Healthcare Designers and Research

Dr Jane Repin Carthey

I recently peer-reviewed an academic paper that explored how well architects and other designers understand and value ‘research’. The author also looked at the degree to which architects engage in or initiate research studies, and then apply original findings to their projects. Reading this paper led me to reflect on how architects define research, and the place of it within the myriad of other information sources that influence architectural work. It also led me back to some research that I conducted earlier in my academic career in conjunction with the then Royal Australian Institute of Architects that investigated the sources of information that architects preferred to use to support their practice.[1]

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Definitions of research

Research can be defined as the search for, and creation of new knowledge. There may be a problem to solve, an idea to be tested, or facts to be established. Research requires more than simply the compilation of existing knowledge to answer a question or to provide evidence for a design decision. In other words, more than simply reading design magazines or trade journals looking for ideas – although this can be useful. Research findings should also be shared, tested, and hopefully evolved by means of further research. Yes, it never ends!

Research for designers

Design research has its own characteristics and application of it to design decision making is different to how research findings are applied in other fields of practice. Some designers are suspicious of research perhaps thinking that using its findings will reduce their creativity or cramp their methods of working. Healthcare designers cannot afford to think this way as they must work with clinicians and other users who use research to guide their practice for example, Evidence-based Medicine (EBM) that relies on the outcomes of scientific, and usually quantitative research. Evidence-based Design (EBD) is often promoted as the design equivalent to EBM. This is a simplistic response that often fails to appreciate how design practice differs from clinical practice especially in terms of how decisions are made by practitioners in each professional area of expertise. This is an important topic that I will talk about in future posts.

How does research fit with the sources of information that designers use?

My study was undertaken in 2005 and published in 2007, but I suspect not much has changed in the meantime. The results of a survey showed that healthcare designers most preferred to use their own experience from previous projects plus their own ‘research’ followed by information provided by their client. Guidelines and standards came next. The nature of ‘original’ research was unfortunately not further explored by the study but would have been an interesting question to ask at the time. Research summaries by others were tenth in the list as can be seen in the table below.

Top 10 information sources used by health architects

So what does all this mean?

The 2007 paper discussed the findings shown in the table, and suggested that personalised and subjective approaches to information use are common among healthcare designers. The pressures of practice and time constraints also work against the use of more research findings by design practitioners. Further digesting the research findings to inform design decisions may require interpretative skills that not all designers possess as a result of their previous professional training and practice. Yet these days, the increasing use of EBD means that more designers are accessing research findings and quoting them in their submissions and to support their design decisions.

Hopefully, design students are increasingly being initiated into the world of research and given the opportunity to conduct small scale research exercises as part of their studies. In the world of practice, post occupancy (POE) and other forms of design evaluations offer the opportunity to gather research data. These opportunities offer healthcare architects the means to contribute towards developing a body of knowledge around how to improve healthcare design projects in Australia and other countries. Project clients such as Health Infrastructure (HI) NSW use POE to inform development of health facility guidelines and this is highly appropriate. To understand more about how HI NSW undertakes POE, you can view the presentation on the subject (available to members only) in the Australian Health Design Council past presentation archives.

POE is also relevant to practice settings, for disseminating information and ongoing education of healthcare design practitioners as they go about their daily work. So let’s have a conversation about designers and research as an introduction to using the research showcased by this blog.

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What does research mean to you? And how do you do it or use it to inform your design decision-making on healthcare projects?

[1] Carthey (2007), Healthcare designers and information use, Connected 2007 International Conference on Design Education, 9-12 July, UNSW, Sydney, Australia.

99 Ways to Flexible Hospital Design

By Dr Harm Hollander

Dr Harm Hollander – eternal student!

Harm Hollander is a Principal with Conrad Gargett and has a desire to advance improvements in the health care environment. A Fellow of the Australian Institute of Architects, Harm has also lectured in Construction, Professional Studies and Design at various universities.  He has developed comprehensive skills in leading large projects from commencement to completion, working meticulously through brief, design and delivery challenges. As a recent graduate with a Doctorate of Creative Industries, Harm remains the student in seeking further improvement towards better design outcomes.

