It is interesting, when delving into the history of Architecture, to see how little the “common man” figures into the overall scheme of things. Those soaring, spectacular Gothic cathedrals, for example, were built not for man's comfortable contemplation, but to inspire in him awe and praise of God. America's Great Houses of the 19th and early 20th centuries were designed to show how great, indeed, were their inhabitants.

Le Corbusier thought people should consider themselves privileged to serve as cogs in his “machine for living.” Even Frank Lloyd Wright, who was said to have “democratized” 20th-century Architecture, was known to get involved in ideologic tussles with sometimes unwilling clients.

Then we look at some of the articles in this issue (and earlier ones, too, for that matter) of HEALTHCARE DESIGN. We find architects and designers going to extraordinary lengths to determine what will appeal to the common man—or woman or, better yet in this context, patient/staff member. D. Kirk Hamilton explains the studious process of evidence-based design, as the architect progresses through ever-deeper explorations of patient and staff needs (“The Four Levels of Evidence-Based Practice,” p. 18). Pittsburgh architect Louis D. Astorino describes a patented process in which patients, staff members, and families are asked to express their thoughts about the healthcare environment metaphorically, with artists assembling the resulting images in montages aimed at guiding architects to more effective human-centered design (“Enhancing the Design Process Through Visual Metaphor,” p. 12).

Past issues of HEALTHCARE DESIGN have revealed hospital designs intended to entertain children (“Phoenix Arises,” p. 46, and “Voyage of Discovery,” p. 56, HEALTHCARE DESIGN, May 2003) and to provide nursing staff with a soul-restoring retreat (“Nurses' Refuge,” p. 52, HEALTHCARE DESIGN, March 2003). The Pebble Projects, for which our partner organization, The Center for Health Design, is famous, are all about investigating, identifying, testing, and proliferating elements of patient-centered design.

It is striking, in short, to see how today's healthcare designers are striving so mightily to please not only well-heeled and influential hospital owners and clinical department chiefs, but also the hands-on staff and the average Joes and Josephines who require their services. It just might be that the true democratization of Architecture is happening now. If so, in the vanguard of that movement is the healthcare designer. HD

Richard L. Peck, Editor-in-Chief

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Healthcare Design 2003 November;3(4):4