ARCHITECTURE AND DESIGN The Norwegian
Outdoor Care Retreat (Friluftssykehuset) by Snøhetta featuring
secluded wooden shelters near Oslo University
Hospital and Sørlandet Hospital.
Laura Carrara-Cagni
Laura Carrara-Cagni RIBA, is director of Cagni Williams Associates, a practice specialising in sustainable healthcare design, and co-founder of Cagni Williams Energy, a consultancy delivering Net Zero strategies for healthcare estates. With over 30 years’ experience, she has led numerous projects across the civic, cultural, educational, and residential sectors, integrating energy- efficient strategies to achieve Net Zero Carbon (NZC) goals. She is committed to
advancing sustainability in the built environment, notably through innovative solutions in healthcare, such as the Midland Metropolitan University Hospital and La Spezia Hospital in Italy. A passionate advocate for reducing carbon emissions in architecture, she serves as co-chair of the Urban Land Institute Europe – Life Science and Healthcare Product Council. She also takes up speaking engagements, writes, and serves as a juror for architectural and art awards.
The Acute Psychiatry
Ward at Östra Hospital in Gothenburg, Sweden by White Arkitekter.
beneficial for patients with cognitive challenges or high stress levels.
As we design for 2070, not just 2025, biophilic healthcare spaces must be adaptable and integrated with emerging technologies to be future-proofed: n Smart building integration: Biophilic elements should work alongside intelligent building systems, with sensors monitoring air quality and automated systems adjusting natural lighting based on circadian rhythms.
n Technology-nature balance: Future healthcare will integrate AI diagnostics and robotic surgery within biophilic environments that work with infection control material and regulations. The challenge is creating spaces where high-tech medical care feels human and connected to nature rather than cold and intimidating.
Measuring success: Mental health outcomes The effectiveness of biophilic healthcare design must be measured through comprehensive mental health metrics: n Patient satisfaction scores and anxiety levels. n Staff turnover rates and job satisfaction surveys. n Recovery time data and medication usage. n Sleep quality assessments for both patients and staff. n Cortisol level monitoring in high-stress clinical areas.
Implementation challenges and solutions Creating truly biophilic healthcare environments requires addressing practical concerns and lessons learned from complex healthcare projects across multiple trust partnerships: n Infection control: Modern horticultural techniques allow for plant systems that meet strict healthcare hygiene standards. Experience from specialist treatment centres has shown that air-purifying plants can actually
62 Health Estate Journal November 2025
improve indoor air quality when properly maintained, even in environments requiring the highest levels of clinical precision.
n Integration with complex systems: Advanced medical facilities, particularly those involving specialised equipment and multi-trust collaborations, present unique challenges for biophilic integration. However, these projects have demonstrated that natural elements can be successfully incorporated without compromising technical requirements or clinical workflows.
n Maintenance requirements: Biophilic elements require ongoing care, but automated watering systems and hardy plant selections can minimise maintenance while maximising benefits.
n Cost considerations: While initial investment may be higher, biophilic design delivers measurable returns through reduced staff turnover, shorter patient stays and improved satisfaction scores.
The path forward As the New Hospital Programme moves forward, architect selection must prioritise firms capable of integrating biophilic design principles with clinical excellence. This means choosing architects who understand both the science of nature’s impact on human psychology and the practical realities of healthcare delivery. Our experience as Design Lead Architects for the UCLH and SWBH NHS Trusts collaborating with Scott Tallon Walker Architects, HKS Inc. and Sonnemann Toon has shown that the principles are already working successfully in the UK, but we are glad not to be alone here. Several outstanding hospitals around the world provide inspiring examples, including: the Khoo Teck Puat Hospital in Singapore by KTPH with its superlative planting on balconies, courtyards and bridges; the Norwegian Outdoor Care Retreat (Friluftssykehuset) by
Agnese Sanvito
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