Design and Health World Health Design

Standpoint: Designs on shared ground

Sunand Prasad says that building interdisciplinary relationships is key to the delivery of good design.

The emergence of patient-focused medicine in the 1980s, followed soon after by patient-focused design of health facilities, were part of a change in the way the relationship between consumers and producers was viewed in our working culture. We realised then what now seems so obvious – though is still neglected – that focusing on the needs of the ‘customer’ greatly increases the value that services and products release.

The therapeutic value of good design has come to be widely acknowledged, both directly by creating a healing and stress-reducing ambience, and indirectly by benefiting the operational aspects – greater clinical effi ciency and improved staff morale. I would argue that a well-designed environment will even improve the quality of thinking and innovation.

What remains elusive is how to consistently deliver good design and how to systemically identify and clear the obstacles to that delivery. Although knowledge and skill are important, I believe that there are two greater challenges. Firstly, consistent good design requires leadership and passion, especially at the top of an organisation. However, not enough people in these positions are yet convinced of the argument.

The second challenge is that without excellence in collaborative processes and interdisciplinary working, you cannot achieve good design. The disciplines of architecture, engineering, landscape and project management remain inadequately integrated and silo attitudes prevail, developed from early days in the education of professionals. And the interface between these and the medical clinical professions is also insecure.

Leadership – there is no substitute for bloody-minded determination. Those of us that believe in, and are committed to, good design have simply to go on convincing non-believers. We need to recruit more consumers to the cause since market pressure is the most effective way of influencing the behaviour and objectives of those in public organisations who are not yet on board. Now more than ever the value argument has purchase. Bad design or the provision of second-rate environments should be as intolerable and unacceptable to the consumers of public services as patient neglect or indeed inflated banker bonuses.

Collaboration – from the identification of business needs to the maintenance and periodic modifi cation of a facility, we need to join up the thinking as well as the project process. A key is for interdisciplinary teams to be assembled in a way that is appropriate to each stage of the process. Architects have an opportunity to step up to the plate and provide leadership. But they must understand that their knowledge has no traction without the knowledge of others – facilitating a synthesis of objectives and intellectual effort should be an integral part of being an architect.

A building project is only one of the possible solutions to an organisational or business need. True interdisciplinary working must start at the very beginning, at the stage when such a need is being identified. Too often what happens is that decisions about service configuration and the location of its delivery are prematurely fixed in a way that compromises the whole result – practices ‘frozen’ into built form. There may be raw logic in saying that first you work out the ‘why’ and the ‘what’ of an organisation, and only then the ‘how’, but in reality they interact. This alone is a strong argument for interdisciplinary working, involving researchers, clinicians, academics and managers as well as architects and engineers.

Good client-side skills are indispensable to achieving excellence in interdisciplinary working but they are lacking in many public sector organisations round the world – and certainly in the UK where they have been allowed to degrade from the quite high levels reached in the 60s and 70s. Additionally, pressure on fees means less time to think and interact. It is a false economy – one which inhibits the achievement of value through innovation.

Now the climate change emergency has brought the imperative of interdisciplinarity into sharp relief. To create sustainable environments that support low or zero carbon lifestyles and business operations requires us to fully form any constructional solution in a much more intense and concentrated way than we have been used to. Never before has it been so urgent to assemble interdisciplinary teams at the start to achieve an encompassing view of the project – because true knowledge lies in the shared ground between the disciplines and not within any one.

Sunand Prasad is co-founder and senior partner of Penoyre & Prasad and president of the Royal Institute of British Architects (RIBA).

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