ORCID 0000-0003-0234-976X

Design flexibility and adaptability inside hospitals

Design flexibility inside a hospital building serves as an enabler for a health service to clinically progress.  The definition of flexibility has, however, had a disparate response from various researchers and a lack of a universal understanding has led to a restricted over-arching view.  This resulting level of comprehension directly affects a potential design.  Design, being a responsive solution to a set of issues, attempts to develop a synthesis from a wide range of inputs.  The more comprehensive the inputs, the more enhanced the design solution can be.  This research investigated the relationships of flexibility categories inside hospitals, recognizing the subject consists of physical solutions, human behavior, wider systems, accessibility towards ready-change and prioritization.  In the first instance, it presented a summarized, objective-based, open-ended, method of approaching flexibility inside hospitals.

The research framed and collated divergent existing knowledge.  This mapping formed a basis to respond to the future with innovative designs, by first allowing an understanding of both the objectives and techniques of flexible design.  The resulting publication,  99  ways towards flexibility inside hospitals, communicated the synthesized and collated catalogue of available methods.  Design opportunity could therefore follow as a response.

An example of design opportunity: Premanufactured volumetric construction

An often-cited constraint of a premanufactured module system is its tendency to be delivered with non-flexible, load-bearing walls or at least, with added bracing inside the partitions to face the harshness of transit. Any such hindrance towards future change to walls is certainly not flexible and does not allow the hospital to keep up with the health service. A health service nowadays is fast-developing, and the building which accommodates it needs to be responsive to the accelerating need for change. In some premanufacturing projects, this first barrier to flexibility has been overcome by providing an independent structural frame, rather than load bearing walls. The need for the additional bracing has also been overcome by making these elements redundant (or at least, relocatable) after the building modules are assembled on site. Designers must, of course, remember to clearly identify the expendability of the bracing so that it is clear to ongoing trades who open up walls in the future. 

However, hospital flexibility is more than the ability to move the internal walls.  Once the changeability of partitions has been tackled, there are many further adaptability opportunities in modular construction. These include:

  • Consistent presentation:  It is an advantage for hospital users to utilise repeated building elements. An example may be a uniform consulting room. The uniform presentation ensures familiarity and a universal procedure[1], reducing a risk of errors (in health care, a small lapse of attention can be significant). Prefabricated building units have a greater chance of keeping their elements similar because of their regular set-out and the factory technique embedded into the nature of production.  
  • Universal rooms[2]: Generic rooms which suit multiple functions. For instance, a bed room may be structured to suit a regular patient, mother, child or obese patient. Each function can swing with little alteration.  With the room being suited for multi- purposes at the outset, it is likely to be rounded to a size which suits the multipurpose function and this again coincides with modular construction where the regular manufactured component is also expediently rounded. The result of the premanufactured module technique is a planning layout which is more likely to serve multi-use universality.
  • Modular planning:  The technique allows zones to capture a number of varying suites or rooms. Examples may include a series of operating suites or imaging modalities. Unlike universal rooms, this technique is more an allocated floor allowance, requiring a level of construction to move from one state to another. The technique is significant because it allows evolving change to clinical needs. Again, premanufactured construction is more modulated by its nature and has a greater predisposition towards modulated planning allowances.
Approaches to flexibility

The informed and collated flexibility offered by prefabricated modular building systems represents the opportunity. Naturally, these advantages do not just fall into place. Designers will need to develop informed planning priorities to gain the benefits. Each new design should strive to improve the last. This process will incrementally increase value as well as the ability for hospitals to better face the future.

Innovative contribution to policy and practice:

Since global approaches to hospital design have substantial commonalities, this research contributes to enhancing the design of future universal hospital stage-sets. The potential provides founding information to design continued improvements in clinical outcome, efficiency, value and satisfaction.

[1] There is ongoing opinion on whether reverse handing or mirroring layouts present enhancements or hindrances.

[2] Some variances on this theme are loose-fit rooms, the ‘duffle coat’ approach (reference to a limited range of incremental sizes of a coat in a few select sizes, to fit all) and multi-purpose rooms.

This is the first in a series of posts that Harm will write for this blog about designing hospitals for flexibility and adaptability!

A Better User Group Experience?

Dr Jane Repin Carthey

Why have design user groups at all?

