CHMhealingENVIRONMENT
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This document discusses creating healing environments. It notes that a healing environment stimulates and supports the inherent healing capacities of participants, their relationships, and surroundings. Various elements that can contribute to a healing environment are mentioned, including nature, spirituality, balance, distraction, colors, and hope. The document also references experts in the field and provides general encouragement.
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CHMhealingENVIRONMENT
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- 7. creating a healing ENVIRONMENT september 12.12 a healingENVIRONMENT …creates "conditions that stimulate and support the inherent healing capacities of the participants, their relationships, and their surroundings1." 1Jonas W, Chez R, et al. Investigating the Impact of Optimal Healing Environments. Alternative Therapies in Health & Medicine. 2003;9(1):58-64.
- 8. creating a healing ENVIRONMENT september 12.12
- 9. creating a healing ENVIRONMENT september 12.12 greatPYRAMIDS
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- 21. creating a healing ENVIRONMENT september 12.12 pebblePROJECT
- 22. creating a healing ENVIRONMENT september 12.12 evidenceBASED C.H.E.R. - Samueli
- 23. creating a healing ENVIRONMENT september 12.12 contentEXPERTS roger ULRICH jain MALKIN
- 24. creating a healing ENVIRONMENT september 12.12 fengSHUI
- 25. creating a healing ENVIRONMENT september 12.12 yinYANG
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- 67. creating a healing ENVIRONMENT september 12.12 thankYOU! Q -- A
Editor's Notes
- Good Evening. Thank you for having me join you today. My name is Choy Leow & I direct the design & construction department for Allina Health. It will be my 10th year with the system this coming March. This evening I am gonna keep things simple as I address what’s considered to be, among many others, a key element of our, & yours, healthcare services delivery: A Healing Environment.
- Before I continue, let me first take a moment to acknowledge where many of the material that you’ll see was drawn from. Being a visual person in what I do as an architect, and I figure many, if not all of you, deal with data day in day out, so tonight’s presentation will be somewhat be data-light & visual-strong. And I hope you will find my selections will work well with the perspectives that I’d be sharing with you.
- To begin with, a little more on my background. I am often asked, “So, where are you from?” To which I usually say, “Oh, I’m from Moose Lake, MN.” So far I have not been able to pull that off beyond the quizzical looks that you have now…
- My wife & I were born in Malaysia so that made us Malaysian by birth. We grew up in the capital city home to a pair of Asia’s tallest towers. How many of you have seen these towers in person? Our grandparents migrated from southern China to Malaysia in the early 1900’s so that makes us Chinese by ethnicity. And by choice we are Americans. With two daughters pledged into two different sororities, we like to think we also have a dash of Greek in us. .
- Anyway, I went from those towers to these towers…It was the fall of 1981 when I landed in Des Moines, IA. Still remember vividly the aroma of fresh air, or at least I thought it was fresh air back then…as we stepped out of the plane, which at that time, you still have to deplane by way of those portable stairs and either walk or be ferried to the terminal.
- I went to school at Iowa State. Any Cyclones in the room? Any Hawkeyes? Great win for the Clones Saturday at Kinnick! Any Panthers? As I indicated earlier, I’m an architect so that only means my degree was in architecture, but I also have a minor in gerontology. It was a decision made in honor of my grandmother, who passed on during my junior year at Iowa State. Worried that the news will affect my studies, my parents chose not to tell me till a couple of weeks have passed. Later as I recovered from grieving the loss, I decided to pursue the gerontology minor to celebrate my grandmother’s life. She taught me lots. In retrospect, I consider the decision to do so as a way I sought to heal myself. Iowa State, for all intent & purposes, was the healing environment in providing the option & possibility for me to do so. So, what exactly is a healing environment?
