarding how to conceptualise and address "nature" in practise and study, there are still debates and unanswered concerns. In order to analyse biophilic design as a theoretical framework to understand "nature" in architecture, this study reviews the relevant literature. The ensuing queries are addressed: (1) How did the idea of "biophilic design" come about, and what does it mean? (2) How might biophilic design advance the aims of sustainable construction? (3) What are the main biophilic design principles? The basic frameworks of biophilic design are identified, contrasted, and their essential components are explained in this review. Then, we examine the advantages (such as improved health and wellbeing, The sustainable Development Goals provide as a framework for the role of biophilic design in attaining sustainability. These goals focus on productivity, biodiversity, and circularity. The findings show that biophilic design, which encompasses various aspects of nature, including physical, sensory, conceptual, morphological, material, and spiritual nature, is more complicated and richer than simply using vegetation in buildings. Moreover, knowledge gaps are noted to spur further investigation and critical evaluations of biophilic design techniques.

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  • Published: 17 December 2021

Activating biophilic design patterns as a sustainable landscape approach

  • Sahar Ismail Mohamed Abdel Hady   ORCID: orcid.org/0000-0001-9688-9980 1  

Journal of Engineering and Applied Science volume  68 , Article number:  46 ( 2021 ) Cite this article

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Biophilic design elements are found around us in many landscape elements while we do not perceive them as biophilic design patterns. By developing our understanding of biophilic design as a phenomenon, we could discover simple ways to utilize landscape elements and transform them into a good biophilic design that might have positive impacts on a user’s health and well-being. Activating existing biophilic elements as an approach to a sustainable landscape has not been studied yet. Therefore, we rather analyse some international case studies in order to understand how biophilic design patterns can be implemented and see their different forms. Later, we will also go through an Egyptian biophilic design pattern case study and implement it to reach a sustainable landscape model. To summarize, the purpose of this study is to present a new sustainable landscape approach by activating biophilic design patterns in order to increase landscape efficiency.

Introduction

A “love of life or living systems” is biophilia (Aristotle). It is our intrinsic human connection to the natural world. This simple relationship may often seem comprehensive but unfortunately has been lost through the urban world of technology and industrial architecture. In order to get a natural environment for us to live, function, and learn, we should consider biophilic design for this matter. We are unconsciously reconnecting by integrating nature into interior or architectural design, integrating the great nature into our environment. An environment without nature can badly impact health, efficiency, and well-being.

Biophilic design can incorporate nature into our environment and designs places of inspiration and regeneration that bind humans with their environment. Although it is hard to find a space that can accommodate all biophilic design elements, many contributory elements can enhance the space and well-being. It is more than just adding a plant or two to the space! [ 10 ]. A positive effect can be generated by filtered sunlight, planting, green walls, water features, natural textures and materials, and views of nature. If simply looking at nature can inspire you, imagine how living in an environment integrated with elements from nature can do? As a result, an important question comes up “Could we use the biophilic design patterns to increase the landscape efficiency?” And if so, how could it be implemented in existing landscapes to set up a sustainable approach in the Egyptian cases.

It is imperative to apply the concept of biophilic design not only in new designs but also within existing landscape sites. To our knowledge, no study has introduced biophilic design patterns as an approach to increase the efficiency of an existing site and create a sustainable landscape. Therefore, we will explore what is biophilia and biophilic design on a broad scale, then narrowing them into different biophilic design patterns with different landscape design forms. Then, we will study different international case studies and analyse all forms of biophilic patterns. Then, finally, we will repeat the same scenario but to an Egyptian case study, to examine the presence of biophilic patterns and suggest modifications in the proposed design, so we can come out with an efficient, integrated, and sustainable approach using biophilic design.

In this study, the concept of biophilic design was further investigated and studied, concerning its positive contribution to health and well-being. Based on profound theoretical and analytical studies, the principles of biophilic landscape design patterns were concluded. Furthermore, the efficiency of the concluded patterns was tested in a practical case study in the Egyptian urban context.

Sustainable landscape, biophilia, and biophilic design

Themes from nature had been always seen in early human structures, such as cave paintings and statues, which shows that biophilic design is not a new phenomenon. In 1865, the landscape architect Frederick Law Olmsted argued that nature scenery influences the human mind over the body and refreshes the whole system. Later, in the nineteenth century, there was a campaign to create large public parks in order to help in stress reduction and improve health [ 10 ].

