HCD Breaking Through Competition – An experience as told by Kristin Dommer, AIA out of our D.C. office

Recently, I, along with a team of colleagues, participated in a conceptual design competition for HCD entitled “Breaking Through”. The ideas generated for this competition were to address current or future healthcare challenges. Teams were encouraged to propose innovative ideas that are an obvious departure from the current healthcare model while pushing beyond the boundaries imposed by current building codes and guidelines.

Every Friday, E4H team members from nearly every office came together via conference call during our lunch hour to brainstorm ideas, make critical decisions, and create a roadmap for milestones and tasks to be completed. Between meetings, ideas were shared on our Microsoft Teams portal while major decisions were put to a vote. Each meeting began with a summary of decisions made during the previous call and any voting results that came in, after which we would dive into lively discussions concerning our direction moving forward. Our meetings tended to be very energetic with a lot of thought-provoking ideas put on the table for debate, which we did with considerable enthusiasm!

Coming from the new D.C. office, I was late to the game and missed the first meeting where our concept, “See Green”, was developed. However, I was  able to jump in on the next meeting where we began discussing how to take that concept and turn it into a schematic. We went through several possibilities that could allow us to capitalize on the idea that “Seeing Green”—visual access to nature—speeds recovery and reduces dependency on medicinal pain management. Our ideas ranged from using exaggerated double facades to house therapeutic gardens, to implementing mimicry of natural environments, to using light shafts as a functional programmatic element. Ultimately, after a vote, those ideas were rejected in favor of the winning concept of the “See Green 360°” transportable biodome.

The biodome not only places patients in close proximity to nature to aid the recovery process, but brings healthcare to the patient rather than the traditional model of having a centralized healthcare location to which all patients must travel. This new model would allow easier access to general healthcare and specialized medicine in rural areas and third world countries while also providing a reasonable means of addressing crisis situations. Much of the biodome concept can be automated including delivery by drone, an AI healthcare team, and remote access to the dome by healthcare professionals anywhere in the world.

The “See Green 360°” biodome goes beyond the idea of seeing green, and addresses the need for being green. Loaded with ultra-slim solar film, water collection tanks, and atmospheric moisture extraction technologies among other sustainable concepts, the dome is capable of being self-sustaining. The capability to support itself allows patients to be treated anywhere regardless of the utilities and services available in their communities.

During a typical project, team roles are clearly defined. The Breaking Through competition broke with tradition and allowed a more loosely defined collaboration. In a way, the lack of formal structure allowed less experienced team members to step up and take on leadership roles while others were able to step back and refine other strengths. For example, in my typical day, I am an architect. Some days I work in my capacity as a project architect, while other days see me in a support role, but I am still focused primarily on architecture. As a member of a competition team, I was able to volunteer my leadership and writing skills to help carry the deliverable over the finish line. While it was intimidating to put some of these skills on display in front of so many very talented individuals, the reaction I received from everyone was very supportive.

Overall, the competition was a great opportunity for learning and growth while being able to exercise creative energy without the structure and limitations typically imposed by building codes and traditional team dynamics. The interoffice collaboration, while sometimes challenging, was a fun way for our E4H team to exchange ideas and engage peers with whom we may not normally interact. Everyone’s ideas were treated equally whether they came from an interior designer, an architect, or someone from our graphics department. When the next opportunity to participate in a design competition arises, I hope you are inspired to stand up and volunteer. The experience is well worth the effort! 

 

 

 

NeoCon 2018

NeoCon brings together nearly 500 companies and 50,000 design professionals, providing 100 CEUs and showroom tours highlighting new products. We were honored to attend “the commercial design industry’s launch pad for innovation” at the 50th Annual NeoCon.

Similar to a project launch, our trip began with familiarizing ourselves with the site (Chicago) and networking with ten other Boston designers who comprised our team for the week. The icebreaker event at BeSpoke Cuisine divided the group into smaller task forces, each completing one course of the meal. We were excited to work together to make something wonderful, appreciating the unique skills and perspective everyone brought to the table!

The following morning, we headed to the Focal Point factory, which graciously sponsored our trip to Chicago with Boston Light Source. Familiar with the Focal Point, we were excited to delve into their design and development, manufacturing processes, and operational strategies. We were given the opportunity to weigh in on some of their newest product developments like the Skydome Edge Acoustic, an acoustical ceiling solution that compliments their Skydome LED pendant. We are already brainstorming ways we can utilize these innovations in one of our next projects!

