By Anahita Sal Moslehian, PhD, EDAC
Anna is a professional researcher working on healthcare building design. For more than five years, she has been examining the impacts of hospital building design on occupants’ health and wellbeing to create facilities that promote healthier environments for patients and staff. Anna’s expertise expands to design innovation, biophilic design and restorative environment design. During her PhD study, Anna developed her systematic thinking and interdisciplinary research skills that are crucial for generating knowledge in the highly multi-disciplinary context of healthcare design leading to timely design innovations. She is currently a Postdoctoral Research Fellow with HOME Research Hub and Live+Smart Research Lab in the School of Architecture and Built Environment at Deakin University.
LinkedIn: www.linkedin.com/in/anahitamoslehian | ORCID 0000-0002-5692-6748
Evidence for the impact of place
Correlational evidence suggests that place can significantly impact a person’s health, well-being, emotions, self-esteem, security and identity. The impact of the built environment on health and well-being is particularly important when considering the design of healthcare facilities. This is especially true for the most complex form of healthcare building – the hospital.
Medical practitioners, architects, and environmental psychologists have long acknowledged the link between hospital buildings and outcomes such as the potential mitigation of ill health, improved workplace performance, lower staff turnover, and greater organisational efficiencies. Hospital building design innovation may play a critical role in enhancing the quality of care, promoting the healing process, and overcoming past errors and inefficiencies.
The Research-Practice (R-P) gap
Despite the steady increase of research in this field, it seems that few innovations are generated from this research and the process of change is too slow. Hospital building designers and policymakers often face obstacles in fully integrating research evidence into design practice; a phenomenon known as the Research-Practice (R-P) gap. The literature highlights the R-P gap as the biggest challenge of all hindering innovation in hospital design, leading to repeated, similar shortcomings. Six main groups of causes are discussed for the R-P gap in the context of healthcare design with the aim of narrowing this gap and increasing the chance of design innovation (please refer to Sal Moslehian et al., (2020) for a detailed explanation of the reasons behind the R-P gap).
My PhD study, however, argues that an oversimplification of the wider context of the evidence base for the design of hospital buildings, including focusing on one object for innovation at a time, has been a prime obstacle to design innovation. Tracking the evolution of hospital building design through time reveals that hospital design has shifted and developed not just according to research, but also in relation to the strength of many other factors, for example, social shifts, political decisions and policies, war, and architectural design trends as well as medical and technological advancements (see Figure 1). Indeed, innovation in hospital building design is a complex ecosystem with various dimensions and the R-P gap is only a small part of a more complex picture. Overlooking this complexity and therefore insufficient understanding of the nature of innovation in hospital building design has been one of the critical factors in the shortage of timely design innovations in this field.
Figure 1: Schema illustrating the impacts of various factors on innovative moments in hospital design (Sal Moslehian et al., 2020)
The key aim of my study is to conceptualise the evolution of hospital building design over the past 100 years, as well as identify and explain the main factors triggering design innovation. I adopted systems thinking to understand the complex set of interdependent variables associated with hospital designs. My research highlights the main components of the innovation ecosystem, the most influential contextual factors, the most interrelated factors, and the overall behaviour of the innovation ecosystem in this field.
An explanatory innovation framework
Figure 2: The explanatory innovation framework in hospital building design (Sal Moslehian et al., 2022)
As can be seen in Figure 2, my research represents an explanatory innovation framework, containing 617 interconnections between 146 factors classified across 14 categories: Architectural Movements, Urban Reforms, Research Developments, Advances in Medical Science, Technological Developments, Shifts in Attitudes Towards Health, Transition in Institutional Identity, Healthcare Policy, Political Shifts, Economic Shifts, Social Transformations, Developments in Health Service, Shifts in Organisational Culture, and Shifts in Natural Environment. My study argues that the complex innovation ecosystem involves several dynamic actors and multi-faceted processes with both individual and collective impacts on design innovations in hospital building design.
The infrastructure of the innovation ecosystem suggests that design innovations generally arise in many different ways and are often subject to heterogeneous factors that are often neither linked nor mutually exclusive. My study helps researchers, hospital designers, healthcare developers, policymakers, and stakeholders adopt a multidimensional outlook to further develop the system by representing and mapping the successful processes and prior interactions between less-examined contextual factors in this field. This knowledge also allows for the identification of critical interventions and potential collaborations between key players on multiple fronts in generating innovation processes.
Lack of intent has never been the main reason behind any shortcomings in hospital building design. However, the lack of a holistic approach and thus an accurate understanding of the interplay between involved factors, as well as the inability to see how different forces align to add value to the system, have contributed to a lack of understanding of the dynamics of change.
Given the critical role of the healthcare industry, better knowledge of the nature of innovation in hospital building design can not only enhance healing processes and increase organisational efficiency. Such knowledge can also inform stakeholders in other construction industries leading to further innovation and value creation.
Considering the increasingly growing demand for health for all, design innovation in different building types will bring unprecedented opportunities to the health and well-being of humans/society and the environment/ecology.
Sal Moslehian, A., Kocaturk, T., & Tucker, R. (2021). An integral view of innovation in hospital building design: understanding the context of the research/practice gap. Building Research & Information, 1-16.
Sal Moslehian, A., Tucker, R., & Kocaturk, T., Andrews, F. (2022) The Nature of Innovation in Hospital Building Design: A Mixed Grounded Theory Study. Construction Innovation. Ahead-of-print.
Sal Moslehian, A., Tucker, R., Kocaturk, T., & Andrews, F. (2022) An Analysis of Design Innovation in Hospital Building Design over the Past 100 Years. HERD, Health Environments Research & Design.