The beginning of the term “Biophilia” was in 1964 by the social psychologist Eric Fromm who defined it as “Biophilia is the passionate love of life and of all that is alive” [ 22 ]. Later, in 1984, the biologist Edward Wilson contributed in making the term Biophilia more common [ 28 ].

A conference was conducted in 2004 to discuss translating the biophilia into the built environment design; a book was then released sequentially (Eds., [ 1 ]). The book discussed the ways of creating a biophilic experience and summed up the user experience into three main categories: nature in the space, natural analogues, and nature of the space.

The recent decade has shown an increase in the research and practice of biophilic design that it has been included in the green building standards. Some of the most popular texts that have been published on this topic are mentioned hereinafter: Last Child in the Woods [ 23 ], Healing Spaces [ 24 ], The Shape of Green [ 25 ], Your Brain on Nature [ 26 ], The Economics of Biophilia [ 27 ], and, 14 Patterns of Biophilic Design [ 10 ].

Biophilia definitions

Biophilia as a concept promoted the idea that connection with nature plays an essential role in physical and mental health, and this has been proven in many studies [ 16 ,  29 ] In modern society, it also plays a significant role in social and family relationships [ 30 ]. It is also useful in highly dense urban areas office workers [ 31 ] and helps in stress reduction for university students and staff [ 32 ]. Furthermore, a study proved the inherent psychological and physiological link between humans and nature and evaluated the research supporting the social, environmental, and economic benefits of biophilia [ 33 ].

The term biophilia was defined as “The inherent human inclination to affiliate with nature that even in the modern world continues to be critical to people’s physical and mental health and well-being [ 34 ,  35 ,  36 , 37 ].

Terrapin also defined the term biophilia as “Humankind’s innate biological connection with nature” [ 10 ]. He also added: “It helps explain why crackling fires and crashing waves captivate us; why a garden view can enhance our creativity; why shadows and heights instil fascination and fear; and why animal companionship and strolling through a park have restorative, healing effects.” [ 10 ].

Biophilia was lastly defined as “The innate, genetically determined affiliation of human beings to nature and other living organisms.” (Biophilic Design Guidebook, June 2018).

Elements, principles, and experience of biophilic design

Biophilic design dimensions were first introduced in the book ‘Biophilic Design: The Theory, Science and Practice of Bringing Buildings to Life’ [ 1 ]. According to the book, there are two basic dimensions of biophilic design; the first dimension is the organic or naturalistic dimension, which represents the shapes and forms. The becond basic dimension is the place-based or vernacular dimension, which represents the buildings and landscapes connected to the culture and ecology of the local environment [ 21 ].

These two basic dimensions of biophilic design were then related to six biophilic design elements. Environmental features, natural shapes and forms, natural patterns and processes, light and space, place-based relationships, and evolved human-nature relationships are the main biophilic desig n elements [ 1 ] . Table 1 shows the different attributes of each element.

Later, in 2015, the principles of biophilic design were introduced in the book ‘The Practice of Biophilic Design’ [ 38 ]. These principles were repeated engagement with nature, focusing on human adaptations to the natural world, encouraging emotional attachment to specific places, promoting positive interactions between people and nature, and encouraging interconnected and incorporated architecture solutions. Also, the experience of nature was grouped into three types: direct experience of nature, indirect experience of nature, and the experience of space and place [ 38 ].

Categories and patterns of biophilic design

Biophilic design could be summed up into 3 main categories; each category encompasses some patterns. The main categories are as follows: nature in the space, natural analogues, and nature of the space [ 10 ].

The first category Nature in the Space includes all the direct, physical, and ephemeral existence of nature in a place. The influence of the nature in the space experience can be achieved through three main factors which are diversity, movement, and multi-sensory interactions, for instance Some flowerbeds and bird feeders ; this category consists of seven biophilic design patterns and they are visual connection with nature, non- visual connection with nature, non-rhythmic sensory stimuli, thermal & airflow variability, presence of water, dynamic & diffuse light, and connection with natural systems [ 10 ]

The second category Natural Analogues includes indirect and non-living nature evocation. A strong result can be gotten if we can have accurate information, common examples are wooden furniture and granite table tops, they are real if they only represent analogous of the natural state of the objects. This category consists of three patterns of biophilic design and they are biomorphic forms & patterns, material connection with nature, and complexity & order [ 10 ].

The last category Nature of the Space includes all spatial aspects which can be found in nature and it expresses our desire to see things above and beyond our instant surroundings, and explore the unknown in a safe manner. A strong experience is achieved by: deliberate and engaging spatial arrangements, combined with patterns from the two other categories: Nature in the Space and Natural Analogues . This category consists of four biophilic design patterns, they are prospect, refuge, mystery, and risk/peril [ 10 ].

