Academy of Architecture for Health

1.  What is Healthcare Design?

Posted 11-21-2012 16:08
I think we can all agree that Healthcare Design is unique in many ways, but as we think about the essence of "Design", I pose this question to the academy:

Is Healthcare Design fundamentally different from other areas of architecture?  How and Why?  Is that Good or Bad?

Kevin Turner AIA
The Freelon Group, Inc.
Durham NC

2.  RE:What is Healthcare Design?

Posted 11-23-2012 12:55

Michael Holtz FAIA
Michael Joseph Holtz, FAIA, Architect
Boulder CO

3.  RE:What is Healthcare Design?

Posted 11-26-2012 07:31
Healthcare Architecture is uniquely different from other design types for one fundamental reason:  the amount of regulation in terms of varying building codes and design standards.  The "Healthcare" or "I-2" building type has more regulation around it than any other building type.  It is the job of the architect to understand those regulations, how they relate, how they conflict, and how they inform what is necessary for a compliant design.  Often these are considered last because the architect is concerned with other things such as the aesthetics and artistic elements of the design.  Although aesthetics and design are important, this is not the correct approach.  The regulatory element sets the paramenters in which to be creative, and should not continue to be ignored. 

This is not a passive role in the design process, especially when dealing with use groups that may have not been involved in a renovation or design for their entire careers.  Too often "the way we do things" is often outdated or grandfathered, so the architect is called to lead the team in current thought and practice.  These current ideas are manifested in the current standards and codes such as NFPA 101 Life Safety Code, the FGI Guidelines, and, in 2015, the IBC, which recently adopted changes to become consistent with the current standards, in addition to ADA, patient movement, laboratory, radiology, and the multitude of standards that apply to healthcare.  Understanding of and experience working with these regulations is key to a successful healthcare design project, and sets it apart from any other project type.

Jeffrey O'Neill AIA
Senior Planner
University of Pennsylvania Health System
Philadelphia PA

4.  RE:What is Healthcare Design?

Posted 11-26-2012 10:55
While I absolutely agree with Mark's description of architecture, I would argue that Healthcare Design can and should be very different in healthcare.  The excerpt Mark posted concludes with the statement, "Architecture is about shelter and about delight; it is about meeting basic human needs, both physical and emotional."  When it comes to healthcare architecture, the requisite "basic human needs" become the need for survival, physical and emotional healing, effective decision making, and respite.  Another thing that is somewhat unique to Healthcare Design is the need to consider and design for so many different user groups, going beyond the separation of "onstage" and "offstage" design.  All this must be accomplished within the parameters of code requirements, best practices, tight budgets, and often while tying in to existing work.

We can look at these narrow parameters a good thing, as "design opportunities" in which we are reminded to maintain all the essentials of a safe and healing environment while developing a unique design language for the project.  Stringent requirements have the potential to sharpen our design solutions, not flatten them.  This is demonstrated in the beautiful projects that have been built in recent years.

Elizabeth Ernst AIA
Healthcare Planner
The S/L/A/M Collaborative
Glastonbury CT

5.  RE:What is Healthcare Design?

Posted 11-26-2012 12:23
I welcome this opportunity to say a few things about current "Healthcare Design" that have bothered me for some time.  I started working in health care architecture in 1966, after nine years doing several other building types, including three years in the hospitality sector (more about that shortly).  Though no longer active, I still receive a few healthcare design magazines each month (I don't subscribe, but they keep coming), which illustrate a terrible disconnect between what healthcare architects are now doing, and what the newspapers regularly and rightly describe as a national crisis in the unsustainably increasing cost of health care in this country.  Much has been said about the disproportionate share of the nation's energy consumption attributable to buildings not designed to be energy-efficient, and the responsibility of architects to design sustainable buildings that do not contribute to energy waste, and thus to global warming and climate degradation.

But nothing seems to be said about healthcare design that adds cost with no true benefit for the patient treatment and care that is the only reason for the healthcare building to exist. And because those unnecessary costs are added to the daily rate charged for patient care, they are added to the nation's unsustainable health care costs.

