In 2013, landscape architects were able to provide pro bono design services for a healing garden space at ThedaCare Medical Center in Neenah, Wisconsin. The goal of this therapeutic garden was to improve outcomes for rehabilitation patients with a variety of brain and mobility injuries. An in-house micro-grant program funded a post-occupancy evaluation (POE) which allowed landscape architects to evaluate the success of the garden in achieving its intended goals. This research project has proven to be particularly insightful due to the findings, participant-informed design process, important lessons learned and, ultimately, its contribution to the growing catalogue of evidence-based design resources. 

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The ThedaCare Medical Center therapy garden has established enduring impacts on multiple levels. For the hospital and staff, it has provided a pleasant, new outdoor space where lasting, meaningful rehabilitation care can be delivered. For patients and families, the garden has become a place to connect, grow, and learn about nurturing loved ones. And, for the design team, the garden demonstrates the value of landscape architecture in creating therapeutic environments, thereby adding original insight to a growing knowledge base and furthering the opportunities for landscape architects to meaningful provide evidence-based solutions. 

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Funded by an in-house micro-grant program, a study team - made up of a landscape architect, landscape designer, and design researcher - conducted the firms first post-occupancy evaluation (POE) of a landscape architecture project at the ThedaCare garden site. The study aimed to evaluate the success of the garden in achieving its intended goals. A combination of interviews and an on-site evaluation tool, the Healthcare Garden Evaluation Toolkit (Sachs, 2017), were used to gather data. The evaluation tool included an assessment of garden elements and Interviews with 11 staff members (7 PTs and 4 OTs) , focused on whether sensory and physical elements of the garden helped patients achieve therapy goals and met psycho-social needs. 

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Methods 

Researchers followed the Lincoln & Guba (1985) method for naturalistic inquiry to analysis the qualitative data. Each researcher analyzed the data and came up with themes. Then they met as a group and confirmed the themes that arose. Quotes were applied to support the themes. 

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Key POE Findings 

The garden succeeded in achieving its intended goals in a number of ways: three broad categories of findings emerged. 

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(1) Met physical, psychological, and emotional needs of users 

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Rehabilitation spaces (e.g., gyms) often contain features such as stairs that attempt to simulate real-world conditions but instead can feel like “steps to nowhere” for patients. In the ThedaCare garden, climbing the stairs of an actual outdoor deck gave purpose and meaning to the tasks at hand. Spending time in the garden was seen as an inspirational, and sometimes spiritual experience. Staff expressed pride in knowing their facility offered such a special space: “It makes me proud and I feel it makes patients happy.” 

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Patients’ families provide crucial support during the rehabilitation process, often feeling the ups and downs of therapy along with their loved ones. Seeing their loved one interact with elements of the garden and work to regain abilities was emotionally uplifting for families 

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(2) Improved Therapy Practice 

 

The garden was seen by staff as a safe, but realistic environment, in which to test patients’ current-state skills and abilities in preparation for the transition to home. Information about how vision or balance might be affected at home could emerge during a visit to the garden. Staff suggested that having access to the garden sparked professional creativity and expanded thinking about activities that could help patients reach their therapy goals. “The garden definitely helped me be more creative.” 

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Family members often take on the role of caregiver as patients transition home. Staff members valued the frequent, spontaneous opportunities to teach skills to both family members and patients visiting the garden together. Staff repeatedly shared reactions of family members: “We can bring family members out with us…they’re are out digging in the garden with their loved ones and I can do family teaching in a realistic setting.” 

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(3) Connected to nature 

 

Patients experienced a deep-seated, fundamental connection to nature in the garden. Many patients visiting the garden for the first time were moved to tears having been unable to be outdoors for weeks or months. Additionally, the garden often had a calming effect on patients experiencing agitation commonly associated with traumatic brain injury. 

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Not only did the garden connect patients to nature and improve wellbeing, it did the same for staff. One staff member observed: “Getting some sunshine is a positive, if you are feeling good as a person, you are going to portray that to your patients…I love being out there with them.”