- This definition from a 2003 issue of Alternative Therapies in Health & Medicine states that… Healing environments can also be created at home, work, and other settings. Hospitals started incorporating elements of healing environments into patient care over two decades ago. The healing — and the specifics of an optimal healing environment in which it occurs both internally and externally — is as individual as the individual. The ideal healing environment include the following components and others: Kindness, Presence, Touch, Aromatherapy, Sounds & Sights. These elements provide a multitude of options for healthcare architects to create healing environments that support health and healing that resonate with patients, families & care providers. Healing environments can also stimulate and embrace beauty, calm, love, joy, a healthy shift in focus, transformation of the thinking mind to a feeling body, movement of physical tension to a more relaxed state, reminders of past experiences, centering and grounding, and much more. These components offer up a broad array of creative opportunities with which healthcare architects, interior designers & planners work with in helping healthcare organization develop a friendlier, welcoming & conducive healing environment.
- And at Abbott Northwestern Hospital where I began my career with Allina Health, the intention to create a healing environment is guided by these healing quadrants that serve as a reminder that a complete holistic healing environment touches all aspects of spaces & relationships around us.
- Tonight, I’ve been asked to share with you how I go about creating Allina’s version of “a healing environment”. To do so, I thought I’d take you through a few visuals ranging from iconic architecture to simple toys, to help drive home a couple of principles which I believe are key in the effort to create such a healing environment for our patients. To begin, you are looking at the great pyramids of Khufu. How many of you have seen these pyramids in person? The one in the middle is 756 feet long on each side, 450 feet high and is composed of over 2 million blocks of stone, each averaging 2 1/2 tons. Despite the makers' limited surveying tools, the whole structure is stacked perfectly to align with the cardinal points of the compass & the purpose of the structure was to serve as a tomb for the Pharaoh. And as mentioned, these great pyramids, as well as five more examples that I’ll be sharing with you, all share two primary principles of how they are built or created: by stacking & aligning. Why these principles are key in creating a healing environment in my perspective will hopefully become apparent at the conclusion of my presentation.
- Next is Stonehenge. How many of you have seen the Stonehenge in person? Stonehenge is Britain's greatest national icon, symbolizing mystery, power and endurance. The awe-inspiring circle of stone columns with equally substantial stone beams stacked on top is speculated to be that of a temple made for the worship of ancient gods. It has been called an astronomical observatory for aligning significant events on the prehistoric calendar. Others claim that it was a sacred site for the burial of high-ranking citizens from the societies of long ago.
- This series of pictures are examples of Chinese “dou gong”. Dou Gong is a bracketing system unique to Chinese architecture. Chinese builders & craftsmen use this bracket system to solve four problems that arise as they construct larger buildings: how to reduce beam spans, how to brace wall sections above columns, how to support wider eaves, and how to strengthen the overall roof frame. All of these building elements are aligned by using the intricate system of stacked dou gong brackets to transmit the building weight to its footings, providing a sound & strong foundation & helping preserve a long lasting legacy to over 5000 years of Chinese architecture. The Chinese pavilion in the 2010 World Expo in Shanghai was inspired by the dou gong system. And how many of you made it to the expo & seen this pavilion?
- Then there are these log cabins: classical structures of simple stacked rows of hewed logs, aligned at the corners to form efficient & functional spaces that have come to symbolized the rustic lifestyles of idyllic country sides and close proximity to nature. For many of us, to own a log cabin up north or by any lake, is certainly a desired healing retreat. How many of you own a log cabin?
- And here is another example of simple stacking & aligning: an Inukshuk, an ancient cultural icon and practical tool of the Inuit people . The inukshuk is a stack of stones traditionally used by the Inuit of the Arctic to mark anything from a hunting spot to a food cache. These unique stone figures can be found throughout the circumpolar world. Inukshuk means "in the likeness of a human" in the Inuit language. They are created of unworked stones and are used by the Inuit for communication and survival. The Inuit used these stacked stones to indicate that “someone was here" with the intention to help align fellow travelers/hunters to stay on the right path. How many of you have seen an Inukshuk? Or tried creating one yourself?
