Metaphorical Design Method
We conducted 29 interviews with patients, parents, and hospital medical and administrative staff. The participants were asked to spend a week before their interviews collecting magazine, catalog, and other images that would visually describe their most basic thoughts, feelings, and perceptions about both their current hospital experience and an ideal experience.
During individual interviews, participants discussed in detail their reasons for selecting the images and the thoughts and feelings they represented. Working with a graphic designer, each participant directed the creation of a montage based on prioritized thoughts and feelings. The participants' montages and descriptions, combined with the researchers' interpretations of these metaphors, conveyed a wealth of information about the respondents' underlying needs.
The findings revealed both surface and deep metaphors along several clear themes. On a surface level for example, recurring images of confusion and mazes indicated frustrations with the wayfinding in the existing hospital. On a deeper metaphoric level, feelings about the ideal hospital emerged as a transformative experience, providing "a sense of renewal," as one hospital employee noted.
Reinforcing the fundamental theme of transformation were three supporting deep metaphors, or "key domains": the need of patients, families, and hospital staff to have control over their life and environment, their need for different types of energy, and the need to connect with the "inside hospital," the "outside" world, with others, and with oneself.
To distill these results, we used the "Deep Design Filter," a patent-pending tool that helps Astorino to organize the ideas uncovered during the ZMET process and to translate the metaphors into design solutions. For Children's Hospital, the filter supplied a framework for interpreting the key domains of control, energy, and connection.
When this information was prioritized for each type of hospital user — patients, families, and staff — the Deep Design Filter helped identify several important human and environmental design objectives. By refining these objectives and supplementing them with conceptual images, we shaped the architectural design for the hospital.
For instance, the domain of energy — derived from both people and the environment — pointed to a common experience of all hospital users: the need to recharge and rejuvenate. Without the benefit of ZMET and the Deep Design Filter, this domain may have been identified as a high priority for patients, but not necessarily for families and staff.
Understanding the need to give staff and families a place to "charge their batteries" led to more lounges for family and staff, a fitness center, and the "Healing Garden," a natural extension of the enclosed atrium that offers the restorative powers of nature for both children and their families.
While the domain of control — over one's life and environment — had already been recognized as an important program element, the research findings uncovered aspects of control that had not been fully appreciated. For instance, the need for personal space, including private patient rooms, separations within them for privacy/ family areas, and home-like fabrics and colors, took precedence over some other design options.
To support the theme of a transformative healing experience, dynamic design solutions were incorporated throughout the hospital. The building exterior was redesigned with rich colors not seen typically on buildings in the region to communicate that Children's Hospital of Pittsburgh is a facility that is alive and dynamic. Water features and a kinetic sculpture have been added to the front entrance. A concierge service will offer a more personalized sense of arrival.
Upon entering the hospital, patients, visitors and staff will travel through a "Transformation Corridor," which expresses the evolution of healing through design elements suggesting the four seasons.
The walkway starts with autumn-like tones, textures, patterns, and materials for the floors, walls, ceiling and lighting. It then illustrates a sense of transition by moving to cooler, winter design elements, into a mood of revitalization with a softer, spring-like feel and finally into a vibrant, balanced environment evocative of a brilliant summer day.
Our "Deep Design Process," with its ZMET research component, helps us to connect with users on emotional, intellectual, and experiential levels. These evidence-based tools help us make earlier and more effective facility design decisions. For Children's Hospital of Pittsburgh, the result is a design that contributes an experience of transformation, for both the healers and the healed.
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Louis D. Astorino, FAIA is founder and CEO of the architectural and engineering firm, Astorino. He is a frequent lecturer and most recently spoke at the Urban Land Institute on the subject of "The Practice of Sustainable Development."
A montage made by the parent of a patient reveals ideas about isolation and healing, and the need for hope and diversions when time seems to stand still.
Before the research informed design, an early elevation study for the hospital featured materials and colors that fit within the community context.
Later design studies introduced richer colors not typically seen on buildings in the region.
A montage made by a hospital employee expressed feelings of isolation in a hectic world and a contrasting need for the "comforts of home."
Researchers created a composite metaphoric image to represent the feelings of patients, parents and hospital employees, expressing confusion, frustration, and distress at privacy invasion.
A composite image representing feelings of all audiences about the ideal hospital experience, with home-like elements, a sense of belonging, and symbols of escape and future happiness.
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