Some may wonder if there’s anything new or creative in healthcare design. Are we seeing breakaway solutions in response to the changing medical and technological environment, or are we rearranging the deck chairs on the Titanic? This question was the inspiration for a research study at the University of Kansas that resulted in some interesting findings about design creativity in this specialty design sector.

First, a definition is in order. Most experts on the topic identify at least two components to creativity in any field: It must be new and innovative, and it must be applicable. To be new but not meet a real need —be it technical, cultural, or aesthetic—isn’t creative.

The researchers identified four fundamental components to creativity in healthcare: personality, place, project, and process. For the study, the team focused on two of these areas, creative personalities and project process, and recruited a group of 22 healthcare architects, including designers, project managers, and project architects, from five different firms (representing small to multinational practices). Interviews were conducted and personality tests given to help pinpoint the characteristics of success in these different roles and the challenges to creativity encountered in this field.

The creative type
Four personality tests were selected for the research, including the Myers-Briggs Type Indicator that indicates how people perceive the world around them and make decisions based on four dimensions: Introversion (I) versus Extraversion (E); Intuition (N) versus Sensing (S); Thinking (T) versus Feeling (F); and Judging (J) versus Perceiving (P).

The most common mix among participants was Introversion/Intuition/Thinking/Judging, or INTJ (the dominant trait abbreviated by its key letter). This points to creativity, but less risk-taking than a previous study of architects identified as highly creative. That major study conducted by the University of California Institute for Personality and Research (iPAR) of the most creative architects in the late 1950s—such as Eero Saarinen, I.M Pei, and Philip Johnson—found that the most common Myers-Briggs profile for that study group was INTP. The characteristic of perceiving (P) points to exploration of new solutions and willingness to take risks or new challenges.

Additionally, three of the four women in this recent research sample showed profiles with extraversion, sensing, and feeling as strengths. A larger sample would be needed to see if this was a consistent pattern and indicates an ability to empathize with clients that’s not as strong with men. (The researchers plan to explore this with a larger pool of healthcare architects this fall.)

A more contemporary personality measure, called Big Five, was also used. This test looks at five dimensions: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. All of the designers scored very high on the measure of “openness,” for which characteristics include appreciation of art, emotion, adventure, unusual ideas, and curiosity. Project managers also scored high on this measure, but below designers.

Our sample of healthcare architects also scored high on “agreeableness,” which measures compassion and cooperativeness rather than suspicion and antagonism toward others. Conversely, this group scored low on “neuroticism,” pointing to healthcare architects being good team players, which is an essential skill in executing highly complex healthcare designs that require large group efforts.

Two other tests were also given to the sample: the Architectural Creativity Test, which showed architects had significant visual design creative skills, and the Remote Associates Test, which indicated that they didn’t excel in verbal creativity. These tests pointed to success in all three architectural roles requiring skills in openness and collaboration as well as the necessity to bridge the gap between visual, writing, and verbal skills to best work with clients.

Roadblocks to new ideas
In assessing project process, the research team found that physical and practice environments that encourage exploration are essential to stimulating creativity. Documentation of work environments for Pixar Animation Studios, Ideo, and the Monty Python comedy group all point to having open critiques as projects evolve, suspending decisions, and encouraging exploration and play as essential to success. Walter Isaacson’s biography of Steve Jobs, CEO and co-founder of Apple, describes his detailed consideration of designing to encourage informal interaction of staff in the hope that the serendipity of interactions would stimulate new ideas.

Research shows that the design of offices to create a balance between small group interaction, informal gathering spaces, and privacy could be a key element in establishing effective work environments. For example, current research on how we think points to frequent interruptions and distractions contributing to a decline in creativity. In fact, KH Kim, professor at the College of William and Mary, has documented a precipitous decline in creativity test measures over the past two decades, while MIT professor Alan Lightman and other researchers point to disruptions from technology and noisy work environments as a major contributor to this decline.

Perhaps the biggest challenge to all of us is the disruption to concentration that occurs when we allow email, Twitter, text messages, and other electronic communications to conflict with the concentration necessary to create. Many cognitive researchers are recommending disciplined isolation from information disruptions to allow focus and support sustained creative thinking.

Courage to be creative
Through his work on creativity in architecture and other fields, Donald MacKinnon, founder of iPAR, identified key characteristics for a creative person. They include convergent (analysis and reasoning) and divergent (richness and novelty) thinking, the ability to set goals, curiosity about life, and courage. His definition of courage, specifically, includes personal courage to question what’s generally accepted, the courage to be destructive so that something better can be constructed, the courage to follow one’s intuition rather than logic, and imagining the impossible and trying to achieve it.

Based on these attributes, courage may be the most important component of creativity and the most valuable to the healthcare design field. Are we willing to build off research in evidence-based design, environmental sciences, and other fields to explore new physical options? Or will we see these findings as prescriptive constraints on innovation and design?

Successful architects in healthcare demonstrate intellectual curiosity and the ability to collaborate to make complex buildings a reality. Establishing a work environment that encourages candid critiques, trust, and sufficient time to explore novel options is critical, as is working with clients that are sympathetic to testing concepts beyond industry standards.

Frank Zilm, DArch, FAIA, FACHA (retired), is the Chester Dean Director of the Institute for Health and Wellness Design at the University of Kansas School of Architecture and Design (Lawrence, Kan.). He can be reached at