Healthcare Architects' Professional Autonomy: Interview Case Studies
Kim, Duk-Su, Shepley, Mardelle McCuskey, HERD : Health Environments Research & Design Journal
The purpose of this project is to understand the nature of an architect's professional power, as well as the potential absence of the architect's professional power. Understanding does not merely mean comprehension of the causal links of this power; rather, it means a purposive structure emerging from the interaction between researcher and phenomenon (Lincoln & Guba, 1985).
The research presented here is qualitative in nature. Qualitative research is fully embraced by the academic community when it is accompanied by a clear and precise methodology. For this reason much of the literature review in the introduction to this paper focuses on methodology. As is common in qualitative journal articles, references related to issues are provided in the discussion section.
Qualitative research is beneficial in that it provides a theoretical framework for subsequent quantitative research studies and is particularly useful, perhaps essential, in areas where little or no information is available. The topic of this paper, the nature of healthcare architectural practice as it relates to architects' professional power, is a subject with little or no data.
The central questions here are: (1) What is the impact of specialized knowledge on the professional autonomy of architects in general? and (2) What are the relationships between task complexity, specialized knowledge, and the professional autonomy of healthcare architects in particular? The relationships between these research questions are shown in Figure 1.
To answer these questions, this research used three approaches: (1) mail-out questionnaire surveys; (2) census analysis; and (3) in-person and focus group interviews. The latter two are the subject of this paper. The census information was sought to provide a context for healthcare architecture firms relative to other types of firms. Data were obtained from the 1999 Statistical Abstract of the United States, the 1999 AHA Directory of Planning and Design Professionals for Health Facilities, and the 2006 AIA Firm Survey. In-person and focus group interviews were conducted to gain indepth knowledge on a sub-question: How do real-world situations restrict or reinforce the professional autonomy of healthcare architects? While this portion of the research was limited to two southwestern firms, referred to here as firm A and firm B, the structure of the interviews was based on an extensive survey of 134 U.S. firms (Kim, 2001). The questionnaire addressed issues of autonomy, the role of research, and the design process and was conducted as part of a doctoral dissertation. Additional data included a review of firm documents (e.g., press releases and firm histories).
Guided by Strauss and Corbin's (1998) techniques and procedure of theoretical sampling, two architectural design firms were selected because of their similarities and differences. Theoretical sampling is data gathering "driven by concepts derived from the evolving theory" (Strauss & Corbin, 1998; p. 201). "Theoretical relevance and purpose" are emphasized (Orlikowski, 1993). With respect to relevance, both firms have designed distinctive healthcare facilities and have respectable reputations for their design services. Each of the principals of the two firms has held prominent positions in the American Institute of Architects (AIA). Since it is assumed that these two individuals are familiar with the agenda of the architectural profession, they can use their specialized expertise to provide useful information about both collective (i.e., the AIA) and individual (i.e., their own firms) domains in professional practice. The purpose of this study was to generate theory applicable to various healthcare design firms regarding the impact of specialized knowledge on the professional autonomy of healthcare architects. Thus, differences in organizational conditions were sought in the selection of the case firms. These organizational differences included: firm size and age, earning, and the percentage of all design services that healthcare design represents. …