- And then there is Jenga, a delightful but challenging game played with 54 wooden blocks. It has 18 levels of three blocks stacked & aligned with each other along their side and perpendicular to the previous level. The objective, is to simply keep the pieces stacked & aligned. The game ends when the tower falls with he winner being the last person to successfully remove and place a block. Those of us who has played this game can attest to how it draws you in for as long as you keep it upright, offering sessions of unbridled focused fun. So for now, I’d ask that you file the principles of stacking & aligning away as we explore other architectural elements that have influenced & molded my healing environment practice.
- Beginning with this historic English leader who was believed to have once said: “We Shape Our Environment. Thereafter, Our Environment Shapes Us.” Healthcare architects have embraced that statement to reflect how healing environment can help heal us – if built thoughtfully.
- And Louis Sullivan, a foremost American architect, who has been called the "father of skyscrapers“ and "father of modernism“, shown here with his design of the Prudential Building, in Buffalo, New York, considered to be among an early precursor to the modern day skyscraper. Sullivan was an influential architect among his peers & has famously coined the phrase “Form Follows Function”, that healthcare architects take to heart, especially in facing an era of “doing more with less” during times of limited resources, to optimize on every square foot of real estate available to create revenue generating patient care space.
- Sullivan’s work also include a Minnesota treasure, the Owatonna’s National Farmer’s Bank. It also exemplified Sullivan’s mantra of “form follows function”, in creating a carefully & beautifully detailed boxy form to house a highly valued function for a bank. The building today houses a Wells Fargo branch in the city. Such approach to efficiency with just the right touch of class echoes efforts that are constantly pursued by healthcare providers in showcasing their facilities.
- Besides Sullivan, the other American architect who has left an indelible mark on many, including me, is Frank Lloyd Wright, shown here with his landmark design of Fallingwater in Pennsylvania, a home Wright designed for the Kaufmann Family of retail store fame in the 1930’s. Wright believed in designing structures which were in harmony with humanity and its environment, a philosophy he called organic architecture. This philosophy, best exemplified in Fallingwater, has been widely recognized as "the best all-time work of American architecture“. Wright’s sensitivity & respect to the environment he builds in is another attribute that healthcare architects cherish as many recognized the need to be good stewards to our environment & the beneficial effects of integrating nature into our healing environment.
- In addition, Wright’s work not only build on Sullivan’s form follow function to architecture, but in his respect for the environment in which he built, he also gave his architecture a great sense of feel, as captured in his design for the Robie House in Chicago’s Hyde Park, famously known for its sense of scale, fit in the neighborhood & embrace of the site. Healthcare planners & architects alike, me included, consistently strive to bring that tri-factor of “form follows function with feel” to the healing environment we create.
- As the saying goes: “Everything worth doing is worth measuring”. In healthcare architecture’s practice of creating healing environment, Planetree is the yardstick that many successful healthcare organization’s efforts to provide a caring healing environment is measured. Since its founding by a patient in 1978, the Planetree concept has defined what it means to be patient-centered. Its philosophy is based on a simple premise: care should be organized first and foremost around the needs of patients. To understand those needs, Planetree turned to the source: Thousands of focus groups—from bedside to boardroom—with patients, long-term care residents, families and professional caregivers, to create healing environments that are more of a personalized, humanized and demystified health care experience.
- The other yardstick that many healing environments are put to high regard is by way of being a participant in what is known as The Pebble Project. The Pebble Project is a unique and dynamic collaborative, where forward thinking healthcare organizations, architects, designers and industry partners work together to identify built environment designs and solutions that measurably improve patient and healthcare worker safety, clinical outcomes, environmental performance and operating efficiency. While the healing environment work we do in Allina Health have not been put to either of these measurements due to mainly costs conservation, we are well aware of the merits & values these two organizations convey & consistently incorporate attributes & principles advocated by these two entities into our patient care facilities investment.
