Places to Flourish : An Introduction to Generative Space

By Tama Duffy Day

In 2014, Panelists discussed how to design “places that flourish,” to improve the delivery of health services, increase client/physician engagement, and focus on the physical and social space of wellness. The design of generative space in healthcare facilities is a key factor in an emerging culture of healthcare focused on wellness. But what exactly is “generative space”? Tama Duffy Day, director of health and wellness at Gensler and one of our panelists, explained.

In the early 1980s, when I began designing places and spaces within healthcare facilities, I was very interested in understanding how space influenced actions and reactions by patients and caregivers. At that time, however, there were few research strategies easily accessible to architectural and design professionals engaged in the design of healthcare places.

A decade later, information on healthcare design, evidence-based design, and designing for health became more available, and symposia were held that focused exclusively on these topics. There were more tools, classes, and journals sharing valuable information on specific examples of how the places we created impacted patients, caregivers, and their families.

In 2004, Dr. Wayne Ruga, founder of the annual Symposium on Healthcare Design, the non-profit Center for Health Design, and The CARITAS Project, launched Leading by Design, an experiment to pioneer the next generation of improvements in health and healthcare delivery through the design of the environment. Leading by Design is an applied research project with international scientific research and extensive field-testing in five countries. Culminating in “generative space,” Leading by Design focuses on growing leadership attributes in one’s personal life, organizational and professional work, and community engagements.

As defined by Dr. Ruga, “generative space is an environment, a place—both physical and social—where the experience of participants fulfills the functional requirements of that space and it also materially improves the health, healthcare, and quality of life for those participating in that experience in a manner they can articulate in their own terms. By its very nature, a generative space is a place that progressively and tangibly improves over time.” In the simplest of definitions, “generative space” is a place to flourish.

The Arlington Free Clinic (AFC) project is a case study that illustrates how Leading by Design helped to cultivate generative space and how it expanded ideas about healthcare. AFC, a private, nonprofit, community-based organization, provides medical care at no charge to low-income, uninsured people through utilizing volunteers and partnering with other health providers. At its inception in 1994, AFC saw 12 patients in the Thomas Jefferson Middle School. In 2008, AFC provided 8,655 patient visits, including primary care, specialty care, mental health, physical therapy, and patient education. And on June 18, 2009, the Arlington Free Clinic held its grand opening, showcasing a new 8,000-sq.-ft. facility built entirely on donor contributions. This is the first free clinic in Virginia to become LEED certified.

As Nancy Sanger Pallesen, the executive director of AFC, explains, “I was intrigued with the concept of healing design. My initial meeting with the architectural team opened the door to learning how design really can influence healing. Through conversations with the design team, reading articles about healing design, and being introduced to generative space themes, my view of what could be accomplished in our new clinic space increased dramatically.”

Although the project started along the typical phases of programming and schematic design, participation in Leading by Design inspired a different structure for the project. The team focused on distinction of space, or otherwise understanding the importance of creating a physical environment where the patient and medical professional engage in both the physical and the social space. In my role as the leader of this design team while at Perkins+WIll, we embraced concepts of sustainable design and evidence-based design all under the auspices of creating generative space.

In 2010 the Generative Space Award was created to recognize breakthrough designs that improve health and healthcare and to acknowledge projects that clearly demonstrated the integration of the physical and social environments to making their communities “a place to flourish.” The first Annual Generative Space Health Improvement Award was given to The Pennsylvania State University Hershey Medical Center, Cancer Institute. The AFC won the Generative Space Health Improvement Award in 2012, after post-occupancy evaluations and additional statistics illustrated that the clinic continues to improve the delivery of health services, increase client/physician engagement, and focus on the physical and social space of wellness.

Other teams, projects, and communities are being recognized for their leadership on this topic. The first annual Generative Space Week was launched in Chicago on September 27, 2013. During the Healthcare Facilities Symposium and Expo, which occurred during this same time period, Gensler and other Chicago firms sponsored the first healthcare student brainstorm focused on creating generative space for aging populations. The event was created through the American Institute of Architects’ Chicago Healthcare Knowledge Community and The CARITAS Project.

Additional Generative Space Health Improvement Award winners and specific research information can be found on The CARITAS Project web site. Within the web pages of this site you will find ongoing documentation about the annual awards, as well as practical resources about creating places that support and help people flourish in life, work, and the community.

This post was produced in conjunction with the Healthy, Healing Spaces exhibition.