Not all nature works: Rethinking biophilic design for restorative healthcare environments

Moreover, not all biophilic elements work the same way. Plants in passive spaces, like break rooms, may look impressive but have a limited effect if those spaces are underutilized by staff.⁵ A small nature-inspired painting placed directly in a patient’s line of sight may offer greater impact if supported by natural light and a background of nature-inspired texture and patterns. Design properties such as color, scale, placement, and lighting play a critical role in shaping users’ psychological responses.⁶ Too often, these features are applied uniformly across spaces, rather than being adapted to different use cases.^7,8

To address this, biophilic design must shift from intuition to evidence. Experimental studies are needed to better understand how people respond to various biophilic interventions and how these responses differ across different types of features, such as plants, green walls, natural light, and water, each with distinct design properties including size, color, and texture. For instance, restorative effects vary among three types of biophilic environments: indoor greenery, outdoor views, and their combination.⁹ Regarding design properties, two studies investigated the impact of green wall size on human responses, finding that even smaller-scale interventions can evoke measurable restorative¹⁰ outcomes.¹¹

In terms of research methodology, mixed-method approaches can be employed to capture both physiological and psychological responses. Wearable sensors can record physiological indicators such as heart rate, heart rate variability (HRV), and electrodermal activity (EDA), while self-reported surveys such as the Restoration State Scale (RSS) and Perceived Stress Scale (PSS) assess subjective experiences of restoration and stress. In addition, virtual reality (VR) offers a valuable tool for testing design scenarios before implementation, allowing users to explore how variations in size, placement, or combinations of natural elements influence users, particularly in healthcare environments where prototyping is challenging.¹² Finally, innovative methodologies such as eye-tracking can be integrated into both real and virtual environments to analyze attentional patterns and visual engagement with biophilic features.¹³  

Looking forward, biophilic design in healthcare must evolve from an intuitive approach to evidence-based disciplines. While nature-inspired elements are often integrated based on aesthetic appeal or convention, ensuring their true restorative impact requires a deeper, data-informed understanding of how people interact with these environments in real time. Page, now Stantec’s research is beginning to address this gap by combining physiological monitoring, behavioral observation, environmental sensing, and immersive simulation to evaluate the actual effects of biophilic interventions across different spatial typologies. By applying these methods not only in healthcare but also in education, workplace, and community environments, researchers are uncovering patterns of stress, engagement, and recovery that reveal when and how biophilic strategies are most effective. This approach moves beyond static post-occupancy evaluation toward continuous, evidence-driven feedback loops that inform design decisions throughout the project lifecycle. As these insights accumulate, biophilic design can evolve into a more rigorous, adaptive practice, one that ensures its strategies genuinely support human well-being and environmental connection across the full spectrum of built environments.