Description
It has been widely suggested that hospital building design has significant influence on quality of care, healing processes and organisational efficiency. Despite the undeniable need for innovative designs in hospital buildings, the literature highlights the Research-Practice (R-P) gap as hindering innovation in hospital design, leading to repeating similar shortcomings. This study shows such an understanding of the role of R-P gap to be an oversimplification of innovation in hospital building design, which instead must be seen as a complex ecosystem with various inhabitants; meaning the R-P gap is only a small part of a more complex picture. Overlooking this complexity, and therefore insufficient understanding of the nature of design innovation processes in hospital building design, has been one of the critical factors in the shortage of timely design innovations in this field.The key aim of this thesis is to conceptualise the evolution of hospital building design and identify and explain the main factors triggering design innovation. A novel hybrid research design to Mixed Grounded Theory (MGT) methodology, with reference to Charmaz’s constructivist paradigm, is developed as a new systematic way of constructing and interpreting the concepts and interconnections among them that have triggered design innovation over the past 100 years. Here, two diagrammatic representations (network and arc diagrams), along with their associated analytical frameworks, are employed and augmented by the qualitative and quantitative techniques provided by social network analysis (SNA). The aim is to understand the complex innovation ecosystem and leverage big data analysis through the development of a human-centred approach, which keeps both human and computational decision-making methods in the analysis loop. The prime analysis is achieved in four steps: 1) analysing the evolution of hospital design since the 1920s and providing a taxonomy of contributing factors, adopting actor-network theory as a rich theoretical lens; 2) conceptualising how contextual factors have triggered design innovations on account of the increasingly globalised world in a theoretical model based on complex systems theory - network approach; 3) examining the interrelationships between design innovations and contextual factors through characterising the structure of innovation networks, using SNA; and 4) developing an explanatory innovation framework elucidating the nature of innovation ecosystem in hospital building design, which can inform further innovation in this field. This research highlights the main components of the innovation ecosystem, the most influential contextual factors, the most interrelated factors, and the overall behaviour of the innovation ecosystem in this field.
This thesis represents both a taxonomy of concepts and an explanatory innovation framework, containing 617 interconnections between 146 factors classified across 14 categories: Architectural Movements, Urban Reforms, Research Developments, Advances in Medical Science, Technological Developments, Shifts in Attitudes Towards Health, Transition in Institutional Identity, Healthcare Policy, Political Shifts, Economic Shifts, Social Transformations, Developments in Health Service, Shifts in Organisational Culture, and Shifts in Natural Environment. This research argues that the complex innovation ecosystem involves several dynamic actors and multi-faceted processes with both individual and collective impacts on design innovations in hospital building design. The infrastructure of the innovation ecosystem suggests that the generation of design innovations generally occurs through infrequent ways and is subject to links between heterogeneous factors that are not mutually exclusive. Here, this study helps researchers, hospital designers, healthcare developers, policymakers, and stakeholders adopt a multidimensional outlook to further develop the system by representing and mapping the successful processes and prior interactions between less-examined contextual factors in this field. This knowledge also allows for the identification of the critical interventions and potential collaborations between key players on multiple fronts in generating innovation processes.
In the innovation ecosystem, factors with constant influence on design innovation processes are Changes in Medical Practice, different Technological Developments (medical, construction and information technology), Economic Shifts, and Research Developments. It is suggested that fast and revolutionary interactions induced by these factors are as influential as the slow and evolutionary process of change caused by factors in the categories of Social Transformations, Transition in Institutional Identity, and Shifts in Attitude Towards Health. This study highly recommends that hospital designers consider the force of the latter sets of factors while embracing the technological changes in generating design innovations. Further, it is evident that the interdependent factors of distinct natures have impacted different fields of research at certain times in relation to sociotechnical priorities. As a result of these interactions, research outcomes have been translated into design practice effectively to generate design innovations in hospital building design. Notably, mapping the impacts of contextual factors helps hospital designers understand both their systemic impact on the ecosystem and the crucial act of other factors on their decisions. This new, systems thinking would not focus on distinct components of the system but considers the individual and combined impacts of different parts on the system behaviour. This knowledge informs better understanding of design innovation and, in turn, can promote the better design of hospitals. Last, given the critical role of the healthcare industry, better knowledge of the nature of innovation in hospital building design can not only enhance healing processes and increase organisational efficiency, but can also inform stakeholders in other construction industries leading to further innovation and value creation.
| Period | 13 Apr 2022 |
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| Examinee | Anahita Sal Moslehian |
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| Degree of Recognition | International |