Chicago’s architecture has an amazing blend of Neoclassical juxtaposed against the sleek lines of modern design. This contrast of old and new is also apparent in the sculptural art found in the city—for instance Buckingham Fountain with its Rococo-influenced intricacies in comparison to the simplicity of Cloud Gate. And for the record, we Bostonians agree… it’s most certainly a bean, not a cloud.

Over the past few years, we’ve started seeing a shift in healthcare design to take inspiration from other sectors of design, in particular hospitality and residential, and this year’s product introductions at the Merchandise Mart only reinforced this trend. Comfort and flexibility impact the user experience and we’re starting to see waiting spaces evolve. A combination of soft seating, usable work areas (such as a high-top counter), and areas for privacy versus family space are all considerations when designing these healthcare waiting environments. As designers, we are responsible for considering the needs of a wide range of users to make our designs as inclusive and comforting as possible.

The Merchandise Mart also featured a few finish showrooms such as Tarkett, where we saw new releases in both the resilient (Johnsonite) and carpet (Tandus) industries. Bold shapes and tile formats left us brainstorming fresh ways to look at flooring for future projects.

We kept our eye out for unique alternatives for products as our industry continues to look at other markets for inspiration. Carnegie, Buzzispace, and 3form all had great new concepts for combating acoustics, without sacrificing form for function. Incorporating decorative techniques to address acoustics could impact hospitals, specifically regarding HCAHP scores on the “Quietness of Hospital Environment”.

    

The Barbican showroom featured their NeoCon Gold-winning WEV collection and a new concept for ceiling design—a 3D fiberglass printed mesh grid system which could be accented in a variety of colors while allowing lighting, sprinklers, sound, and security systems to live above the tiles. This product lends itself to a particular type of installation where the ceiling plays a more influential role, but if specified in the right application, it could introduce color and pattern in an unexpected way.

A few more product highlights:

  • KI featured their new desking series Tattoo, which won a NeoCon Gold award. This series embodied flexibility with options from sliding privacy screens, height adjustable worksurfaces, and hybrid storage and seating options.

   

  • Doug Mockett had rows and rows of hardware and accessories. This was interesting to see firsthand as these details sometimes come as an afterthought. We’re always keeping an eye out for innovative design.
  • Sherwin Williams highlighted color trends for the upcoming year. To combat the stereotype of hospitals being white and sterile, it’s important to incorporate fresh and engaging schemes. Paint is an inexpensive way to refresh a space.

Gerflor flooring’s European product designers were the masterminds behind the latest Gerflor launch—a terrazzo inspired sheet product with vibrant color options. This product would be perfect in bright colors for a pediatric environment but could also be used in neutral colors for a lobby space looking for a terrazzo visual for a fraction of the price. We’re seeing a growing interest in resilient flooring (rubber, sheet goods, and luxury vinyl tile) because of cleanability, comfort under foot, and acoustics.

NeoCon offered plenty of inspiration for us. We’re looking forward to applying these innovative products to our projects.

Berkshire Hathaway, Amazon, and JP Morgan’s Bold Initiative

Increasingly as healthcare groups consolidate, the single hospital model of healthcare delivery is vanishing. As architects centered in healthcare, working with both for-profit and not-for-profit systems, we’ve seen the consolidation drive a direction from single facilities to real estate management. Larger healthcare groups are now launching their own insurance groups to drive consumers to their care products.  This focus developed the emergence of a new trend, healthcare being stitched into lifestyle communities: why get 15% of a person’s income while under treatment when entire health/lifestyle maintenance organizations could be created, capturing a larger segment of the economic pie. Each of us, in America, has had to deal with rising insurance costs covering less and less care. In a characteristically visionary statement, Amazon, JP Morgan Chase, and Berkshire Hathaway have announced their intent to create a healthcare system for their own employees, effectively capitalizing and driving this transformation.

As consolidation of hospitals into systems have begun in earnest over the last few years, it seems to be inevitable that there will end up being eight to ten national healthcare delivery systems emerging. Although great strides have been made in the for-profit sector, in regards to breaking down the state borders and managing the different healthcare approval agencies, the question remains – where is the funding coming from? In providing a ready source of payees, these three large corporations are basically providing the means to effectively self-insure and care for their employees.

As treatment modalities become increasingly home-based and as humans become intrinsically more disease resistant due to genetic advances and treatments, the large central hospital seems destined to transform into smaller regionally-based trauma centers. We see this emerging in the trend for micro-hospitals, private urgicenters, and the conversion of retail spaces into ambulatory care centers.