When I started in this field, there were strict limitations on total building costs, enforced by state agencies (at least in New York) that would not have permitted even the suggestion of what I see in the current magazines. Construction cost is only part of the problem; function is another:  Large atrium lobbies with elaborate architectural features, hanging light fixtures and sculptures that no housekeeping department can hope to even dust, much less clean, when a surge in hospital-acquired infection demands buildings that can be kept far cleaner than in the past.  Elaborate gardens that no one uses, but do photograph well (when was the last time you saw a patient wheeled by a staff person into a hospital garden except in 1930s Hollywood movies?). Patient rooms trimmed out and with family accommodations that rival, along with the atrium lobbies, anything in my earlier experience in hospitality architecture. But patients and family are not there for a holiday;  they want to get in and out as quickly as possible (an objective insisted upon by the health insurance industry).

Building exterior features share this abundance (and also photograph well). The list could go on and on, but I think the point is made.

Trade magazine narrative is replete with language about patient comfort, family member satisfaction, and staff amenity that, in my view, is little more than eyewash justification for fulfilling architectural design aspirations. And it surely starts much earlier than the magazines, with convincing by the architects of the clients of the necessity of all these things to maintain a competitive advantage in the business of health care, therefore the clients are equally culpable.  And the nation is the poorer for it all.

Certainly much has evolved in medical technology that requires substantial investment in facilities that accommodates its use, and that is where the money should be spent.  But not the frills!

Sidney L. Delson, FAIA Emeritus
East Hampton NY

6.  RE:What is Healthcare Design?

Posted 11-27-2012 08:11
Design is design, regardless of the building type. It encompasses all aspects of architecture, including codes, fumnctions, and economics. It is certainly not limited to aesthetics. All building types have their inate rules, and it is always incumbant on the architect to understand them when undertaking a project. But simply knowing and following the rules does not produce good design. It is the synthesis of rules and practical requirements with aesthetics and spatial form which make architecture, regardl;ess of the specific use.
Jerry Roller AIA
Firm Owner/Architect
JKR Partners
Philadelphia PA

7.  RE:What is Healthcare Design?

Posted 11-28-2012 08:19

Jack Kerr AIA
Senior Healthcare Architect
Array HFS
King of Prussia, PA
I agree with that Design is Design. If we reflect on "Form follows Function" then Design is based on the function of the building. Every building has its own special needs. A church, synagogue, hotel, office building, museum, school and yes a hospital each have unique needs for their special functions. It is the function of the building that requires an expertise that is in addition to design. How we as Healthcare Architects mold the forms around the functions and comply with the minimum requirements, building construction regulations, etc. is the artistic part of the profession.

8.  RE:What is Healthcare Design?

Posted 11-28-2012 18:02
In addition to the special technical considerations previously mentioned in this discussion forum, healthcare facility design is uniquely challenged to understand and successfully address the "What" and "How" complexities of multiple stakeholders and often conflicting client program requirements & priorities, with achievable solutions that also respond to the operational & logistics constraints of building in and/or around occupied healthcare facilities. Further, healthcare design solutions must also be adaptable, understanding that actual end-users rarely participate in establishing the original design requirements.

Peter Dawson AIA
Texas Childrens Hospital
Missouri City TX

9.  RE:What is Healthcare Design?

Posted 11-26-2012 19:31
Michael, judging by the thoughts below your post it appears that you are asking your question from a process viewpoint and with that in mind I'd say the healthcare design process is the same as for any building type - it is still problem solving in its purest form. But the day to day practice of healthcare architecture places different emphasis on aspects of the problem your are asked to solve.  Healthcare design involves many more layers of Code compliance, calling upon the A/E team to determine the most restrictive Code of perhaps several that have bearing on the design.  State approvals are required for most types of projects such as added patient beds or operating rooms before they are assured they can proceed. A client's wants are not always approved by the AHJ.
The cost constraints in healthcare are about as great as they can be. We often talk of 10 pounds of program wants for the 5 pounds of budget.  We live in a world of "Value Engineering" which forces all to recognize those mission-critical pieces of the projects and perhaps jettison those that don't make the cut. 
The functional aspects of healthcare problem solving requires assembling the proper team of consultants and vendors once the design team has been thoroughly educated by the clinical and technical representatives of our clients as to their process, their equipment, the changes they anticipate in the future.  No architect should ever think they can start designing until they have listened to and learned from their client. Each client is different; there are no set answers. Once design is evolving it must be mocked-up, reviewed and checked by all team members every step of the way.  Healthcare design is very much a participatory team sport.
I could go on and on having spent the majority of my career learning and practicing and architecture. 
When I think of my peers designing for example office space I can say - yes there are similarities but there are also many unique aspects to healthcare architecture that make it different and much more demanding. 

David Gardner AIA, ACHA, NCARB
Gardner Plus Architects, PLLC
Rochester NY