- The work that my department is charged with are also done with the desired outcomes championed by other evidence-based organizations like CHER, the center for health & environmental research and the Samueli Institute. CHER is a multidisciplinary research centre & is comprised of a team of investigators all of whom have a common mission: to research and prevent diseases caused by hazards in outdoor and indoor environments that include air pollution, aerosols, noise and other exposures, making healthcare environments safer & more healing. The Samueli Institute is a non-profit research organization that supports scientific investigation of healing and its role in medicine and health care. Founded in 2001 by Henry and Susan Samueli, the Institute pursues advancement of the science of healing. Its focus includes complementary, alternative and integrative medicine, optimal healing environments, relationship-centered care, the role of the mind and lifestyle in healing.
- Besides the principles, ideas & best practices promoted by those organizations, I am also inspired by the work that many thought & concept leaders in healing environment design, including these two. Roger Ulrich, a professor of architecture at the University of Texas, conducts research in evidence-based design for healthcare environments and Jain Malkin, a highly recognized interior designer who created many successful environments that support healing.
- Together with historical & current leading thoughts, guiding principles & best practices from the institutions & individuals I’ve shared with you, I, by way of my background & upbringing, also weave in my influences of the concept of feng shui in my responsibility of creating many of my healing environment work with Allina Health at Abbott Northwestern Hospital & elsewhere in the system where appropriate. How many of you have heard of feng shui? It literally mean “wind & water”, a subject matter worthy of a whole dedicated session in examining how the Chinese seek to understand & work with the forces of nature. In short, feng shui is an ancient art and science developed over 3,000 years ago in China. It is a body of knowledge that reveals how to align & balance the energies of any given space to assure the health and well being for the people inhabiting it.
- As indicated, a key element or objective of Feng shui is to attain alignment & balance. This is conveyed through the concept of yinyang, represented by this perpetually interlocking symbol & has come to embody the desire for peace, tranquility & well being . Yinyang serves as one of the main theories of ancient Chinese schools of thoughts. Feng shui, along with the practices of Taoism, traditional Chinese herbal medicine & martial arts, are all based on the dynamics of yinyang, emphasizing particularly on the idea of complementary opposites.
- This idea of complementary opposites is best represented by Newton’s 3rd Law, which states: To every action, there is an reaction. Meaning that to achieve or regain a state of balance, one has to find, figure or devise a way to honor, respond or counter the impacting force. To fight it is potentially hazardous, as illustrated by this visual of the boxer, who did not react in time to defend, respond or counter the impacting
- The concept of yinyang is also reprecented by these trigram symbols shown here, three simple aligned & stacked lines, celebrating the essence of the Heaven, Earth & Humanity. These pair of trigram reinforces the Chinese desire to attain alignment & balance by recognizing that everything around us is composed of two opposing, but deeply interconnected & complementary forces - the Yin (feminine & graceful), represented by the split stack and the Yang (masculine & exciting), in the solid stack.
- Knowlingly or unknowingly, the yang trigram offers the most opportunity for various graphic application & symbolic interpretation. The red square is my “yang” simplification of my last name L, E, O & W. And in this ad for the Chevy SSR from a few years ago, the excitement of the model is expressed in the simplified trigram E in Revolution. force…The yinyang & trigram symbols provide me with opportunities to infuse the healing environment I create with “softer, gentler & soothing” features to complement the often “hard, rigid & functional” space dictated by programmatic needs. It is with this constant awareness & intention of focusing on the positive that I bring ideas, options & solutions to serve our healing environment effort.
- As such, in my approach to healing environment work, influenced by various schools of architectural theories & practices, guided by current researched evidence & grounded by my personal cultural upbringing, I am constantly aware & respectful of the energies, of which the Chinese call ‘qi’, that for good, bad or otherwise, impacts each & every decision we have to make in creating, adapting and nurturing the healing & caring environment we provide our patients.
- The effort to lay out spaces to care & treat our patients are consistently done so with intention to provide an aesthetic sense of flow that feature not only elements of nature like water that is frequently used as an effective accent healing environment, but also a functional sense of flow that provides least disruptive impact to support requirements like various supplies & services that constitute very much part of our hospitals & clinics.
