Abstract

This article aims to complement the historical literature on the evolution of hospital buildings via a holistic analysis of the contextual factors triggering hospital design innovation over the past 100 years. Innovation in hospital building design should be considered as a complex ecosystem with a heterogeneous set of actors. A novel hybrid research design to the Mixed Grounded Theory methodology, with Charmaz's constructivist paradigm, was developed to explore, construct, and interpret concepts and the interconnections between them. Six hundred seventeen interconnections between 146 factors, classified across 14 categories, were developed to explain the individual and combined impacts of all components of the design innovation ecosystem. This study provides hospital building designers, researchers, policy makers, and stakeholders with a systemic understanding of the innovation ecosystem and their potential role in this system. This knowledge suggests the need for interdisciplinary education to address complex and quickly evolving real-world building design problems.

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