-By Tama Duffy Day, FASID, IIDA, LEED AP

Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's article focuses on an applied research project focused on creating “generative spaces.”

In 2004 Dr. Wayne Ruga launched Leading by Design, an experiment to pioneer the next generation of improvements in health and healthcare delivery through the design of the environment. Leading by Design is an applied research project, currently working with 10 active case studies in five countries. Culminating in “generative space,” Leading by Design focuses on growing leadership attributes in one’s personal life, organizational and professional work, and community engagements. In the simplest of definitions, “generative space” is a place to flourish.

Bruce Raber, vice president and practice leader for healthcare at Stantec Architecture in Vancouver, B.C., a participant in Leading by Design for the past three years, states, “When Wayne first approached me about the project, I was excited about the opportunity to get involved with a group of people from around the world who all really wanted to make a difference. Through participating in Leading by Design, I have learned concepts about leadership that allow me to be a better leader in a generative organization and hopefully to use those skills to inspire our design teams to truly create generative space.”

Another participating in Leading by Design, James Lesslie, president of BýýLYÜ Contract Carpet, says, “This collaboration completely changed our product design thought process. The concept of ‘generative space’ challenges everyone to expand their ideas about healthcare.”
The Arlington Free Clinic (AFC) project is one example of a case study illustrating how Leading by Design helped to cultivate generative space and how it did, indeed, expand ideas about healthcare. As Nancy Sanger Pallesen, the executive director of AFC, explains, “I was intrigued with the concept of healing design. My initial meeting with the Perkins+Will team opened the door to learning how design really can influence healing. Through conversations with the design team, reading articles about healing design, and being introduced to generative space themes, my view of what could be accomplished in our new clinic space increased dramatically.”

AFC, a private, nonprofit, community-based organization, provides medical care at no charge to low-income, uninsured people through utilizing volunteers and partnering with other health providers. At its inception in 1994, AFC saw 12 patients in the Thomas Jefferson Middle School. In 2008, AFC provided 8,655 patient visits, including primary care, specialty care, mental health, physical therapy, and patient education. And on June 18, 2009, the Arlington Free Clinic held its grand opening, showcasing a new 8,000-sq.-ft. facility built entirely on donor contributions. This is the first free clinic in Virginia to become LEED certified.

Although the project started along the typical phases of programming and schematic design, participation in Leading by Design inspired a different structure for the project. The team focused on distinction of space, understanding the importance of creating a physical environment where the patient and medical professional engage in both the physical and the social space. We embraced concepts of sustainable design and evidence-based design all under the auspices of creating generative space.

More data on the AFC project can be read in the Leading by Design Case Studies, but through action research strategies including behavioral mapping, observation, questionnaires, programming and reflective study, one consistent element connects all the research: nature. Nature always had a core, a center—the AFC logo was a tree with a core of people, the director of the AFC was the core of the organization. And with that connection, a simple flower became the diagram for the plan and our design parté. Bloom became our symbol, and this core engaged the four essential elements of the Arlington Free Clinic: welcome, support, community, and treat. As the physical design emerged, the multifunctional conference room became the literal core of the plan, as it was used by patients, volunteers, and staff alike. As the design components grew from the floor plan (Click here for AFC floor plan.)—the shapes and forms in the flooring materials to the ceiling elements to the wing-like moveable workstation dividers—all solutions built on the symbolic element of “bloom.”

Since opening, the success of the clinic has been recognized through a number of awards in design, sustainability and sustainable leadership. In addition, Arlington Free Clinic and Perkins+Will along with team members—Integral engineers, Bognet Construction, and Washington Workplace—won the Team Award, presented during the Healthcare Facilities Symposium. The Team Award focuses on a project team that has worked together to change the face of healthcare design through innovation, creativity, efficiency, and teamwork.

In a post-occupancy survey of the 14 full-time clinic staff, 100 percent responded that the new clinic space is “light filled and uplifting,” and 75 percent indicated that the new space “inspires health.” Mardelle McCuskey Shepley, D. Arch. at Texas A&M University, is conducting additional independent post-occupancy research. Results of that study will be shared on June 4, 2010, when the Arlington Free Clinic will be the location of a tour and presentation during the Environmental Design Research Association (EDRA) conference in Washington, D.C. EDRA advances and disseminates behavior and design research toward improving understanding of the relationships between people and their environments.

Upon completion of the clinic, the patients had a celebration in which they brought in homemade food, played music, and danced to celebrate the space, the care, and the community. “Healing design really did create a place where all who come through our doors immediately felt better. They tell us that they feel they are in a truly special place,” Pallesen says. Recently, a patient held the front door open for another patient and said, “Welcome to the Arlington Free Clinic. This isn’t a clinic, this is a space for healing….”

As the clinic continues to provide clinical services, we will continue to seek additional quantitative metrics to evaluate and track its ability to support generative space—life-enhancing, systemic, and sustainable improvements. As a result of these evaluations, the physical and social spaces will continue to evolve as a reflection of the continued learning that will enable a progressively improved generative space to be cultivated.

To see a video of the completed clinic and their journey, please view the YouTube video here.

Tama Duffy Day, FASID, IIDA, LEED AP, has been an active participant in Leading by Design since 2007. She is a principal at Perkins+Will and is the national interior design healthcare practice leader, formulating research and design initiatives throughout the firm. She can be reached at Tama.DuffyDay@perkinswill.com.


Additional resources:
Arlington Free Clinic web site: http://www.arlingtonfreeclinic.org
Bognet Construction: http://bognetconstruction.com/
BýýLYÜ Carpet: http://www.bolyu.com/index.asp
Environmental Design Research Association: http://www.edra.org/
Healthcare Facilities Symposium ‘Team Award’: http://hcarefacilities.com/awards.asp
Integral Engineering: http://www.integralpe.com/
Leading by Design Case Studies: http://www.thecaritasproject.info/leadingbydesign/index.html
Stantec Architecture: www.stantec.com
Texas A&M University: http://www.arch.tamu.edu/
The ‘Generative Space’ Health Improvement Award: www.thecaritasproject.info/aplacetoflourish
The CARITAS Project: http://www.thecaritasproject.info/index.html
Washington Workplace: http://washingtonworkplace.com/

Past installments of "Designing for Health" include (click on title to access the full article):
• Expanding the Definition of Sustainability to Include Chemical Awareness
• 10 Strategies to Move Your Client Toward Sustainability
• The Age Factor--Energizing the Healthcare Workplace
• Medical Teaming Centers
• Integrating Security in Hospital Emergency Departments
• We Eat What We Build
• Evidence-Based Healthcare Design Forum
• Designing the Ideal Space