- Recognized by many as an effective healing environment tool, artwork that showcase the beauty & calming effects of nature as well as landmarks that help contextualize an otherwise hard & institutional environment are used deliberately & purposefully as “points of respite” or “positive distractions” throughout Allina’s facilities. Healing art techniques & provisions have both evidentially & intuitively shown to help create a desirable soothing & neutralizing healing environment by drawing viewers momentarily to a “better place” even as they wrestle with their health situation when they come seek treatment from us.
- To help provide a reasonable way to create & maintain a consistent brand of healing environment, I helped developed a “healing palette” that is used system-wide throughout Allina that minimizes potential subjective preference of the multitude of colors to a range that speak to common goals of healing attributes & help guide the selection of paint, vinyl wall covering and other finishes. There is a one primary earth-tone “field” color that promotes calm & our end users are also provided with four accents colors that suggests comfort, compassion, courage & celebration to choose from to enable them to have a sense of ownership in creating the appropriate mood and setting for our patient care & healing environment.
- Likewise, common building materials are also presented in a manner that reflects the appreciation of nature, which incidentally, also represent what is known as the “constructive cycle” in the practice of feng shui that honors how each elements interconnect & influences each other positively when paired to complement each other. When presented in this simplified manner, it helps Allina Health systemize & standardize what could otherwise be a very daunting, overwhelming & intimidating selection process as they are always a wide array of latest & greatest choices to choose from. Providing this healing palette helps us manage expectations accordingly & help our staff conserve time & energy to focus on what they do best: providing patient care.
- Together, the ideas, tools & intentions are consistently engaged in my options to bring balance…
- …provides alignment, regardless whether it is the well-being of our patients, their families our staff or if it is the bottom-line that we constantly & mindfully manage to…
- Above all, I try to keep it fun by staying positive, thinking creatively & promoting fresh perspectives each time I am charge with a healing environment assignment, regardless whether it is a small 1-room remodel or a large, thousands of square feet expansion. Strung together, they all adds up to a collectively consistent & comforting healing environment throughout Allina.
- The next series of slides illustrate a collection of work that espouses many of the components of healing environment: Kindness, Presence, Touch, Aromatherapy, Sounds & Sights at Allina Health. My role as the lead of our design & construction department is to provide initial “vision to mission” as I bring my architectural skill set to the table as many of our patient care & healing environment needs are being served.
- The Canyon Charm: A simple visual roof garden that offers up a positive distraction of a delightful sight viewable from elevator lobbies & surrounding conference & patient rooms. It helped soften an imposing enclosed space by buildings from years of hospital growth.
- The Healing Pad: A repurposed heliport from when the Heart Hospital was built. Instead of spending funds taking it down, the pad was secured & turned into a destination that offered up sights, sounds, smells & tactile experience away from the hustle bustle of the main hospital. Patients, staff & volunteers thoroughly enjoyed the healing aspect of being away from it all for a while.
- The Harmony Habitat: Working with our behavioral health program leaders, I helped turn a former smoke shack to a horticultural therapy garden, transforming a space with a negative use to a positive healing outdoor environment. Besides birdhouses, we also put in a journal box where users can leave their thoughts. Often on my more challenging days, I’d find time to go sit in this garden & read what others have left as they experience the healing journey with us.
- The Community Courtyard: Funded by the hospital auxiliary for another outdoor healing environment, the courtyard helped transform a former hard & harsh space between two of ANW’s buildings into another more cozy, inviting outdoor gathering area featuring both annuals & perennials, a rock feature & dwarfed maple at each end along a meandering planter/seating with a spine of ornamental grass that creates a natural visual separation each half of the courtyard.
- The Heart of the Mall: By way of a 2-year employee giving campaign, I helped transformed the central campus mall into a healing garden of perennials, annuals, water features with kasota stones boulders & outdoor furniture for ample seating & gathering options. These earlier conceptual visions were eventually “right-sized” to what you see in this next slide:
- Since its opening to this rededicated use, I’ve led several enhancements supported by sustaining gifts to this healing intention as it continue to attract appreciation of its presence on a very urban hospital campus.
