Five Lessons From Architectural Design

Closler.org has an email subscription of ~6,000 healthcare providers and is regularly visited by thousands of individuals from 70 countries. 
Emerging professionals in architecture and medicine are moving beyond infrequent intersections and seek a convergence of career models. What can clinical practice learn from the design field of architecture?

Here’s what I’ve learned in my career as both architect and physician:

Lesson 1: “Always design a thing by considering it in its next larger context – a chair in a room, a room in a house, a house in an environment, an environment in a city play.” – Eliel Saarinen, Finnish Architect, 1873-1950
Architects are taught to respect context and design for the experience of being in a place. As providers, learning the context of our patients and their social determinants of health is key to the biopsychosocial model of care. It becomes more than just the pathophysiology of presenting illness or symptoms.

Lesson 2: One size does not fit all.
At a recent design meeting for a critical care renovation project, the intensivist noted the provision of a large conference room in the proposed floor plan which could be used for both rounds and to break bad news to families. The physician recounted that from his experience, under or oversized rooms can have an effect on the experience of these difficult conversations – a separate smaller room is often needed. As providers, we know that patients and disease effects are not created equal. Patient health burdens can be unequal within a similar pathophysiological framework.

Lesson 3: In architecture a “parti” is the central idea of a building, usually represented as a diagram in shapes to explain the design concept.
As designers, we need a way to explain the idea of our product. We use the parti as a guidepost in designing the many aspects of a building, and always consider how its design can express and reinforce the essential idea of the building. In medicine, our patient histories involve a chief complaint and history of present illness, but what would happen if our clinical parti was the social history and the patient’s overall narrative as our foundation –  who they are, what is important to them. These should never become lost and should always ground us in the care of a patient.

Lesson 4: “We shape our buildings: therefore they shape us.” – Winston Churchill
Architects design for experiences by developing spaces for people. Indoor and outdoor spaces, buildings, landscape architecture, and city planning have important effects on us – design can promote exercise and health, keep us safe, inspire us and made us feel good or bad. As providers, we care for people and in the process impact their lives. In return, patients can profoundly impact our practice and lives as well. Just like architecture, medicine is not only a science but also a craft.

Lesson 5: “The Sun does not realise how wonderful it is until after a room is made.” – Louis Kahn, American architect, 1901-1974
In architecture, the concept of void or negative space is something we incorporate into design of buildings. There is a well-known series of black and white photographs which capture the sky by viewing upwards within narrow European streets. The building facades are in silhouette around the edges and the sky becomes a form, shaped by the buildings. One cannot have a building without the framing of abstract spaces/voids; the negative can become the positive and the two work in harmony to create the whole. As clinicians we cannot forget this “negative space” in addition to the positive. Sometimes not pursuing a treatment may be the best option for a patient, or even just a silent pause during a patient history can give someone a chance to mention something important.

Together, clinicians and architects can find a balance between illness, health, and design, inspiring the emergence of a new mode of practice. Therapeutic design as a form of treatment and support requires participation of both the clinician and the architect.