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A Performance Based Perspective on Health and Wellness


As we enter quarter four of 2020 amidst the very difficult and stressful pandemic context that we’ve all been mired in since March, it seems appropriate to reflect upon the ever-evolving nature of our work in the healthcare sector. More specifically, we want to share how our work is adapting to focus and perform at the intersection of health and wellness – two interrelated terms, but both top of mind for our communities and for our healthcare practice, particularly within this public health crisis.

Health and Wellness Defined
Health refers to an individual’s physical, mental, and social state and is typically institutionally delivered and supported, i.e. at a hospital facility and/or campus. Historically, our work in this sector has been site specific and focused upon supporting positive health outcomes for patients, their families, and the caregivers/essential workers (a new COVID lexicon). Wellness refers to the state of living a healthy lifestyle. Wellness is typically individually driven, and community supported through many of our other community-based sectors of work – sectors which are more commonly becoming interconnected with healthcare facilities, such as parks. The public realm is oftentimes the connective tissue.

Designing for Performance
The goals for success that we seek in both health and wellness are framed in Landscape Performance, which, as defined by the LAF is the measure of the effectiveness with which landscape solutions fulfill their intended purpose and contribute to sustainability. Landscape Performance in healthcare evolved from the advent of evidence-based design (EBD), which was popularized by a seminal study by Roger Ulrich in 1984 that demonstrated the positive impacts of a window view of nature upon patient recovery. EBD has continued to expand through research the relationships between design of the physical environment and improved health outcomes, and Landscape Performance continues to evolve to support these trends.

All work that we share here, beginning with Dell Children’s Hospital in Austin, has sought to achieve specific Landscape Performance goals and contribute to sustainability through their own site specific and context sensitive approaches. Dell Children’s is the first LEED Platinum children’s hospital in the world and has achieved multiple performative health and wellness outcomes since its opening in 2007, including:

    • Multi-level on structure and open-air garden courts and terraces embedded within the building footprint allow light to penetrate shallow building wings while facilitating proximate fresh air circulation more easily to the HVAC systems. EBD has demonstrated the positive impacts of both upon patient recovery.
    • Multiple therapeutic needs, such as occupational therapy and physical therapy, were accommodated in a series of exterior spaces strategically located to directly correlate with interior spaces, and
    • Within the broader Mueller development context, the hospital was planned to evolve over multiple phases to become a wellness hub for a diverse mixed-use community.

At St. Mary’s Children’s Hospital in Bayside, New York, TBG expanded upon lessons learned at Dell Children’s to more substantively engage therapy staff and truly adhere to the placemaking principle of “Form Supports Function” (Project for Public Spaces – 11 Principles). Multiple garden spaces were created and interconnected to simulate through a child’s eyes real-world environments, allowing therapists to work with and teach children requiring varying levels of support and adaptation. The spaces were dynamically varied to accommodate 1-2 individuals comfortably or larger gatherings or performances. Environmentally, all the garden spaces were ‘knitted’ within and amongst existing trees, providing visual therapeutic benefits for those within adjacent interior spaces as well as beauty and comfort for those out in and enjoying the gardens. The extent of existing canopies also provided significant carbon sink capacity. Color was used strategically extensively to support and enliven the children’s experiences and provide the calming, soothing tendencies that color can offer for a child, family member or caregiver.

Our Lady of the Lake (OLOL) Children’s Hospital in Baton Rouge, Louisiana represented a conscious effort to demonstrate for all patients and visitors the dynamic, indigenous historic and environmental tapestry of the region, and to create an authentic, soothing, stress reducing series of spaces. All manner of flora and fauna of the region are whimsically represented, including child’s scale owl, pelican, and woodpecker playhouses. The natural ecology of the area – winding rivers, rolling hills and verdant marshes – were represented in a child’s procession throughout the spaces. And all contributed to landscape performance outcomes, including social (through active therapy and scaled outdoor gatherings), environmental (through water quality, heat island mitigation, low water consumption) and economic (through revenue generating opportunities and operational/cost savings benefits).

