Money doesn't usually grow on trees, but it just might in hospital healing gardens.
Cropping up in medical centers coast to coast, healing gardens are gaining ground as a way to help patients relax as they await treatment or recover from surgery. Many healthcare providers agree that flowers, trees and running water create an oasis in the clinical desert of intimidating machines and sterile hallways.
Those who have built and supported such gardens believe that clinical outcomes improve when patients spend time in nature. That may be true, but healing gardens also are proving their ability to attract two things every hospital wants: money and customers.
"I'd love to be able to say that the truth is that hospitals build healing gardens because it's a great idea and they believe in the arts, humanities and poetry," says Wayne Ruga, a Loeb Fellow at Harvard University and a healthcare facilities architect. "But the reality is that the business imperative is driving these decisions."
Hospitals tout the therapeutic advantages of their healing gardens, asserting that not only patients but also staff members benefit from accessible natural surroundings. Many readily admit, however, that the gardens also play a role in bringing charitable donations and appealing to prospective customers.
"We can't document that more patients have come here because we have a garden, but it is incorporated into our overall strategy of demonstrating that this place cares about the human side of medicine," says Steven Seiler, chief executive officer of Phoenix's Good Samaritan Regional Medical Center, a 697-bed hospital that spent $750,000 constructing a 12,500-square-foot outdoor garden using plants and trees indigenous to Arizona, and even a coffee bar.
Good Samaritan, which features photographs of its garden in hospital marketing materials, raised the $750,000 entirely through private donations, including $250,000 from the estate of a former hospital employee and $300,000 from the hospital's charitable foundation.
Even some of Good Samaritan's doctors chipped in, despite their initial hesitation to support an artsy project when funds were limited.
"The garden was proposed at a time when operations were difficult, so I made it clear to employees that we weren't taking money from them for a garden," Seiler says.
Built in 1996, Good Samaritan's garden receives ongoing funding from the hospital's operations budget. Seiler says that keeping up the garden is "not all that expensive."
A majority of hospitals, according to those who have followed the growing popularity of healing gardens, fund their flower beds and waterfalls through charitable organizations -- and even generous patients -- and rarely pay for construction with hospital dollars.
For most healthcare organizations that have incorporated a garden into their facilities, "someone in the hospital community has gone to bat to raise the money," says Clare Cooper Marcus, professor emeritus of architecture at the University of California-Berkeley, and co-author of Healing Gardens: Therapeutic Benefits and Design Recommendations, published in 1999.
"Gardens are a lot less expensive than the latest medical technology," Cooper Marcus says. "I think it's unfortunate that the hospitals themselves aren't paying. I would hope that sometime soon, hospitals will see these spaces not as a cosmetic extra that do-gooding philanthropists organize but as an essential part of the healthcare environment."
Those philanthropists have contributed to the development of several new healing gardens in recent months. Last September, the Medical University of South Carolina, a 572-bed hospital in Charleston, announced plans to construct a healing garden at its Hollings Cancer Center. The garden's initial $1 million funding grant came from Edwin Pearlstine, whose late wife, Barbara, had been treated there.
Measuring 90 feet by 90 feet, the garden, on which construction is scheduled to begin in August, will help "treat the whole patient and not just the cancer," says Carolyn Reed, M.D., director of the Hollings Cancer Center and a practicing thoracic surgeon.
The Medical University of South Carolina will not need the entire $1 million to build the garden, Reed says, so some of the money will be used to maintain it.
Also on the list of hospital-gardeners-to-be is St. Francis Hospital in Milwaukee, a 260-bed facility that will include a $100,000 healing garden in its new 19,000-square-foot cancer center to open in October.
St. Francis, which is part of Milwaukee-based Covenant Healthcare, will design the garden to minimize ongoing costs, says Alicia Modjeska, St. Francis' vice president of operations. Using perennial plants is one strategy Modjeska has in mind.
Hospitals with healing gardens agree that aesthetically pleasing wooded areas provide a place for patients, families, guests and staff members to escape from an otherwise cold and clinical setting. And while they downplay the extent to which the gardens attract new patients, there is little question that boosting the hospital's public image is part of the harvest.
"Our patients say they like our environment here and that they have chosen us because of that," says Diane Postler-Slattery, chief patient-care executive of 321-bed Wassau (Wis.) Community Hospital in far northern Wisconsin. Wassau has two healing gardens, which most of the hospital's patients can see from their rooms.
Across the country in Santa Fe, N.M., 268-bed St. Vincent Hospital raised $600,000 in three years to build its healing garden, which is set in a previously concrete and gravel space between two sections of the facility. St. Vincent's garden replaced that concrete with winding paths, flowing water and even a fresco by a local artist.
"Santa Fe (residents) are very into complimentary therapy, so the healing garden was a very attractive project," says Gary Steinbach, St. Vincent's senior director of corporate development. When all was said and done, $450,000 went into the garden; the remainder of the $150,000 was used for a new entrance and waiting area.
According to Steinbach, St. Vincent spends from $300 to $500 monthly to support and maintain the garden. That money also comes from charitable contributions.
The benefits of healing gardens are difficult to quantify in terms of patient recruits or better outcomes, but improving staff productivity is among the reasons proponents list to support them.
"Healing gardens improve the ability to retain quality staff," says healthcare architect Wayne Ruga. "(The gardens) increase staff satisfaction because they reduce anxiety and give staff members a place to go during break time to overcome the stress of the job."
At Good Samaritan, that has been the case, Seiler says: "Our staff uses the garden as often as our patients."
Regardless of who uses the garden most, and despite the impressive price tags attached to some of them, spaces set aside for nature-assisted healing do not have to cost much or look like the gardens at Versailles Palace, observers said.
"Medical facilities are constantly being remodeled; why not break down a wall, put in some glass, and make a place people can sit with ficus," says Sam Bass Warner Jr., visiting professor in the urban studies and planning department of the Massachusetts Institute of Technology in Boston.
"Gardens can be fused into existing buildings without a lot of cost and they improve the patient environment," he says.
As for wintertime, Good Samaritan in Phoenix doesn't have much to fear, but St. Francis in Wisconsin just might.
"We're designing it so that patients can be sitting inside and can look in any direction and get a sense of being in the garden," Modjeska says.