Ever wondered why we consult with user groups on healthcare design projects? We all know that user groups can be really helpful but they can also be incredibly frustrating. As every healthcare designer knows, managing the user group process efficiently and effectively is key to getting the best out of it for our projects.

My recent research for a Doctorate in Creative Industries asked why the user group process came about. It also explored how those who have experienced it on recent projects in Australia and New Zealand rate its success. It also looked at how different types of users (e.g., clinicians, managers and designers) think about key issues such as design quality and the importance of this in creating a successful project. Users were defined as those who will “use” a new or refurbished healthcare facility. They will work together in a design user group usually led by a designer or project client representative such as a project manager/director, drawn from an inhouse role or an external consultant.

Research findings

So what were the main findings?

  • Designers are far more experienced with the design of healthcare design projects than almost all other user group members – no surprises there as this is usually their bread and butter work, and most have made it a focus of their practice and careers.
Designers are more likely to have greater experience with health design projects than other user group participants
  • Designers are more realistic about the faults and issues that arise in user group design settings – and in most cases think that it is probably the best way to design a healthcare facility compared to other possible alternatives.
  • Clinicians are often very cynical about the process. They are usually much less experienced in hospital design as design is not their focus or pre-occupation given their day to day jobs are to treat or look after patients!
Clinicians are more likely to believe that the user group process achieves ‘poor outcomes’ for projects than designers believe.
  • Managers, including project managers leading the design process on behalf of the project client, are keen to please as many people as possible – it makes their jobs easier and there is less chance of political interference if the clinicians are happy! Hence they sometimes make impossible demands of the design team in terms of program, time and scope of works for the design team.
  • When these impossible demands are met, everyone is unhappy and the project suffers.
In terms of achieving the requirements of project clients or funding bodies, clinicians were more likely to feel that the process achieves poor outcomes.

No surprises there either for anyone who has been through a user group process!

So what does this mean for designing our healthcare projects?

I am going to touch on a few key suggestions now, and expand on them in future posts.

To start with I suggest that we need to do the following things better:

  • Understand how other user group participants understand the world and how they make decisions. This includes how professional training and work practices shape interactions with colleagues within a profession or discipline, and also interprofessionally.
  • Appreciate how evidence from research is valued – as this should inform our design decisions.
  • We also need to appreciate the attitudes towards leaders and views about collaborating with others in a sometimes messy, extended process. This process often requires compromises and acknowledgement of the viewpoints of other team members.
  • Project governance – this is a whole topic all on its own – and many useful suggestions came from the research.
  • Decide and communicate exactly what a user group is supposed to do including the power it has to make or influence project-related decisions.
  • Evaluate the success of user groups in terms of achieving project aims and objectives – and learn from these evaluations to improve the future outcomes of the user group process.

This is just a very short introduction to the findings from my research. I will share more in future posts. I look forward to your comments and discussions on this topic.

A workshop run at the ACHSM Conference in 2019 worked with users to create greater understanding around how to improve the user group design process – more on this in future posts!

What’s next?

My next post will look at how our professional training shapes the way we see the world, analyse problems, and collaborate with other professionals.

What is the focus of this blog?

Dr Jane Repin Carthey

The Australian Health Design Council promotes the use of evidence-based healthcare design. We also believe that we need to support the development of, and then to share widely the research that provides this evidence especially when it comes from academic and similar expert sources. We want to share rigorous, practical and useful research findings that can be applied to improve the design of our healthcare facilities.

Let us know if you can help us discover this and alert us to interesting research projects being conducted especially in Australia and New Zealand. Also, if you are working on a research project that may interest our members please drop us a line so that we can work with you to promote your work by inviting you to post on this blog. We look forward to hearing from you.

Why has AHDC started this blog?

Dr Jane Repin Carthey

Sharing research about health facility design with industry colleagues was one of the main reasons that the Australian Health Design Council (AHDC) was set up in 2012 by Editor Jane Carthey and colleagues. AHDC now has a well-established program of regular events for our members sharing health design innovations, evidence and experience. So it’s now time for us to go further in delivering value to our members. We invite you to view this blog regularly, and to contribute your experience and expertise wherever and whenever you can. This is a new and exciting journey for the AHDC and we invite you to join us on it.