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Metaphorical Design Method
by Louis D. Astorino, FAIA
Every hospital architect strives to create a physical
environment conducive to healing. But an elusive
challenge in achieving that goal is understanding the
innermost thoughts and feelings of the people who will
occupy the hospital.
This challenge prompted my architecture firm Astorino
to adopt the Zaltman Metaphor Elicitation Technique
(ZMET), a research protocol that elicits information from
respondents based on visual images, metaphors, and
emotions. ZMET — most often used in market research
studies — gave us a new perspective on the needs of
patients, families, and staff as we designed the new
Children's Hospital of Pittsburgh .
The design started with a clear objective, to create a
state-of-the-art pediatric healthcare facility that would
anticipate and respond to the deepest needs of its users.
The existing facility is one of the top ten children's
hospitals in the United States, so the new design was
required to meet and exceed the standards of quality of
the medical, professional, and support staff.
To fully understand user needs, the team integrated its
existing design process with ZMET research protocols.
ZMET was developed by Gerald Zaltman, a Harvard
Business School professor. It is based on the premise that
95 percent of thought occurs in the unconscious mind
and is not captured by traditional research methods.
Astorino's goal for using ZMET was to gain insights that
would give structure to potential design ideas.
Research Process
We conducted 29 interviews with patients, parents, and
hospital medical and administrative staff. The
participants were asked to spend a week before their
interviews collecting magazine, catalog, and other
images that would visually describe their most basic
A montage of images selected by a
young patient reveals some sadness
as well as the importance of color,
toys, and access to nature.
A redesigned patient room features
"home-like" fabrics and colors,
separation for a family area, and
hidden medical gases.
01 October 2003
thoughts, feelings, and perceptions about both their
current hospital experience and an ideal experience.
During individual interviews, participants discussed in
detail their reasons for selecting the images and the
thoughts and feelings they represented. Working with a
graphic designer, each participant directed the creation
of a montage based on prioritized thoughts and feelings.
The participants' montages and descriptions, combined
with the researchers' interpretations of these metaphors,
conveyed a wealth of information about the
respondents' underlying needs.
The findings revealed both surface and deep metaphors
along several clear themes. On a surface level for
example, recurring images of confusion and mazes
indicated frustrations with the wayfinding in the existing
hospital. On a deeper metaphoric level, feelings about
the ideal hospital emerged as a transformative
experience, providing "a sense of renewal," as one
hospital employee noted.
Reinforcing the fundamental theme of transformation
were three supporting deep metaphors, or "key
domains": the need of patients, families, and hospital staff
to have control over their life and environment, their
need for different types of energy, and the need to
connect with the "inside hospital," the "outside" world,
with others, and with oneself.
To distill these results, we used the "Deep Design Filter," a
patent-pending tool that helps Astorino to organize the
ideas uncovered during the ZMET process and to
translate the metaphors into design solutions. For
Children's Hospital, the filter supplied a framework for
interpreting the key domains of control, energy, and
connection.
Design Solutions
When this information was prioritized for each type of
hospital user — patients, families, and staff — the Deep
Design Filter helped identify several important human
and environmental design objectives. By refining these
1 objectives and supplementing them with conceptual
A montage made by the parent of a
patient reveals ideas about isolation
and healing, and the need for hope
and diversions when time seems to
stand still.
Before the research informed design,
an early elevation study for the
hospital featured materials and colors
that fit within the community context.
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images, we shaped the architectural design for the
hospital.
For instance, the domain of energy — derived from both
people and the environment — pointed to a common
experience of all hospital users: the need to recharge and
rejuvenate. Without the benefit of ZMET and the Deep
Design Filter, this domain may have been identified as a
high priority for patients, but not necessarily for families
and staff.
Understanding the need to give staff and families a place
to "charge their batteries" led to more lounges for family
and staff, a fitness center, and the "Healing Garden," a
natural extension of the enclosed atrium that offers the
restorative powers of nature for both children and their
families.
While the domain of control — over one's life and
environment — had already been recognized as an
important program element, the research findings
uncovered aspects of control that had not been fully
appreciated. For instance, the need for personal space,
including private patient rooms, separations within them
for privacy/ family areas, and home-like fabrics and
colors, took precedence over some other design options.
Transformative Experience
To support the theme of a transformative healing
experience, dynamic design solutions were incorporated
throughout the hospital. The building exterior was
redesigned with rich colors not seen typically on
buildings in the region to communicate that Children's
Hospital of Pittsburgh is a facility that is alive and
dynamic. Water features and a kinetic sculpture have
been added to the front entrance. A concierge service
will offer a more personalized sense of arrival.
Upon entering the hospital, patients, visitors and staff will
travel through a "Transformation Corridor," which
expresses the evolution of healing through design
elements suggesting the four seasons.
2 The walkway starts with autumn-like tones, textures,
Later design studies introduced richer
colors not typically seen on buildings
in the region.
A montage made by a hospital
employee expressed feelings of
isolation in a hectic world and a
contrasting need for the "comforts of
home."
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W ARCHITECTUREWEEK
patterns, and materials for the floors, walls, ceiling and
lighting. It then illustrates a sense of transition by moving
to cooler, winter design elements, into a mood of
revitalization with a softer, spring-like feel and finally into
a vibrant, balanced environment evocative of a brilliant
summer day.
Our "Deep Design Process," with its ZMET research
component, helps us to connect with users on emotional,
intellectual, and experiential levels. These evidence-based
tools help us make earlier and more effective facility
design decisions. For Children's Hospital of Pittsburgh,
the result is a design that contributes an experience of
transformation, for both the healers and the healed.
Researchers created a composite
metaphoric image to represent the
feelings of patients, parents and
hospital employees, expressing
confusion, frustration, and distress at
privacy invasion.
A composite image representing
feelings of all audiences about the
ideal hospital experience, with home-
like elements, a sense of belonging,
and symbols of escape and future
happiness.
Louis D. Astorino, FAIA is founder and CEO of the architectural and engineering firm,
Astorino. He is a frequent lecturer and most recently spoke at the Urban Land Institute
on the subject of "The Practice of Sustainable Development."
This article may also be found on the web at
3 http://www.ArchitectureWeek.com/2003/1001/culture_1-1.html
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