As pharma starts to integrate into these large corporate entities, they will have access to large national distribution centers with ready buyers and prescribers of their products. To be sure, there is a great deal to be developed in this new corporate model, integrating employees with health systems, but we have already seen it taking root in the pharmacy chains such as Walgreens merging with nationally recognized healthcare providers.

Although US healthcare is divided currently into three sectors, regional, for-profit, and not-for profit, these too may merge as the need for research-fed, targeted, precision medicine will be required to be market-ready and competitive. The merging of for-profit versus not-for profit care models will help defray the costs typically associated with research. Nowhere is this more evident than the groundbreaking work in IVF where costs have vastly dropped and success rates drive the patients to providers who yield the best outcomes.

Governmental cutbacks to funding have spurred a need to come up with affordable care alternatives. Although companies such as Prime, Kaiser Permanente, and Adeptus, to name a few, have established much of the groundwork for such large corporate healthcare entities, this bold step by these three corporations represent a modality and reality that was thought to be far in the future. Healthcare Center construction demands great financial resources and long lead times, it is incumbent on those in the healthcare design community to provide for flexibility for an uncertain future. As professionals schooled and dedicated in the planning of healthcare centers, we need to be helping our clients plan for diverse and innovative options as these consolidations speed forward.

Designing with Holograms

Advancements in technology have transcended the limits of discovery and innovation in the world of modern healthcare, not only in terms of scientific discovery but also in the way hospitals do business. Physician and hospital personnel have incorporated technology into their everyday routine by switching over to electronic medical records and scheduling. We are living longer, finding cures to the so-called “incurable” and designing new and improved techniques to teach the next generation of doctors because of these recent developments.

One of the latest technological advancements that may change the way we design healthcare space is the partnership between global medical technology company, Stryker and Microsoft. The two companies have teamed up to create a new method of designing operating rooms. Using Microsoft HoloLens and Stryker software, hospitals can better visualize plans for their new operating room with 3D holograms. No more need to push and move around expensive and heavy equipment to see the design of the room. With the HoloLens you can move and shape the equipment with the pinch of two fingers to create an operating room that satisfies the needs of all departments.

In addition to making healthcare architecture more efficient, Case Western Reserve University and the Cleveland Clinic have been using it to teach the next generation of physicians human anatomy in completely new ways. Students can see human anatomy layer by layer by isolating specific systems and organs. For example, students are able to gain a deeper understanding of the inner workings of a heart before ever opening a human chest. We are excited about the Stryker and Microsoft HoloLens technology and the possibilities it creates for medical teaching and scientific discovery.

For more information on this promising new technology click here.

Trends in ED and Inpatient Services

In March, an interesting article was published examining the trends in the supply of beds in California’s emergency departments in relation to those in inpatient services. This retrospective analysis reviews the supply and demand of beds from 2005 – 2014. It addresses several factors contributing to the ebb and flow of bed availability across the state and presents a new methodology for analyzing trends. The new metric – ‘beds per visit’ –  suggests the State of California has an inadequate supply of ED and specific inpatient beds.

While this study looks only at the State of California, the issue of ED overcrowding continues to plague hospitals across the United States. We are interested in better understanding this phenomenon and how the hospitals in which we work strive to manage this symbiotic relationship between emergency departments and inpatient services.

Design Review in VR

Elliot Hospital team members review proposed design for new Urgent Care center.

As the dust settles from the recent explosion in Virtual Reality [VR] technology, one thing is becoming clear: it is changing the way we interact with the digital environment. Up until recently, developments in CAD and BIM technologies, as impressive as they are, had been stymied by the limitations of computer monitors and print media. The arrival of VR headset technology breaks through the traditional limitations of the screen and puts people “in” the design to experience, evaluate and comment from a first-person perspective. Over the past few years, we at E4H have been exploring ways of incorporating VR in the design review process, starting in the office and then bringing it to our clients.

At the Office

One of the most important things an architect can do is open their work up to their peers for review and commentary. This has historically been by pinning up work on the wall or showing things on a monitor, but lately we have been incorporating VR into these informal design review meetings in the office. One of our team rooms in the Boston office doubles as VR Lab, with furniture moved to the side to create an open space for walking around the virtual model without bumping into physical objects that can’t be seen with the VR goggles on. Team members can give feedback based on what they are seeing, including the “feeling” of the room using the true-to-scale nature of the software. Using IrisVr’s Prospect software, we can cycle through preset locations for doing multi-room reviews, add markups to the model, draw in space, and take snapshots for sharing these notes with others later

These VR design reviews also help to eliminate the distance between our offices and allows the opportunity to get feedback from our diverse group of designers across the country. Using our high speed network and multiple VR headsets, teams in Texas can review a project in New York and share comments based on their own recent work.

