Collaborators Must Work Together to Share Results

Clinicians and Healthcare Professionals Collaborating With Designers

Many healthcare architectural and design firms have added clinicians to their staff and benefitted from the additional capabilities and expertise these professionals bring to the design process (Stichler, 2010). It pleases me to believe that the majority of these clinicians and healthcare professionals have a genuine appreciation for evidence-based design as a means of encouraging improved design decisions. As someone who employed nurses while I was a practicing hospital architect, I was pleased to see that these specialists had meaningful roles within the workshop firm’s design process.

When this collaboration is working well, the clinicians are respected by the designers and considered to be a full partner in the planning process (Stichler & Gregory, 2012). They work together closely on aspects of the project where the experience of the clinician can inform the designer of important functional issues. The clinicians, as they adapt to working in the design process, must learn how a project moves through the increasingly specific phases of design and documentation and how best to communicate with the designers. The designers must learn to understand the concerns brought forward by the clinicians and find ways to incorporate this valuable input into the planning process. Design professionals (like architects, interior designers, and engineers) and clinicians (like nurses and physicians) rarely share an educational or training background and have had dissimilar experiences prior to finding themselves sharing responsibility for healthcare facility planning. Working together with open communication, mutual respect, and complementary skill sets produces joint products superior to what either might have accomplished without the other.

The designer–clinician collaboration model has been successful for so long that it is neither controversial nor surprising. Some firms, however, may not have adopted the model because of the cost of adding staff that cannot produce drawings or because they have insufficient healthcare project volumes to justify additional specialized staff.

Researchers Collaborating With Designers

The firm with which we interacted in the recent workshop has several researchers with doctorates who are available to assist with business development, project description, programming, literature review, preparation of research summaries and analysis, and the ability to perform postoccupancy evaluations that do not involve the responsible design team. And even more important, the research group has a budget independent of individual project managers. As someone who has advocated the use of trained researchers within design practices, I was excited to learn of the progress they are making.

Unlike the designer–clinician collaboration model, designer–researcher collaboration has not been common in practice for very long (Hamilton, 2011). Just as with clinicians, some firms may not have adopted the research model because of the cost of adding staff that cannot produce drawings because they have insufficient healthcare project volumes to justify additional specialized staff, or simply because they have not considered how to make effective use of these skills within their design delivery process. As a new capability or service for firms to consider, the addition of internal researchers in firms is evolving slowly. A few firms that have added researchers are not yet clear on how to incorporate research efforts within project budgets and how to get the best value for their investment.

The researchers, just as the clinicians before them, must adapt to working in the design process and learn how the project moves through the phases of design and documentation and how best to communicate with their design colleagues (Hamilton, 2009). Researchers in practice cannot behave like academic researchers at universities. Much of their effort will be to interpret and simplify the research findings for consumption by nonacademic colleagues. The designers must learn to understand the material brought forward by the researchers and find ways to incorporate this valuable input into the planning process. The designers, however, did not learn about research, literature review, evaluating the quality of scientific papers, or extracting the design implications of research while they were receiving a traditional design education. They need much gentle guidance through this unfamiliar process.

Just as has been the case for designer–clinician collaboration, designer–researcher collaboration requires working together with open communication, mutual respect, and complementary skill sets to produce joint products superior to what either might have accomplished without the other. This method of working together requires some time and shared experience to become the normal way of delivering better projects.

Mind the Gap

During the workshop, I noted with concern several comments in which the participants expressed frustration with episodes in which the work products of the research group had not been considered by the designers who had been provided with research summaries and interpretation of implications for the project. The potential for evidence from current research to improve design decisions was lost and ignored. I do not pretend to know what actually happened, but it was clear that all is not well with this part of the process, and I found myself considering two trains of thought that may or may not be relevant.

First, there is apparently a serious problem with the process. When the research group independently prepares material and “hands it off” to the design team, I am led to believe they are not working together, side by side, with common goals as is done in the designer–clinician collaborations. The designers are therefore far less likely to understand and value the research input, since they played no role in the search and interpretation. The process gap may be one of failing to work together or not spending enough time in the same room on a common task. Building mutual respect and understanding requires a good deal of face-to-face interaction and open communication. I hope the workshop firm is prepared to resolve this apparent disconnect.

The other concern is that the decision about whether to use the information generated by the researchers may lie with old-fashioned designers who cherish complete control of a subjective and primarily aesthetic design process. These capital D designers might be rejecting a perceived limitation on their design freedom, and this new research stuff may appear to stifle their creativity. Maybe they are set in their ways, approaching retirement, and unsure about how to use this new information. Based on the comments about them, it certainly seems they lack an appreciation for evidence-based design. I’m sorry, but I have no sympathy for these creative dinosaurs. I believe it is unacceptable for a designer to simply reject, without review, any input that might allow for improved design decisions on behalf of the owner. This becomes a failure not only at the level of the individual head-in-the-sand designer but also at the level of senior management within the firm. Recalcitrant designers should be sanctioned and corrected by enlightened leadership or dismissed. Imagine what the reaction would be if the designer refused to consider valuable clinical input or decided to ignore material that impacted the project’s future sustainability or the project’s limited budget. The firm’s leadership must play a role as an internal champion for an evidence-based design process (Hamilton, 2009).

Working in Effective High-Performance Design Teams

The literature on teamwork includes advice for high-performance teams (Katzenbach & Smith, 1993). It seems to me to be relevant for these designer–clinician and designer–researcher teams. We are told a high-performance team is a small group with complementary skills committed to a common purpose, joint goals, and mutual accountability. I suspect that high performance for the design team in its interactions with clinicians and researchers can be reached if they are fully integrated into a single team, sharing their understanding of the project goals and working together closely to achieve the common project goals for which they are jointly accountable. The complementary skill sets are guaranteed by their multiple disciplines (Hamilton, 2010). It can’t be successful without plenty of honest communication and mutual respect.

If they will learn to consistently work together to incorporate the best available information from multiple sources, I have full confidence that these effective teams of designers, clinicians, and researchers can produce ever more outstanding results for their clients. Superior shared results require respectful, productive, and enthusiastic collaborations.