Toward a More Sustainable Future
Two recent TBG healthcare projects, Covenant Medical Center in Lubbock, Texas and THR Frisco in Frisco, Texas, represent a growing trend to expand upon traditional, site contained EBD/Landscape Performance noted above and consciously support community wellness through direct and indirect interactions and relationships with the communities in which they exist.

Covenant Medical Center is in Lubbock in far west Texas, and regionally known as the Hub City. Five freeways connect Lubbock with the expansive and desolate west Texas region as well as parts of neighboring New Mexico, making the city appear as the hub of a wagon wheel. Covenant Medical Center has served this vast area since 1918 when it constructed its first 25-bed facility. Since then it has grown to be a regional ‘powerhouse’ and pillar of the community. Given its long history in the region, Covenant Medical Center recognized the significance of its relationship with the community and hired IDEO to conceive of an updated brand approach that best represented the hospital within this unique physical and cultural context. Aspects of hospitality, representing a warm west Texas embrace, were introduced to open the facilities arms to the community both upon approach and at arrival. And the harsh, west Texas environment, with endless plains and expansive agricultural assets, though desolate and foreboding to some is uniquely endearing to those born and raised here. Those characteristics were purposely integrated into the site for the hospital, using indigenous plant materials and demonstrating sustainable practices through bio-filtration and water catchment – both in recognition of Lubbock’s lack of underground storm drainage.

TBG’s site planning for the CMC campus sought to expand the warm welcome in all directions to connect with the greater community as well as the Texas Tech campus. Both pedestrian and vehicular approaches were emphasized through hierarchical use of paving patterns, planting, signage and lighting. All supported the EBD research that emphasized the importance of way finding in reducing stress and anxiety for patients and visitors. And for essential workers, an exclusive outdoor garden court was provided to support the need for a stress reducing respite and reinforce employee retention practices for the facility. During our current pandemic, this has proved to be a particularly critical campus offering.

THR Frisco is the newest addition to Texas Health Resources network of community-based health care campuses located around the Dallas/Fort Worth metroplex. Though it fronts upon the heavily trafficked Dallas North Tollway to the west, the design team’s intent was to support THR’s community-based wellness initiatives through purposeful, physical design interactions with the adjacent neighborhoods to the immediate north, east and south. Strategies and associated performance goals with which to achieve these initiatives include:

    • Extensive trail system connections around and through the campus provide walkable access for adjacent neighborhoods and actively expands upon campus, and community programming opportunities, supporting the hospitals goal to actively engage with the community.
    • Environmental context was celebrated through sensitive acknowledgement of existing patterns of drainage and soil associations, and introduction of bio-filtration and bio-swale complexes throughout the site, and
    • Creative representation of the prior creek character on the property were represented through selection of native stone and plant materials.

These five projects, both for children and for the general public, represent the evolution of our practice in healthcare as well as the expansion of our efforts to engage the mission of these facilities with the broader communities that they serve. Each has integrated key aspects of hospitality design, including a warm, welcome, intuitive approach/arrival and an authentic representation of the culture and context of the communities in which they exist. During COVID-19, the initiatives applied for each have certainly served to improve upon the general wellness of the community by providing quality natural and accessible open space. They have also served the essential worker community by providing needed respite space and active stress reduction strategies. And lastly, they accommodate evidence-based positive outcomes for patients and accessible, proximate space for families – even when restricted from interior spaces deemed off-limits during the pandemic.

As we all long for a post-COVID world and speculate on what a new normal will look like when we get there, we can learn many lessons from the performance centric, typically evidence-based world of healthcare, and we can apply those lessons to expand beneficial health and wellness advantages far beyond the bounds of the healthcare campus to the benefit of the greater communities in which they serve and we all live and work.