Canada’s Healthcare Crisis: why healing must extend beyond hospital walls

The COVID-19 pandemic exposed deep fractures in our healthcare system. We saw loved ones isolated, frontline workers pushed to exhaustion, and cracks in the ways we define care. The lesson was clear: healing cannot be confined to clinical interventions. It must address the whole person—body, mind, spirit and community.

One of the most promising opportunities for transformation lies just outside the hospital doors: outdoor healing environments. These are not mere gardens or green spaces. When designed intentionally, they are evidence-based interventions that reduce stress, support recovery and restore connection. And for many—especially Indigenous communities—these spaces are not optional; they are essential.

This article explores how outdoor healing spaces can reimagine healthcare delivery in Canada. We examine policy gaps, Indigenous teachings, design strategies and our role in advancing a more inclusive and restorative approach to health infrastructure.

More than four decades of research confirm that access to nature promotes faster recovery, reduces anxiety and improves both patient and staff well-being. Landmark studies by Roger Ulrich found that patients recovering from surgery who had views of trees left hospitals earlier and required less pain medication than those facing brick walls. Other studies have shown improved sleep, reduced stress and even enhanced immune function when nature is incorporated into care environments.

Despite decades of research supporting the benefits of nature in healthcare, outdoor healing environments remain inconsistently implemented across Canada. While Ontario’s Long-Term Care Home Design Manual (2015) mandates outdoor access for residents, broader healthcare infrastructure policies often fall short. The CSA Z8000 standard—Canada’s national guideline for healthcare facility design—does require integration of healing gardens and access to nature, yet its adoption is not uniformly enforced. 

To close this gap, healthcare planners and policymakers should advocate for mandatory inclusion of outdoor healing spaces in all new hospital and care facility builds, with clear funding pathways and accountability measures. Institutions like BC Children’s Hospital and London Health Sciences Centre are already leading by example, embedding Indigenous gardens and nature-based design into their care environments. These models demonstrate that policy alignment and cultural partnership can transform infrastructure into healing.

These spaces are more than visual comfort, they support resilience, dignity and recovery in moments of crisis. Designs also need to consider how to enable access, even if just visually, for those with more limited mobility, such that they are also access the power of this healing. 

We should also consider interior environments that allow nature deeper into the healing space and not have it end at the periphery—interior courtyards, rest spaces adjacent to windows and light wells can extend these benefits to those who cannot access outdoor spaces.

In many Indigenous worldviews, healing and land are inseparable. The land is not a backdrop to wellness—it is an active participant in it. Healing happens in relationships, not just with people, but with all living things.

Indigenous health practices are inherently relational. In First Nations, Inuit, and Métis cultures, the land is a living relative and a source of knowledge and identity. Healing is found in ceremony, in harvesting medicine, in walking the land and in shared community traditions.

Programs across the North demonstrate the effectiveness of land-based healing—combining cultural knowledge, language and traditional practices like hunting, storytelling or medicine gathering. These practices restore connections with community, ancestors and self, especially among youth and intergenerational survivors of residential schools.

In healthcare design, inclusion must move beyond symbolism. True partnership means engaging Indigenous communities early, listening to Elders and Knowledge Keepers and ensuring that healing spaces support cultural ceremony, sovereignty and identity.

Outdoor healing spaces are not luxuries—they are vital components of holistic care. When designed with intention, they promote emotional recovery, cultural safety and physical well-being for patients, families and healthcare staff.

Moving from theory to practice, here are practical solutions that can and should be incorporated into healing spaces:

Therapeutic gardens with sensory-rich plantings, shaded seating and culturally meaningful flora can support quiet reflection, rehabilitation or ceremonial practices. 

Walking loops provide gentle, continuous paths encourage physical movement and provide space for staff to decompress during demanding shifts. 

Family gathering spaces with outdoor areas with picnic tables, benches or fire circles create places for connection, especially important in collectivist and Indigenous cultures.

Outdoor treatment zones allow therapy, counseling or group support to be held in nature-based settings, reducing stress and increasing engagement.

The above offer numerous benefits to both patients and staff. Nature reduces anxiety, lowers heart rate and accelerates healing. For staff, it improves focus, decreases burnout and fosters emotional resilience. At a time when our healthcare workers are being pushed to the brink, we need to do better—we need to consider their emotional and mental wellbeing into the spaces we design. 

Healing spaces should reflect the diversity of the people they serve, and inclusivity in the design process matters. This includes considering accessibility through wide, gently sloped paths, non-slip surfaces and varied seating for people of all abilities. Cultural symbolism through inclusion of Indigenous artwork, traditional patterns, gathering circles and water features communicate safety, belonging and respect. Sensory engagement through the consideration of sounds of water, birdsong, fragrant plants and textured surfaces to stimulate the senses and calm the nervous system.

Designing for healing means centering human experience. Nature must be part of the plan—not an afterthought.

Equity in healthcare means more than treating everyone the same. It requires us to acknowledge differences—of history, identity and experience—and to design systems that address them.

For Indigenous Peoples, the legacy of colonial institutions—residential schools, segregated “Indian hospitals” and systemic racism—still shapes healthcare encounters. Cultural safety is a concept developed by Māori nurse Irihapeti Ramsden that demands healthcare systems confront bias and power imbalances and actively create spaces of dignity and trust.

In healthcare design, cultural safety means creating environments that affirm cultural identity and support traditional practice. It means embedding Indigenous voices in decision-making and ensuring healing spaces are inclusive, welcoming and representative.

Outdoor healing environments offer tangible opportunities to advance this vision. When designed collaboratively, they can integrate Indigenous language, art and plantings; provide spaces for smudging, ceremony or quiet reflection; and serve people of all backgrounds, ages, and abilities with care and intention.

The Truth and Reconciliation Commission of Canada’s Calls to Action #22 and #23 urge healthcare systems to respect Indigenous healing and increase cultural competency. Integrating land-based elements is one way to honor these calls—not as a gesture, but as a commitment to justice.

At GHD, we believe healing is connected to land, culture and community. Our commitment to restorative, inclusive infrastructure is reflected in every stage of our work.

We contribute to this shift by co-designing in partnerships with Indigenous communities, Elders and Knowledge Keepers; integrating healing elements such as therapeutic gardens, gathering circles and culturally symbolic landscapes into planning and design; and maintaining sustained community engagement to help voices be heard and lead the way.

With interdisciplinary expertise in planning, architecture, engineering and social performance, we support trauma-informed, culturally safe and sustainable environments. 

We don’t just design spaces—we walk alongside communities in creating them.

As Canada faces growing infrastructure demands and a deepening mental health crisis—particularly among Indigenous communities—it is clear that healing must extend beyond medicine.

Outdoor healing spaces are not amenities. They are acts of respect, reconciliation and resilience.

What would it mean to design healthcare environments that heal not just the body, but the spirit, the culture and the community?

Whether you are a designer, planner, healthcare provider or community leader, you have a role to play in transforming care environments.

Ask how your next project can include healing spaces. Listen to Indigenous voices and community needs. Design with dignity, equity and connection at the core.

Let’s build spaces that truly heal—together.