HOLISTIC HEALTHCARE DESIGN, SPECIALIZED KNOWLEDGE, AND HEALTHCARE ARCHITECTS' PROFESSIONAL AUTONOMY

1-?????Introduction

Two types of knowledge have shaped the path for the professionalisation of architecture and the contingent skills claimed by architects.

Occupational and professional powers are related to technical (i.e., the component transferable by standardisation and routinisation) and Indeterminate (i.e., the non-transferable component, such as artistic initially inaccessible components of new research) elements of professional knowledge.

In architecture, technical aspects are adapted from engineering and technological fields, such as civil and mechanical engineering and computerised information.

The utilisation of technical knowledge is a significant source of income because it is an instrumental tool (e.g., BIM and CAD programmes) in carrying out architectural tasks, informed decisions and input in the early design process. Nonetheless, the progressively technical nature of professional knowledge dramatically develops de-professionalisation.

Therefore, technical aspects may unintentionally decrease professional autonomy. By contrast, the indeterminate components of professional practice, including aesthetics and generating new scientific knowledge, might permit architects to preserve some exclusive professional autonomy.

Aesthetics is scientific and non-transferable, as knowledge cannot support evidence-based design until it is produced and shared. These contributions are essential to the users, clients, and society.

However, there are concerns about architectural knowledge domains using knowledge formalisation.

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2-?????Autonomy

Provides an analysis of the formation of the discipline of architectural design: "The Production of the Practical Knowledge – The specific articulation of theory and practice that characterizes a professional discipline – is a constitutive component of a structure of occupational control that characterized professionalized occupations."

Architecture varies from the professions in several aspects; for example, the architects' "work can't match the essential needs for medical and legal services concludes".

The autonomy of the architect is bordered in all directions; the client controls most of the budget while the building technology is controlled by builders, engineers, and industries that produce materials or equipment, and it is susceptible to economic conditions; architecture operates on conditions that can be easily doubted, its legitimating is obstinately cultural rather than compelling scientific, and issues of style are particularly outstanding.

Autonomy has been defined as self-governance; in theory, professions are equipped with specialized knowledge utilizing extensive education and license. In architectural practice, autonomy is found when architects can make design decisions free from external constraints.

Architects need to become client-focused and entrepreneurial to win design commissions. The same leads to decreased artistic autonomy for practitioners because "most owners want to control or select their aesthetics". Thus, the conflict generated from the interaction between style, other healthcare design issues and different tastes among architects and lay people is defined as aesthetic complexity in this study.

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3-?????Specialized Knowledge

Considering increasing project complexity and technological development, the specialized knowledge domains of architecture are more important than ever. Healthcare architecture, as one of the most complex design types, demands a range of knowledge and skills, including:

1-????Functional efficiency and flexibility to expand, downsize or reconfigure.

2-????Medical technologies.

3-????The influence of medical knowledge on design.

4-????The design impacts the behaviour and the psychological needs of visitors, patients, and staff.

5-????Market and finance changes.

6-????Future pandemics and risks.

?Below Categories summarize the holistic healthcare design in terms of specialized knowledge:

1-?Function

2-?Technology

3-?Research (Scientific knowledge)

4-?Aesthetics

5-?Interest group

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4-?????Holistic Healthcare Design

4.1- Functional Complexity

Operational issues associated with healthcare facility design led to complexity. For example, a modern hospital is split into three functional zones based on services:

A.???Medical services (e.g., surgical/medical ward, outpatient, consulting clinics, accident and emergency, radio-diagnostic, operating rooms / obstetric delivery, ICU/CCU/ laboratories).

B.????Medical support (e.g., pharmacy, central sterile supply, medical library, central medical records).

C.???General support services (e.g., administration, food and disposal, linen and disposal, engineering and maintenance, transportation and communication).

Different degrees of change within these three zones increase the complexity of hospital design. For example, rapid developments in medical technology in the diagnosis and treatment department change medical practice and demand modifications in functional relationships (e.g., the proximity of spaces) in hospitals. Therefore, the unprecedented functional requirements increase the functional complexity of healthcare facility design.

?4.2- Technological Complexity

The medical technology available during construction time is another factor influencing healthcare design. Mechanical systems are a particular example; back in the 19th century, mechanical systems for interior environmental control were designed with sealed windows to support a closed system. Other technological innovations such as elevators and radiological technology have also influenced the form of hospitals as a critical component of modern hospital design. The most significant factor influencing modern medical practice is radiological technology with a significant impact (e.g., using X and Gamma rays or Electrons) and Magnetic Resonance Imaging (MRI).

