The Healthcare Facility Design Process: Is Interactive Design the Way Forward?
Towards the end of the 1990’s, at a health facilities design jury in the USA, over 250 entries were reviewed, and only one project received a design award! We healthcare designers need to hang our heads in shame. Increasingly we find clients asking us about the role that art and nature could play in creating “healing” environments, color therapy and stress reduction now being cocktail party chatter. With this increasing sensitivity on the parts of the healthcare providers and users, why are these depressingly similar and ugly hospitals still the norm in India?
We are just beginning to learn how to execute the project design without too many flaws and thus reducing the large amount of demolition and reworking that has plagued the industry so far. There is a failing at a deeper level, in the very structure of the healthcare design process itself. In the book “Hospital Interior Architecture” Jain Malkin writes the following as related to beginning a project:
“Every project must start with intensive programming and interviewing sessions with key staff who will be using the facility. The quality of this aspect of the project, combined with a sensitive design team who can emphatically imagine in the roles of patient, family member and staff, is directly proportional to the success of the outcome…. An aesthetically beautiful project can be created without a rigorous programming effort, but can such a project be viewed as successful if it fails to meet the users immediate and long-range clinical objectives?”
In reality, simple space lists are often misunderstood as representing “programming” and seldom identify global design issues. The typical, conventional design process falls far short of creating the synergistic interplay of complex elements, both real and perceptual, for a successful health facility project. We need a design process that incorporates the diverse and essential design criteria for a health facility, a “structured” design process.
The first interactive structure in the field of healthcare design is generally attributed to the architectural firm of Caudill Rowlett and Scott, Inc. (CRS) in the mid-1960’s. The process was later documented in “Problem Seeking”, a book by William Pena, a principal at CRS. Pena identifies five steps in the programming process: (1) establish goals (2) collect facts (3) uncover concepts (4) determine needs (5) state the problem. It is interesting that he ends with “state the problem”, as I have always maintained that the solution to any problem is to be found within the problem itself, and not outside it, hence the greater the clarity and accuracy with which a problem is defined, the easier it is to solve it. If a problem is perfectly defined, the solution becomes self-evident.
The first challenge of an interactive design process is to create a seamless integration of the less graphic, analytical programmatic criteria into the synthetic design process itself. Programming should thus be an essential part of the design process, and not separate and distinct from it.
The Interactive Design Process
Very few projects are designed with a truly interactive design structure. To qualify as an interactive design process, the following should be true (according to Mayoras and Moon):
• Establishes universally accepted and measurable goals for the project.
• Provides direct client/user authorship in the project design
• Communicates ideas in a graphic format understandable to the client/user
• Provides a single-project-focused format
• Allows the design team to experience firsthand actual existing conditions
• Provides simultaneous resolution to various (and often contradictory) points of view
• Creates a sense of project urgency and realism by establishing project momentum
• Creates real-time physical deliverable(s) for immediate client discussion/review
Other names for an interactive design session are “design workshop”, and lesser used in India, the “charette”. The charette, then, is an on-site interactive session in which ideas are documents and communicated visually through drawings, diagrams, models and other graphic tools. Concepts are tested and evaluated in an open team format with the client as an integral team member. It is not within the scope of this article to document all the activities that go into a successful charette. Suffice it to be said that it is an intense design experience, and is usually a very effective way of establishing a design direction for the project.
Conclusion
Conventional design processes often draw on previous firm experience and/or precedent, but the design of complex, successful health facilities project is a lot like having children – no matter how many you’ve had before, each one is certain to be slightly different. An interactive design process unites the wide-reaching pool of various perspectives into a single project context, and can provide each project with an inherent uniqueness of experience for each client and patient who uses the facility.
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