Creating an optimal healing environment in a clinic or outpatient setting is not easy. After all, patients are on-site for a relatively short period of time and the encounter with the provider often is hurried. But there are clinics making extraordinary advances in creating healing environments for their patients and employees, and even extending these efforts into their communities.

Samueli Institute of Alexandria, Va., defines an optimal healing environment as one in which the social, psychological, spiritual, physical and behavioral components of health care support and stimulate the individual's capacity to heal. Clinics throughout the country have taken unique approaches to ensure that patients, their families and their own staff are afforded the opportunity to begin and continue on a healing journey.

Yoga, Cooking and Fitness

Take, for example, the Scripps Center for Integrative Medicine in La Jolla, Calif., which is affiliated with Scripps Health, a community-based health care system with five acute care hospitals, a network of clinics, home health services and 2,500 affiliated physicians. The clinic started with mainstream interventions that have a solid evidence base such as acupuncture, biofeedback, yoga and nutritional counseling, and carefully blended these with conventional testing and treatment. Over the last decade, the clinic was able to build a comprehensive program of services.

"We add value," says medical director and co-founder Mimi Guarneri, M.D., "which is appealing to physicians and providers throughout the Scripps Health system." When a patient comes into the early detection center for a scan (in a state-of-the-art, 64-slice PET/CT scanner) for example, he or she also may receive nutritional counseling and an exercise prescription. Today, Scripps Center for Integrative Medicine sees nearly 3,000 patients per month, has ample philanthropic funding and a profitable bottom line. The center's commitment to and strategies for creating an optimal healing environment for both patients and staff have become a model for many other organizations around the country.

Guarneri's journey from a physician-researcher to a healer began when she realized that medicine was not merely about stitching up her patients and sending them on their way. Hearts could not be healed simply by a knife or stent, she observed; the patients also needed healing in the emotional, mental, intelligent and spiritual dimensions. These experiences led her to create a "center of healing" that tends to the needs of the whole person by building a healing and meditative space for patients.

To ensure that the caring culture she aspired to create was emulated by both clinicians and staff at the clinic, Guarneri realized she had to model that behavior and serve as an example for her team and her patients—whether with her daily meditation or her yoga practice. All clinic staff are offered free access to the fitness center, encouraged during their first 90 days of employment to attend at least four classes (yoga, cooking, mind/body techniques) offered at the Scripps Center, and participate in such training as healing touch and mindfulness-based stress reduction. All programs and classes are free for center employees.

The center offers a wide variety of services and programs for patients and the community that cover the continuum of care: from lifestyle modification and prevention, to early detection and treatment of cardiac conditions, to pain management and more.

In addition to providing patient services, the center is committed to ongoing education for the community, and continuing medical education for physicians and other health care practitioners.

The objective in designing the center was to create a warm and inviting space. Jain Malkin, the architect on the project, said she drew inspiration from nature and used the principles of sacred geometry—the mathematical order intrinsic in nature. "The ceiling of the PET scan room was designed as a chambered nautilus, the most perfect manifestation of the golden mean, and represents harmony," says Malkin. Fiber-optic lighting in the colors of the rainbow help patients feel calm and less fearful as they enter the room for procedures. The existing skylight above the reception desk was fitted with a prism that creates rainbows, a universal symbol of hope, throughout the waiting area.

Given the nature-inspired themes for the design, it is apropos that the center does its part to reduce its carbon footprint and its impact on nature. Scripps Green Hospital, in which the clinic is located, has a sweeping environmental initiative, Living Green, that includes switching cleaning products to more environmentally safe options; providing eco-friendly food and drink containers; recycling water for irrigation; and conserving energy. "We are constantly examining our surroundings and trying to reduce our waste stream," says Rebecca Cofinas, vice president of operations for the hospital.

Guarneri points out that there are many ways to enhance the healing encounter even if it is for a brief period of time. "When people come into a health care setting for care, they are vulnerable, fearful and stressed," she says, "and every attempt should be made to alleviate those feelings." At Scripps, they have taken pains to ensure that every detail, from removing such obvious triggers of fear as needles from plain view to adding sacred symbols. "Research has shown these fear responses can elevate stress hormones and blood pressure," Guarneri adds. She encourages her staff to welcome patients with love and compassion.

Naturopathy for Indigent Patients

Far up the West Coast, in King County, Wash., Tom Trompeter, CEO of HealthPoint (formerly Community Health Centers of King County) is working with a different set of challenges and patient populations. This nonprofit system of community-based health centers with a primary mission to serve the underserved was the first in the nation to receive public funding for integrative health care, including naturopathy, acupuncture and nutritional counseling.

Over the last two decades, HealthPoint has become home to 62,000 patients who speak more than 70 languages—mostly indigent, uninsured or working poor, many of whom are recent immigrants or refugees. HealthPoint has made a conscious and concerted effort to create a patient- and family-centered environment that serves the physical, emotional and social needs of its growing clientele.

