Healing Architecture: Evidence, Intuition, Dialogue

Licentiate thesis, 2015

In today’s healthcare architecture there is a striving to make better use of evidence to achieve environments that can contribute to patients’ healing, recovery, and well-being. These ideas are in part a legacy of the theory and practice of evidence-based medicine and the success it has enjoyed in its field. However, the volume of evidence in the field of construction is limited, and there is no reason to expect rapid growth anytime soon. This provides some explanation for why evidence alone cannot be expected to lead to healing architecture. But the design qualities for which research has found evidence of improved patient outcomes have long since been assumed and applied by experienced architects. To achieve a healing architecture, architects must embrace—and be allowed to embrace—the tacit knowledge of intuition they have accumulated over time. This intuitive knowledge is the fruit of the direct exchange they have with the surrounding physical environment through their experiences—in everyday life, in education, in professional practice, and so forth. Intuition is personal and subjective, but it is an essential tool in the architect’s work. By establishing a constructive dialogue with healthcare providers, the architect’s sketches, models, and ideas can be exposed to critical evaluation, questioning, and discussion. This minimizes the risk for arbitrarily designed buildings. The dialogue between architect and client organization, facilitated by the architect’s sketches, follows a cyclical pattern of proposal, evaluation, and modification that recurs in one iteration after another. At the same time, the architect and client work together in dialogue about each proposal to articulate and refine the organization’s demands and desires. Each of the participants has practical knowledge that may be hidden even to themselves, and dialogue brings that hidden knowledge to light so it can contribute to new thinking and innovative solutions. A positive side effect is that this process often leads to the development of the client’s own operations and organization. The point of departure for this licentiate thesis is an experienced architect’s critical reflections on his own design practice and extensive reading of research literature in the field. The work can therefore be placed in the tradition of practice-based research in architecture, present in Sweden for many years and currently in strong development internationally. The author’s objective has been to contribute to defining a healing architecture that joins the collaborative culture found in Sweden today with a strong American influence that argues for an architecture based on evidence.