Hospital in a Garden by Timothy Beatley

Khoo Teck Puah Hospital

Hospital in a Garden
Tim Beatley, Ever Green

Anyone who has had to spend time in a hospital knows well how discouraging and dismal hospital environments tend to be: they are places to be endured, and places that are the settings and backdrops for some of the most difficult times in our lives. At a point when we are most distressed, both as patients, and the parents and family of patients, the physical settings of these places further compounds the stress. They are often noisy places of artificial lights, machines that are buzzing and beeping (and typically one or more blaring televisions) and generally spaces that are at once sterile and depressing. But things are beginning to change and there has been emerging a very positive trend of designing hospitals and health facilities to take full advantage of the healing powers of nature.

We have known for years that the design of hospitals and medical facilities can make a profound difference in healing and recovery. Roger Ulrich’s study of patient recovery from gall bladder surgery is a key reference point. He found that patients in rooms with views of trees and nature (compared with those with views of a parking lot) recovered more quickly and needed less post-operative medication.

Yet, few hospitals have been designed to take advantage of these healing powers, though that has been changing in recent years. One of the most powerful recent examples can be found in Singapore, where a new hospital is not only setting new standards for integrating nature, but helping to profoundly re-define the very nature of healing spaces. I had the chance to visit this remarkable facility earlier this year and to visit with Mr. Liat Teng Lit, the CEO of the Khoo Teck Puat Hospital (KTPH), who passionately runs what is perhaps the greenest, most biophilic hospital in the world.


What makes this hospital so special? It is truly designed to be a hospital in a garden: there are plants and greenery everywhere, and many of the patients’ windows look down on a large green interior complete with waterfall and meandering stream complete with native fish. There are extensive gardens found on different levels throughout the facility, planter boxes in windows and along balconies, and even a large urban farm on one the rooftops, compete with 140 fruit trees. And the hospital is embedded in the neighborhood, chairs and tables serving as destination and gathering space for nearby residents.

Khoo Teck Puah Hospital

From the beginning, Liat tells me, the architects were given an unusual charge: this should be a building where when patients enter their blood pressure and heart rates go down, not up!

Restoring Patient and Planet

And the KTPH aims to do even, to serve essentially as a biological ark, restoring not just the wellbeing of patients but the planet as a whole. This is an unusual goal for any building, nevertheless a hospital. As Liat explains: “Just as the rest of the world is chopping down all the rain forest, we declare ourselves as the Noah’s Ark of tropical rain forests. That means we consciously with every single project bring back a few species of tropical rain forest.“ This hospital explicitly seeks to provide safe harbor for the amazing array of biodiversity found on this tropical island city. Indeed, Liat and his staff judge the success of KTPH in part by the numbers of butterflies and birds seen in and around the hospital, and there are prominent wall placards that track the running totals of species sighted. Even the stream and water feature is a chance to support native fauna, with some 92 native species of fishes found there (and non-native koi not allowed). There many other ecological features of the facility, beyond the nature, including extensive use of photovoltaics and a complex energy strategy that includes sunshades and natural ventilation.

There are few hospitals in the U.S. to compare with KTPH, but this is changing and there is here a similar trend in the direction of integrating nature into these facilities, and ensuring that natural daylight, views of outside nature, and healing gardens and spaces are abundant and central.

One impressive example can be seen in the Laguna Honda hospital in San Francisco. This major renovation of an older rehabilitation hospital, owned and operated by the City of San Francisco, incorporates many green features. The first LEED-certified hospital in California, it is a refreshing change from most long-stay facilities of this kind. Two (and eventually three) multistory residential towers are linked by a new modern building that serves as a “downtown and main street” for residents. The residential towers, and the facility’s 800 beds, are creatively organized to overcome social isolation and to foster a sense of community and connectedness. Each wing is designed as a “household,” with living room, dining room, and individual bedrooms, while each floor (comprised of four wings) functions as a “neighborhood,” providing common activity spaces, and common kitchen and eating areas.

Laguna Honda Gardens

There are nine healing gardens around the hospital. And there are greenhouses and raised beds gardens. There is even a small farm, with goats and rabbits. The buildings are surrounded by large heritage trees, that are seen from windows. Perhaps the most impressive feature is the ubiquitous daylight, and the large windows providing extensive views of the greenery and the surrounding green spaces in this expansive 58 acre campus in the heart of San Francisco. All patients have their own window and all windows can be opened by patients, providing a level of personal control and comfort. As project architect Tyler Krehlik, who showed me around this facility, notes, “Even if you’re sharing a room, there’s never a person between you and a window.” The design of the buildings with an emphasis on slender, long wings, makes this possible. And there is greenery inside the building, including a series of green walls on the main street, and plantings and green ledges that also seem to pull nature into the building.

Laguna Honda Main Street Lobby

The main floor of this linking building is designed as a main street and does seem to function as such. Interior lighting is designed to mimic street lamps, and there are designed focal points and nodes along the street where residents can stop and gaze or talk. The uses along this main street are many and include a branch of the San Francisco public library (with extensive computer terminals), a bank, convenience store, and a movie theatre.

The signage, Krehlik tells me, is designed to look and function like street signs, “trying to create that language of being in a town center.” And it seems to work well. On the day I visited there was lots of activity—an art class underway, residents on computers and reading books in the library, indeed it did not feel very much like a hospital at all.

And there is extensive artwork throughout the hospital. Much of it functional, such as the undulating and visually distinctive handrails that run the length of the hospital’s main street (and are cool to the touch). And there are spectacular stain glass panels on one end, designed by artist Arlen Huang, and that serve to generate beautiful outside life along the hallway. And the art work serves to identify key points, providing signage for the hair salon or bank, for instance. The art work also helps with wayfinding and memory (important as the hospital is home to patients with various degrees of dementia), and each household and neighborhood has its own distinctive artwork (and each resident has their own memory box at their door).

The San Francisco and Singapore examples are indicative of a larger, positive trend in re-thinking the health and healing dimensions of the built environment. We must increasingly recognize that we can and must enlist nature and art in the healing process, and that creating uplifting and restorative environments may be as important as the conventional tools of medicine in caring for the ill.