Playing with place: Co-designing landscapes through games in healthcare settings

Hospital greenspaces have the potential to contribute to public health, environmental sustainability, and the wellbeing of patients, staff, and visitors through meaningful interactions with nature. While it is widely acknowledged that time spent in nature benefits health and wellbeing, there remains uncertainty of which individual landscape elements are linked to particular outcomes. Moreover, tools to support shared decision-making in the early stages of healthcare estate planning are scarce. This research developed, tested, and evaluated a novel co-design tool that translates evidence on human-nature connections into a tangible method for co-designing NHS greenspaces. The outcome was Mosaic Landscapes, a serious game that combines indexed landscape elements with persona-based role play. Landscape elements were derived from environmental quality indicators and mapped against potential biopsychosocial-spiritual health outcomes. Mosaic Landscapes was tested in ten engagement contexts including knowledge exchange, exhibition, and healthcare sessions. Qualitative data were gathered through observations, facilitator reflections, and participant surveys. The results were evaluated using a new combined Salutogenic-Sekhon integrated evaluation framework. Mosaic Landscapes demonstrated positive outcomes in terms of engagement, acceptability, and applicability across settings. Findings suggest that Mosaic Landscapes offers a practical and adaptable method for integrating health evidence into place-based design within institutional contexts.