Therapeutic hospital gardens (THGs) need to be purposefully designed for hospital users and well-integrated into the clinical hospital treatment plan to be effective. Healthcare decision-makers are critically important in establishing therapeutic gardens in hospitals and healthcare facilities because they have the ultimate decision-making power to include such gardens for the holistic care of their patients, staff, and visitors. This study aims to establish how THGs can be successfully created by investigating the professional experiences of 12 global healthcare decision-makers in hospital administration, executive government, and senior consultancy to government on the role of THGs in creating a healthy and sustainable hospital environment. This article shows how these decision-makers, who have already worked with healthcare designers and clinical practitioners to design and establish THGs, have been selected and interviewed. The qualitative analysis of these semi-structured interviews uncovered why and how these healthcare decision-makers made THGs a reality in their hospitals. This analysis informed the development of the THG Healthcare Decision-maker Guidelines, which were designed to guide all hospital CEOs, government executives, and senior consultants to the government to both design and then establish THGs successfully. These guidelines include five systematic steps: 1. design for hospital cohorts; 2. purposefully design and integrate THGs well; 3. facilitate inclusive and defined stakeholder engagement; 4. evaluate the garden visitor experience; and 5. understand the benefits and values of THGs. These five systematic steps can be used immediately by healthcare decision-makers to work with healthcare designers and clinical experts to implement such gardens in hospitals successfully. When the three sectors, healthcare governance, healthcare design, and clinical health, work together, more THGs can be established in hospitals for better patient care, visitor well-being, and a healthy and sustainable hospital environment.
