Design Quality Standards: Intangibles that bring hospitals to life This research project assesses the effectiveness of a step-by-step model for developing site-specific, meaningful and measurable design quality standards, while creating supporters who were prepared to implement them.
Tye Farrow, BArch, MArch UD, OAA, MAIBC, NSAA, NAA, FRAIC; Sharon VanderKaay, BSc Design, ASID
Bluewater Health in Sarnia, designed to provide ‘light, life and comfort’ (photo courtesy Farrow Partnership)
For over 25 years, the terms ‘patient focused care’ and ‘healing environment’ have been in common use by hospital administrators and healthcare design professionals. Despite well-intentioned efforts to provide psychosocially supportive settings, we continue to see spaces that demonstrate little empathy for the vulnerable state of patients, family and staff1.
Canadian architecture critic Lisa Rochon has described the majority of hospital environments as “factories built to contain the ill”. She continues: “Sadly, for the most part, inspired hospital design is wishful thinking.”2
Figure 1: The Hospital Asset-Liability Pyramid illustrates how intangibles can contribute to wealth creation
While there are rigorous technical construction codes that dictate the requirements for fire and life safety, no code protects the public from exposure to austere healthcare infrastructure. To avoid the risk of building hospitals that function merely to process sick people, decision-makers must confront the inherent challenges of defining, monitoring and implementing intangibles.
For example, the intangible design qualities of a hospital influence its position on the Asset-Liability Pyramid (Figure 1). In contrast to technical standards, design standards cannot be validated by means of traditional scientific methodologies. However, if such barriers to working with intangibles are viewed as insurmountable, it will be difficult to make a convincing case in support of economically vibrant healthcare assets.
Generic and vague statements such as ‘patient-centred’ or ‘re-thinking the 21st-century hospital’ may represent the sincere aspirations of decision-makers; however, these phrases are inadequate when creating meaningful, location-specific design quality standards.
Desire v reality
The research presented in this paper set out to examine the nature of gaps that frequently occur between espoused desires to create a ‘healing environment’ and the built reality of these spaces. This research began broadly by reflecting on over 10 years of conscious experimentation in the field with client stakeholder groups. Six questions were raised at this early stage: 1. Why is there frequently a gap between espoused aspirations and physical reality? 2. Can one assume that improved design quality standards will inevitably result in truly therapeutic hospital environments? 3. Are decision-makers capable of discerning the difference between facilities that are merely new in contrast to facilities that address complex psychosocial issues? 4. What motivates administrators and politicians to take a strong advocacy role in achieving optimal human-centric design? 5. What motivates apathetic or hostile decision-makers to become strong advocates for improved design standards? 6. Can we assume that the causal connections between intangibles – for example, design that conveys a meaningful identity and makes an emotional connection – and tangible outcomes, such as attracting staff and major donors, are apparent to decision-makers?
Several preliminary hypotheses for further study were identified as possible responses to questions 1-6 above. All of the themes that emerged from this early stage of inquiry were related to an inconsistency between espoused values and built reality. Explanations for this discrepancy that appeared worthy of further investigation included:
* a lack of rigour in defining what constitutes a therapeutic healthcare...
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