?4.3- Research (scientific knowledge) complexity

Research plays a significant role in healthcare design and is among the most dramatic transformations in the field. healthcare design has been affected by two scientific (research) knowledge domains:

A.???Medical knowledge on the health outcomes of the patient.

B.????Environmental psychology in response to the "supportive design".

The architecture of hospitals is affectionate with medical knowledge and practice forms. Thus, all subsequent modifications to hospital design might be the product of alterations in medical knowledge. For example, the transformation of hospital shapes (e.g., from block-plan to pavilions to skyscraper hospitals) presents the knowledge impact on hospital design.

New scientific knowledge generated by environmental psychologists has also shaped current healthcare facility configurations, suggesting that nature has a healing effect on patients. Therefore, the healthcare design of the future will be more hospitable.

The human touch is based on the premise that the design goals must enhance the quality-of-life experience through hospitable design; healthcare environments need to be designed from a psychological perspective. This can promote wellness by providing:

A.???Controllable in physical and social surroundings

B.????Social support

C.???Positive distractions in physical surroundings.

Using the concept of "supportive design" becomes a focal point in the discussion of healthcare architecture.

?4.4- Aesthetic complexity

The research of environmental psychologists has suggested that architects, when compared to lay people, use a different system to understand the evaluate the environment. This different system of judgment is implemented within the architectural schools during the period of architectural education; the same implies that aesthetic appraisal could be different between architects and users due to their different educational backgrounds. Thus, this difference can cause conflicts associated with a design decision between clients/users and architects.

?A discussion about the aesthetic attributes of architecture suggests inherent factors involved in architects' attitudes and the consequences of these attitudes. Architects are the only licensed artists, and their artistry is the core skill in architectural design. Architecture has not established a monopoly over other aspects of building in those professions such as engineering claim expertness in building practice. Thus, aesthetic theories have influenced architecture to secure its position in the building industry. Aesthetic theories (e.g., postmodernism, deconstructionism) have generated their own style. The rhetoric of style is an acritical component of coherent aesthetic practice in organizing professional status and constructing a market for professional services.

?4.5- Interest group complexity

The hospital's design includes many interest groups, including funding agents, administrators, and doctors. This multi-voiced situation leads to conflicts. Politics in planning and consensus building among a heterogeneous planning group determine the design process.

The architect's role is not limited to physical problem solving and aesthetic expression; instead, it needs the skill of consensus building to negotiate the different demands among different interest parties. Conflicts among interest groups can be a challenge to architectural practice.

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5-?????Conclusion

Through comparison and contrast, the descriptive analysis of the data suggests the following:

A-???The context of healthcare design complexity appears to influence the culture of healthcare design practice. Likewise, changes in the culture of healthcare design practice may impact the context of holistic healthcare design complexity.

B-????Increasing holistic healthcare design complexity may cause low credibility regarding the task performance of healthcare architects. Thus, increasing holistic healthcare design complexity decreases the design-decision autonomy of healthcare architects.

C-??Specialized knowledge, including evidence-based design, may increase the design-decision autonomy of healthcare architects.

D-???Healthcare design firms, which emphasize knowledge generation and evidence-based design, may increase the number of indeterminate elements of professional power. Consequently, this type of firm preserves design=decision autonomy.

In summary, it's always recommended that the complexity of healthcare design results from external influences, the demands of clients and users, and the need for extensive knowledge. The culture of healthcare practice is perceived to be one in which the credibility of the expertise of architects is challenged. They experience difficulty convincing clients of their design decisions, and the informality of standard information acquisition (without research / scientific knowledge) is not fully respected. This paper proposed that developing and marketing this knowledge will increase the profession's credibility.

Strong delivery is a dominant design philosophy of healthcare design firms. The external context of healthcare design complexity includes external influences (e.g., regulatory issues, healthcare policies). Demands from clients/users are the most influential factors in health care design complexity. Specialized knowledge domains (e.g., technical aspects, building systems, and indeterminate elements, such as artistry and unique knowledge generation through research) play a critical role in holistic healthcare design.

?Another finding, clients/users of healthcare facilities are knowledgeable and specific about what they want. Healthcare architects deal with high-status clients (e.g., government officials, hospital corporations, doctors). Healthcare architects struggle to persuade clients/users to accept their design decisions due partly to their lack of knowledge, which reverses the competence gap between professionals and clients. Consequently, healthcare architects perceive that their design-decision autonomy is decreasing.

It is always suggested that specialized knowledge and skills positively impact design-decision autonomy. Therefore, research-informed design decisions may increase the design-decision autonomy of healthcare architects. The implication for the practitioner is that they will benefit significantly from incorporating research into the design process. Additionally, to support this process, universities should incorporate curricula in evidence-based design to prepare young architects to interpret and conduct research.