"In 1995, a survey of patients showed that 60 percent were interested in natural and alternative therapies. As a consumer-driven-and-directed organization (many board members are former clinic patients), they made a commitment to find ways to provide access to these modalities to those who may not normally be able to afford them," says Cindy Breed, N.D., who is the lead provider in the natural medicine program and is directing the newly formed wellness program initiative. In a unique partnership with Bastyr University, the first natural medicine clinic was established in Kent, Wash. Since then, natural medicine services now are available at all seven clinics throughout the county.

First-time patients to the clinic can choose to see either a conventional physician or a naturopathic physician. Otherwise, because naturopaths are considered primary care providers in the state of Washington, patients can be assigned to either provider. "Primary health care services are provided by these clinicians in collaborative teams. This model provides an opportunity for providers—both conventional and alternative—to learn from each other and develop a comprehensive understanding of their styles of practice, and collaborate to best serve the needs of the patient," says Trompeter.

Creating a healing and caring environment is crucial. Today HealthPoint serves as the medical home for thousands of patients who look to the network of clinics for all their needs—preventive, medical, dental and behavioral. "Allowing patients to develop long-term relationships and build trust with their providers is critical," says Judy Featherstone, M.D., HealthPoint's medical director. "Many of the conditions that bring the patients to the clinic are related to chronic pain and stress in part due to their financial and socioeconomic status. For this reason, case management, coordination of care and patient advocacy are crucial and are a key function of clinic staff."

Promoting wellness and proper nutrition also has become an important part of the clinic's goals, not only for patients, but also for the system's 400 employees. Breed says that the health-education programs will be offered on a sliding scale since there is currently no reimbursement for these services. Clinic staff started by conducting health-risk assessments and providing incentive programs for employees. In fact, they also have lobbied to allow their patients to use their food stamps at local farmers' markets.

In October, HealthPoint received a $6.8 million grant, authorized under the 2010 Patient Protection and Affordable Care Act, to help construct a new integrative clinic in Bothell, Wash., that will serve more than 6,000 low-income and uninsured patients each year.

From Acute Care to Wellness

In North Carolina, CaroMont Health, a regional nonprofit health care system, is launching a new model of outpatient care called CLiC—convenient, local, immediate and individualized care—in which patients' immediate care needs are used as an opportunity to focus attention on their longer-term health and wellness. A physician trained in integrative health care serves to "triage" patients and oversees the other care providers.

Complementary and alternative medicine providers and therapies also are integrated as part of the patient care continuum. Patients first may access CLiC for an urgent need or because they either don't have a primary care physician or could not get a timely appointment to see their own physician. The CLiC providers meet the presenting need, but direct their attention to the whole person and overall health needs.

"Entering the facility you see that it's unique—starting with a welcoming, curved front reception area with no glass or other barriers, a very friendly and welcoming staff (Ritz Carlton-trained), a feel of embracing openness, healing color and all natural light," says Jim San of drivearchitecture ltd, the project's design and architectural firm. There is a CLiC "feature wall" presenting large screen monitors with streaming video of health and wellness tips, inspiration and information. There is also a touch-screen computer with access to health and wellness links, so patients can download a variety of useful apps to their smart phones or laptops.

Adjacent to the waiting areas is a health store with health and wellness products that focus on sleep, nutrition, movement and exercise, a "relaxation station," children's books, tapes, and other goods to support health and well-being. The store is staffed with health coaches and health product experts. Next to the store are two consult rooms that convert to sleep-study rooms at night and can be used for acupuncture or massage. The entire facility is designed for optimal healing with natural light in every room, healing colors and artwork. There are separate sick and well—"stay well" and "get better"—waiting areas, as well as a staff recharging area, all with views of the outdoors.

According to Mary Hassett, a principal of Integrations Inc., and conceptual strategist for the CLiCs, while a patient's first visit may be to address a specific immediate need, the idea is to create an environment and caring relationships that support ongoing individual health needs. For example, CaroMont Health offers smart technologies that connect people to information and access points for care beyond the walls of the CLiC facility.

"We also hope to attract 'health visits' by the appeal of the retail and consult environment and the opportunity to drop in for a healthy snack or to get some quick advice and support for health and wellness issues," she says. The goal is to create an optimal healing environment to address the immediate need, and to use that opportunity to create conversations and provide convenient support that meets personal health-improvement goals.

"We've put a real focus on an integrated-team approach and a culture that promotes health and healing as well as increased personal accountability for self-care and improved health," says Valinda Rutledge, CaroMont's former president and CEO and now director of the Patient Care Models Group at the new Center for Medicare & Medicaid Innovation, which was created by the Patient Protection and Affordable Care Act. She adds that "building caring relationships is key and so is having convenient, immediate access to a health and wellness support system that goes beyond the walls of a visit."

Americans make almost 1.1 billion visits to outpatient clinics each year—an average of four visits per year per person. Each visit is a unique opportunity to engage providers in creating their own optimal healing environments.

Author's note: This work is supported by the U.S. Army Medical Research and Materiel Command under Award No. W81XWH-10-1-0938. The views, opinions, and/or findings contained in this work are those of the author and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.

Sita Ananth, M.H.A., is the director of knowledge services at the Samueli Institute in Alexandria, Va. She is also a regular contributor to H&HN Daily.