Zen and the Art of Healthcare Facility Programming:
The Qualitative v/s Quantitative Approach
Hospitals can be seen as a model of the “high tech” – “high-touch” organization that evolved during the twentieth century. A notable characteristic of any hospital is the division of information and technology into sub-units (departments), which function autonomously to a greater or lesser degree. A significant amount of decision-making authority rests with these departments, as well a great degree of control over their own operations.
In this sense, hospitals only appear to be organizations that are hierarchically structured; in reality they bear more resemblance to symbiotic organizations which function by maintaining a functional and political balance between its constituent parts. This presents a particular problem for the healthcare programmer, one that s/he must recognize and accommodate.
Using experience as a guide, an architectural program for a healthcare facility can be generated by a programmer with specialized knowledge in the field. S/he needs to recognize the complex power plays that exist in the organization and try to decipher (yes, almost like hieroglyphics) the “real” needs of each user group that will eventually form the hospital’s organization. These needs may need to be considered within the context of the needs of the healthcare provider or “client” that is financing the project.
To a large extent, the so-called “concept” of the architect as form-giver is determined, given abstract shape, by the facility programmer. This can be a subtle influence, difficult for an outsider (or layman) to perceive. There needs to be a “meeting of minds” between the architect as form-giver and the architect/healthcare professional as programmer.
Quality architecture originates from a synthesis of quality programming and visionary design. Great buildings result from a symbiosis of form giving and user insight, a collaboration of design and programming skills. The fallacy of separating programming from architectural design is that traditional programming builds from the inside out and is two-dimensional in nature. It assumes that complete building requirements and operational systems can be established without testing context-sensitive site and building concepts. In this kind of programming the emotional needs of patients and their families, the need to reduce stress among the staff through appropriate design and environmental friendliness and effective strategies for conserving energy, often get short thrift.
Two-dimensional programming is quantitative in nature.
It is derived from a narrowly focused analysis of user function divorced from any special knowledge of the needs of that specific building type, functional or emotional. In many occasions, in response to this type of architectural program, the building is conceived in a formalistic sense as sculpture. Imagine a hospital conceived as a monumental building, importance being given to symmetry and a grand entrance with an atrium lobby, or worse, maybe two triangles with points touching! The needed space is then stuffed into the building form in the best way possible. Such approaches ignore the actual needs of those for whom the structure is intended.
Great architecture needs interaction between programming and design. The programmer needs special knowledge of the building type, knowledge that transcends space needs derived from activities and objects that the building is to house. The program must additionally be derived from particular problems, particular needs that necessitate an insight into the way the building functions and the particular emotional needs of its users.
That is, a third dimension is needed in programming. It is a dimension that contains sensitivity to the special needs of that building type, thus bringing the program out of the paper.
Three-dimensional programming is qualitative in nature.
In the teaching of Buddha, there are three things that make all the difference between your meditation being merely a way of bringing temporary relaxation, peace and bliss, or of becoming a powerful cause for your enlightenment and the enlightenment of others. They are called: “Good in the Beginning, Good in the Middle, and Good at the End.”
Architectural design can be seen as a progression from a more abstract representation of a building to a less abstract form of the visualized end result, the completed building. A Buddhist might argue that even the completed hospital is nothing more than an illusion, but for the purposes of this article we will maintain that there is a “solidifying” of sorts over the duration of the project. Programming is the first step of this process. Good programming makes for a good beginning.
Good in the Beginning springs from the awareness that we and all sentient beings fundamentally have the Buddha nature as our innermost essence, and that to realize it is to be free of ignorance and to put an end, finally, to suffering. So each time we begin the practice of meditation, we are moved by this, and inspire ourselves with the motivation to dedicate our practice, and our life, and to the enlightenment of all beings.
What I am recommending, so to speak, is simultaneous programming and design. The program has to be derived from the concept, and simultaneously it has to define the concept. It must speak of the building as an architectural object, with all the associated perceptions of being perceived as a work of art, and at the same time it has to efficiently address the needs of its users. Beyond this, it must establish in the collective client’s mind the potential inherent in a well-designed building. The program must be very down to earth, have both feet firmly on the ground, and simultaneously must give us a glimpse into the nirvana of the afore-mentioned Buddhist. It should contain the seed of an insight into the problem, put us into the frame of mind conducive to finding a good solution.
Good in the Middle is the frame of mind with which we enter into the heart of the practice, one inspired by the realization of the nature of mind, from which arises an attitude of nongrasping, free of any contextual reference whatsoever and an awareness that all things are inherently “empty”, illusory, and dreamlike.
Healthcare architecture needs to mirror sub-specialization in a way that reflects the needs of the clients we serve. Healthcare providers are looking for a high degree of skill, expertise and experience while selecting architects for their hospitals. There is also an ongoing initiative to humanize the health care environment and an acknowledgement that health care buildings are major works of architecture that have impact as buildings, both on the community they serve and on those who use them. In selecting a planning team, enlightened healthcare providers increasingly are looking for a blend of specialization and design leadership. These forces reflect basic market-driven economics. Clients will select firms or combinations of firms that are perceived to have an effective blend of specialization and architectural design commitment. Such firms, or combinations of firms that routinely work together, that offer a successful blend of these skills will increase market share by providing a unique understanding of health care and architecture that can be applied interactively during the programming and design process. In the end, it’s about touching excellence in what you do.
Good in the End is the way in which we bring our meditation to a close by dedicating all its merit, and praying with real fervor: “May whatever merit that comes from this practice go towards the enlightenment of all beings; may it become a drop in the ocean of the activity of all the buddhas in their tireless work for the Liberation of all beings.”
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