Buildings in the making: a sociological exploration of architecture in the context of health and social care

This study has two interrelated aims. One to develop a sociological understanding of the day to day work of architects and two, to cast light on the way knowledge about health and social care is, quite literally, engineered into buildings designed for care. Architects are not health and social care professionals, but they are employed to create buildings within which care can take place. A better understanding of their ways of working and their contribution to the design and delivery of care therefore offers a novel path for research.

The study is led by a research team who are developing a suite of projects on the sociology of architecture. Our previous work on Maggie's Centres provides a point of departure for this study of architecture in the care sector. Maggie's is a charity that provides informal support centres for people living with cancer. Founded by architectural practitioners, Maggie's has a distinctive relationship with its architects who are given significant scope and autonomy in their designs. However, their client-professional relationship is atypical, and architects in the care sector face multiple commercial and regulatory constraints. Thus the Maggie's study provides a point of comparison for our ethnographic investigation into the work of architects in mainstream settings where buildings for care are commissioned by a mosaic of private, corporate, charitable, and state providers.

To frame the ethnography, qualitative interviews with architects (n = 10) will scope issues and challenges that they face when designing buildings such as care homes and dementia centres in commercial, charitable and public contexts. An accomplished researcher will then 'enter the field' to work alongside teams of designers in an architectural firm for 18 months. The firm was selected because of their extensive portfolio of projects in the health and social care sector. Attention will be given to the processes of commissioning, planning, concept and technical design of buildings in the making. Fieldwork will involve interviewing architects, commissioners, operators, planners, and service users. The research team will examine documentary sources (e.g. architectural briefs, perspective renderings, policy guidelines and specifications), and observe meetings and site visits. We will address questions such as: How are architectural briefs negotiated and operationalised? Do commercial, care and design considerations give rise to conflicts? Are original design concepts modified and why? Which care guidelines and design models are imported into the design process? How are users configured? What types of knowledge about the care needs are sourced and how are they translated into the materiality of design? Through our detailed observations of working practices we will also generate insights into the architectural craft and the complexities and tensions of design work in the commercialised sectors of care.

The project is informed by theoretical perspectives from medical sociology and science and technology studies (STS) that presume the constructed nature of health and medical knowledge and the malleability of technological artefacts. By opening the 'black box' between the commissioning of buildings and their delivery, the study will shed new light on the way evidence based knowledge of health and social care is woven into design, as well as factors that hinder or enhance these processes.

Findings will be disseminated to academic, professional, policy and practitioner audiences. We will establish a British Sociological Association 'sociology of architecture' study group. To ensure impact extends beyond academia we will work with our professional collaborators to reflect on how our findings may be used alter to their practice. We will invite practitioners and policy makers to a series of themed symposia, design a stand to exhibit our findings at the 'British Care Shows', and host an end of project dissemination event.

Beneficiaries of the research will include:
Architecture firms working on building projects for health and social care
Health and social care operators and providers in charitable, commercial and public sectors
Health and social care policy makers and regulators
Service users and wider publics
Charities working to engage audiences in culture and aesthetics

Benefits comprise:
Knowledge translation and communication
* Detailing processes of collaborative working along with sources of tension between clients, architects and related stakeholders (planners, service users, and care providers) will benefit these players as our findings provide insight into the perspectives of those with whom each routinely have to deal with.
* Findings will inform best practice at all stages of the building projects, most especially the commissioning and briefing stages.
* Insights into the way architectural briefs are operationalised will enable health and social care providers to better appreciate the pragmatics of design work and be useful for preparing guidelines and briefs.
* Findings will inform dialogues on the need for inbuilt flexibility of care.

Education, training and on-going professional practice
* Sociological insights on the nature of architectural work should inform training of architects and planners through the development of teaching materials, and research outputs published in professional journals.
* Findings may be used in professional development of care commissioners and those involved in the procurement of buildings in public, commercial and third sector organizations.

Implementing evidence based practice
* Earlier work has found that knowledge about care needs is differentially interpreted by caring professions, policy makers, and providers. Our work will widen this by documenting how architects, planners and commissioners interpret and communicate what constitutes 'evidence based practice' through our focus on the way these ideas are woven into design and construction.
* Service users may benefit indirectly through improvements in the design that may result from changes in working practices and collaborations, most especially outputs that speak to the complexities of future proofing inherent in design work.
* The research should impact on the field of elderly care services dove tailing with our work on design, clothing and care for older people, particularly those living with dementia. In concert with this we will continue to challenge dominant representations of older people. Our pilot research has indicated that a crucial matter for architects is the longevity of care homes which requires flexibility of design to respond to changing care needs and which emphasize 'living with' conditions. Architects would welcome opportunities to debate these issues with operators and developers.
* The research should impact on those involved in commissioning and overseeing building projects in the care sector by disseminating examples of best practice in the provision of supportive architecture, and open up dialogue about the commissioning process. It will unlock some of the 'ways of knowing' about health and care that architects, as professionals shaping the experience of care in contemporary societies, bring to the buildings they design.

Aesthetics of place
* Service users and wider publics may benefit indirectly through the production of buildings that are aesthetically valued as well as functional. We will work with those in design fields and education (e.g. international charities such as the Helen Hamlyn Foundation and Engage) to explore the value of aesthetics in buildings for care.