In order to understand the design implications of the triangle of supporting environments and the concepts related to it in Fig. 2, Fig. 3 and Fig. 4, we find Bengtsson and Carlsson, 2006 and Bengtsson and Carlsson, 2013 concepts of comfortable design and inspiring design to be useful. Comfortable design is intended to meet the need for comfort in the outdoor environment by providing security, safety and comfort and, thus, is in accordance with the pathogenic strategies of avoiding risk factors. Inspiring design is intended to meet the need for access to nature and surrounding life by providing variation and change in daily life, the freedom to choose among alternatives and stimulation of the senses and intellect and, thus, is in accordance with salutogenic strategies supporting salutary factors. Comfortable design needs to be considered in the environment as a whole so that everyone, irrespective of physical and cognitive condition, is able to use and experience the garden in its entirety (Fig. 5). According to Bengtsson and Carlsson (2013), some users are eager to obtain new impressions, whereas others are very sensitive to anything unknown. For this reason, the qualities of inspiring design should be placed according to the gradient of challenge so that users can choose whether or not they wish to confront the more challenging qualities (Fig. 5). Also, the deliberate disposition of salutary factors supports the healing process and is the basis that allows people to move upward in the triangle. The three concepts of comfortable design, inspiring design and the gradient of challenge are intended to be used as guides in the design process using the QET, as they place individual environmental qualities in a larger context. In relation to the users’ specific wishes and needs, a well-considered gradient of challenge and a balance of comfortable and inspiring design are key to designing a pleasant healthcare garden (Bengtsson et al., in press).