Since Wilson published The Biophilia Hypothesis almost two decades ago; the biophilia term has expanded considerably and the final biophilic patterns were analysed to disclose emotional connections mentioned by Wilson.

The term “pattern” is not only related to the natural environment through psychophysiological and cognitive relationships, but it can be an independent description for three main reasons: set up clear and standardized terminology, avoid confusion, and maximize accessibility across other disciplines. Table 2 gives a brief explanation of each biophilic pattern [ 10 ].

Biophilic design application

Good biophilic design is usually drawn based on the user’s influential perspectives which can be impacted by health conditions, sociocultural norms, past experiences, and frequency and duration of experience are some of the most common examples [ 10 ].

Understanding the project’s design intent is one of the vital steps for a designer; the user’s performance needs must be precisely set up to identify the design strategies and interventions; to apply this scenario, two approaches can be used: first is to ask : What is the most biophilic space we could possibly design? Another query is to ask : How can biophilic design boost efficiency indicators that are already used by the client? [ 10 ]. Reducing stress and improving overall mood is one of the many biological responses that may occur to the design, besides other unlimited combinations of design interventions and patterns. A biophilic design’s impact on health represents great importance to managers, planners, and policy makers [ 10 ].

There is no appropriate duration when it comes to the time of exposure to a pattern; ideal duration depends upon the user and the required effect; it has been verified that health benefits could occur in a time of 5 to 20 min [ 39 ,  40 , 41 ]. When a little duration of exposure is required, a pattern is usually located along paths with high foot traffic; this helps in improving access frequency [ 10 ].

Biophilic design impact on health

Evidence of the impact of biophilia on health was shown mainly in three mind-body systems: cognitive, psychological, and physiological systems; the impact on these systems was tested and explored in various ways to understand how the environment could impact a user’s health and well-being [ 10 ]. The results showed how each pattern can affect three main categories: stress reduction, cognitive performance, and emotion, mood, and preference . All patterns had an impact on at least one category but most of them impacted two to three categories.

Framework of biophilic design patterns

Biophilic design patterns have been defined to guide and assist in the design process and the main purpose was to explain the connection between the characteristics of built and natural environments [ 10 ]. Table 3 shows the summary of each pattern’s experience, objective, design attributes, and examples.

Biophilic design patterns are very flexible and could be implemented in design using various shapes based on user-specific needs; the combination of patterns tends to increase the positive impact on health and also integrating design strategies could lead to a restorative environment for users from different cultures and demographics [ 10 ].

Case studies

When it comes to studying the different biophilic patterns in a landscape and their efficiency, we need to choose spaces that are accessible to the public and created for different types of users. In that order, we can understand if all different users receive the same experience or not.

Case 1 (Greenacre Park)

Greenacre Park is a small park that is located between tall towers in Manhattan; it consists of three different levels offering users various environmental conditions; the excellent implementation of the biophilic design patterns creates a quiet and peaceful space, which is rare in the city centre.

The site plan is divided into three different spaces using plants, water, and trellises (Fig. 1 ). A T-shaped flower bed acts as a physical divider, the water bordering the lower level and a steel trellis demarcating the raised platform. This section highlights the elevation change between the street and space levels (Fig. 1 ).

figure 1

Site plan. Source: www.terrapinbrightgreen.com

Case 2 (Paley Park)

Paley Park was the first of its kind when initially opened back in 1967; it was created right after designing the concept of very small accessible parks that are open to the general public; today, it is one of the most common parks in New York City (Fig. 2 ).

figure 2

Section. Source: www.terrapinbrightgreen.com

The way this park was designed makes it a unique space for office workers and Museum of Modern Art patrons during short breaks.

This site plan shows the honey locust trees arranged loosely to assure the casualness of the space (Fig. 3 ). A tall waterfall acts as a focal point and dominates the space. Also, the movable site furniture allows flexible seating throughout the space, which creates a dynamic series of layouts (Fig. 4 ).

figure 3

Biophilic design patterns implemented in case studies

Table 4 shows biophilic design patterns in the case studies.

Applied case study

As mentioned in the previous section, existing landscape spaces need to be accessible to the public and visited by different types of users; our case study is a commercial administrational complex that is sought by various user types; the space offers a pleasurable pedestrian experience and also a great haven during short breaks for different types of employees in the complex.

