An investigation of the use of health building notes by UK healthcare building designers

Building design in the healthcare industry presents a complex architectural challenge. This paper reports a qualitative study to investigate the use of building design guidance by healthcare architects and planners in the United Kingdom. Sixteen architects, healthcare planners and facilities managers participated in 11 group and individual interviews. The data were analysed using NVivo2, resulting in three main themes: changes in the design culture over 20 years for the context of guidance use; quality of the evidence base to support the guidance; and future guidance needs to include patient expectations, new building techniques and generic room templates. The use of guidance was variable, with some participants seeing a clear role for new (more standardised) guidance in the future, whereas others were more concerned about loss of design freedom. Two clear roles for ergonomics were identified to: (1) facilitate the participation of patients and clinicians in the design process; and (2) generate new research evidence with respect to spatial requirements for clinical activities to support standardisation. These recommendations pertain specifically to healthcare facility design for the National Health Service in the UK.