- Since the Heart of the Mall effort, I’ve incorporated the healing garden/healing campus concept & intention Allina-wide at our Buffalo Hospital, Owatonna Hospital, Unity Hospital and the reason Ramsey Clinic, all continuing the healing objective by building upon. i.e. loosely put: symbolically stacking one success upon the next to create realignment and new-found balance for our patients, families, staff & neighbors.
- A mile & a half loop around Owatonna hospital & our partner on this campus, the Mayo Clinic, connecting an inside wellness walk to the outside, through a healing garden that I just helped commissioned a sculpture that reflects our healing campus intentions.
- Another mile-long healing walk that transformed what used to be an isolated campus to now a ‘destination’ for the community. The walk’s populated with healing amenities like reflection points, picnic shelter & community & celebration gardens. It also connects into the city’s trail system.
- On the inside, I’ve helped put in place many “positive distractions”, shown here is the Heritage Hall at Abbott Northwestern Hospital, which was staged to recall the rich history of the coming together of the various care entities, providing a reflective journey in an otherwise long, ho-hum hallway, of which we have miles of throughout Allina. To date, I’ve put in place over 3 dozens of this type of acknowledgements, celebrations & recognitions system-wide, all contributing to & serving the need of a holistic healing environment, providing not only comprehensive clinical care but also creating areas of caring, comforting & calming features.
- Nursing Excellence: with mission statements, achievements, actual staff moments.
- The Solace Room: Converting an old tired break room into a rejuvenating quiet place for nurses, with massage chair, soothing music, water feature & a miniature zen garden. A similar “Spirit Room” was added to the Heart Hospital program, complete with salt lamps.
- The Penny George Institute for Health & Healing, incorporating feng shui & bio-geometry elements to infuse positive energy into an otherwise challenging space.
- The Abby Salon: On-site personal beauty care, bringing therapeutic comfort to our patients during their extended stay with us.
- The Skyway Café: A convenient & popular amenity…using the attributes of finishes & materials from the healing palette, showcasing & sharing the free, aromatic smells of daily brews…
- There are many other examples system-wide that continues the healing environment intention, despite continuous changes in priorities & strategies. Our constant challenge is to be find ways to be responsive to both the spiritual needs often associated with healing & the technological demands that comes along with each generation of latest & greatest equipment needs.
- For example: To create a more soothing environment for our imaging rooms, I gave this CT room at our Saint Francis Regional Medical Center a “simple glimpse of nature” as its positive distraction. The service statement for Allina Design & Construction continues to be: A consistent approach to design & construction of healing environment that serves Allina’s patient care goals and objectives. This treatment has been replicated effectively in several of hospitals providing CT services.
- My task as leading Allina Design & Construction department to creates healing environments that helps all those who come to us for treatment to…
- Provides processes of service delivery that enables our customers & users to…
- …and help build facilities throughout our system that…
- …which is what we look forward to deliver by early 2013 for The Mother-Baby Center. As with many projects that I’m involved in, I make a concerted effort to integrate elements of the curve that’s reminiscence of the flow of positive energy, balance & grace as we fulfill functions with forms that exude also feel of prominence, excitement & healing intentions.
- The yinyang concept inspred garden…curved form to alleviate long hallways…
- A deliberate gentle curve to calm the prevailing emergent urgency…
- As such, our department service delivery cornerstones as illustrated by this diagram:
- Regardless, no matter how noble & intentional this model we adopted to design & construct Allina’s healing environment, I also take it to heart that we need Continuous Improvement
- As such, as a constant reminder to myself to be mindful of my alignment & balance, I enjoy stacking stones...when I am out hiking, I stack stones…
- In and around my home & office, I stack stones…
- Along the way, I also continuously practice “KAIMIF: Keep At It & Make It Fun” in aligning, creating & maintaining the stacking & balancing effect of all things healing.