Rivulet is a fully integrated complex that is located in El Sheikh Zayed City on the main 26th of July corridor combining different categories of attractions like restaurants, cafes, shops, and gyms and also has a business hub and medical centres; the space’s unique and simple design makes it a harbour for visitors and workers during short breaks (Figs. 5 , 6 , 7 , and 8 ).

figure 5

Green wall. Source: Researcher

figure 6

Reflecting pool. Source: Researcher

figure 7

Water fountain. Source: Researcher

figure 8

Site Plan. Source: Researcher

The plan shows the green wall and water fountain that is located beside the entrance; the palm trees are arranged with fixed spaces between them; besides the reflecting pool that acts as a focal point in the space, some seat steps are provided by the water features.

The section cut through the centre of the plan showing the reflecting pool area with its deck, railings, and palm trees. It also shows the green wall (Fig. 9 ).

figure 9

Section. Source: Researcher

In order to evaluate this case study, we need to verify which patterns were achieved, and in which form and more over how we could increase its efficiency. Table 5 shows the patterns represented in the case study, with a brief on the form that was used to represent each pattern.

Results and discussion

The unrepresented patterns in the case study, lead to the absence of some important integrations of biophilic design patterns. This lowers the positive impact of design on health and reduces the effect of biophilic design overall. Table 6 shows the missing and achieved integrations between patterns in the previous case study.

The missing patterns could be implemented easily in order to achieve the integration between different patterns and increase the positive impact of the design. Referring to the case study, the missing patterns are dynamic and diffuse light and biomorphic forms and patterns.

Dynamic and diffuse light is an important pattern in order to elicit feelings of drama and mystery, time, and movement, buffered with a feeling of peace; the main goal of this pattern is to achieve an ununiformed distribution of light, but without extreme differences. This pattern could be achieved in many ways; some examples are creating shade structures, providing more shade using trees, or using simulated light distribution at night.

The aim of biomorphic forms and patterns is to use biomorphic styles and patterns in a way that creates a more visually desired atmosphere that enhances cognitive performance while helping to alleviate tension. We are more attracted to organic and biomorphic shapes, but there is a hidden scientific reason that we need to figure out and address. While biomorphic forms and patterns are not living objects, our brain recognizes that they can be represented as symbolic representations of life; this pattern could be implemented in two ways, the decor elements and the form. Some examples in decor include golden mean in fabrics, carpets and wallpaper design, window glass colour and texture, and free-standing sculptures. While in form, examples include building and furniture form, columns shaped like trees, and pathway form.

Conclusions

As explored throughout the paper, biophilic design patterns can increase the efficiency of a landscape site experience; the more varieties of the patterns are used, the more efficiency we get. This takes us back to our main research question: “Could we use the biophilic design patterns to increase the landscape efficiency?”

The research aimed to introduce a new sustainable landscape approach by activating biophilic design patterns, to increase landscape efficiency; this approach was applied to an Egyptian case study, to analyse the possibilities and results and furthermore to suggest a proposed design that activates the biophilic landscape efficiency and achieves pattern integration.

All in all, biophilic design patterns are found around us in the landscape elements of any space, even if not intended or implemented in purpose. With little modifications, some landscape designs could be transformed into an integrated sustainable biophilic design that could generate positive impacts on the users and increase the landscape efficiency. Activating our perception of biophilic design patterns could be easily achieved by increasing the types of patterns and their different forms. This would also impact the user’s health and well-being.

Availability of data and materials

All data and materials will be available upon request.

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Acknowledgements

I would like to express my very great appreciation for the valuable assistance given by Dr. Hesham Mohamed El-Barmelgy. I also wish to acknowledge the help provided by Eng. Shorouk Ahmed Taha.

This study had no funding from any resource.

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Ass. Prof. Sahar Ismail Mohamed Abdel hady

Cairo University, Faculty of Regional and Urban Planning, Department of Urban Design

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Certificate of A Consultant Engineer, Engineering Branch (Architecture), the Field of (Urban Design), 1/10/2018.

Assistant Professor, Faculty of Regional and Urban Planning, Department of Urban Design, 2018.

PHD. Landscape Engineering, Cairo University, Egypt, 2011.

M.sc, Urban Engineering, Cairo University, Egypt, 2003.

B.sc, Urban/Region Planning, Cairo University, Egypt, 1989.

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Hady, S.I.M.A. Activating biophilic design patterns as a sustainable landscape approach. J. Eng. Appl. Sci. 68 , 46 (2021). https://doi.org/10.1186/s44147-021-00031-x

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