With Our Clients

In addition to reviewing the our work as a team, we also conduct VR design reviews during typical meetings with our clients. We recently used this during a final design development review at Elliot Hospital, with multiple users from different departments. We gathered feedback on equipment locations, casework configurations, outlet quantities and furniture arrangement. The perspective from the goggles is duplicated on via projection for everyone else to follow along and continue to offer feedback. Once the group gets past the initials fears or hesitancy to try them out, they often forget they are still sitting in a conference room. The technology has been a great facilitator of discussion with users of all kinds including doctors, nurses, administrators, facilities staff and more.

Find out more about our VR capabilities.

The 3P Workshop

In architecture school students are introduced to Louis Sullivan’s modernist mantra ‘form follows function’. This mantra follows a strict two-step chronology:

  • First, the function of the space is defined, vetted and communicated. Here the needs of the client and the space are outlined. Traditionally, this step is completed by the client with or without outside consultants.
  • In step two, designers are invited to explore the form or how the established function is spatially organized.

While this two-step process is widely accepted as the logical progression of a design, today many architects are being invited into the first step: defining function.

Often, our clients come to us questioning the needs and processes of a facility or department. The hospital has an interest in exploring a change of function, but the new requirements have not yet been defined. For example, we are often asked to examine metrics collected by a hospital and translate patient population projections into spatial requirements. Other times, when a department is interested in exploring a new treatment methodology, we are asked to explore the consequential spatial impact. We appreciate these requests as they seek to engage us in the entire process of defining both the form and the function.

To further provide services in line with our clients’ growing needs, several of our architects and designers have been trained in Lean and Six Sigma strategies. Lean is a process designed to reduce waste and increase efficiencies. Its principles and tools have been widely embraced by the business and planning professionals within the healthcare industry.

One Lean exercise we have found particularly useful is the 3P (Production Preparation Process) event. In these three to five day events both the process (function) and design (form) of a facility are carefully examined. The event is unique in its inclusion of all key stakeholders and users. It is not just healthcare executives making decisions regarding the future state of care delivery, but also physicians, nurses, support staff and patients. At each event current and future state flows are outlined and design solutions vetted across disciplines.

Our Lean Design Team recently hosted a 3P event for Lifespan Health System in Newport, RI. Across three days, more than 70 attendees informed the schematic design of a new 13,100 SF Emergency Department at Newport Hospital. The facility incorporated state-of-the-art strategies for emergency care, increases the number of treatment bays, expand triage capacity, expand waiting room and entrance space, and host a dedicated Rapid Treatment Area, Clinical Observation Unit, and Behavioral Health Suite.

Build for Humanity

An independent affiliate of Habitat for Humanity International, Habitat NYC has worked since 1984 “toward a world where everyone has a decent place to live.” Their mission is to ensure that every New Yorker has a decent, affordable home.”

“Build for Unity” is HABITAT for HUMANITY’s way to bring attention to our country’s growing cultural intolerance and discrimination. Last weekend, many nationalities, faiths, ethnicities and ages, worked side by side to help in the construction of 15 affordable housing units for low-income families to own. It demonstrated that we can all work together altruistically to achieve positive change for the lives of others.

It is an excellent opportunity to do for others while gaining useful construction experience in route to understanding about constructability (what’s easily built from the details we draw). It is rewarding in so many ways and I recommend it for everyone especially our junior designers and detailers. There are few weekends, better spent.

Promising New Treatment for Sepsis

Sepsis is a life-threatening condition associated with an inflammatory response to infection that has the potential to cause multiple organ failure. Sepsis kills more people in the hospital than any other disease. Worldwide, Sepsis is estimated to impact 15 to 19 million people annually with a mortality rate approaching 60% in low income countries.

Many people in the scientific and medical communities are hoping that the findings of Dr. Paul Marik in the Journal Chest will revolutionize the treatment of Sepsis. Dr. Marik, working from preliminary research findings by Dr. Berry Fowler and his colleagues at the Virginia Commonwealth University (VCU) in Richmond, began treating septic patients with an intravenous cocktail of vitamin C, low dose of corticosteroids, and thiamine (another vitamin).

After Dr. Marik treated 50 patients, he submitted his results to Chest. Of 47 patients treated with the vitamin C cocktail, only four died in the hospital. Of the four deaths, all were from their underlying diseases – not from sepsis. For a control, Dr. Marik looked back at 47 septic patients treated previously in his hospital without vitamin C infusion and found that 19 had died. While the data is still suggestive, the outlook is promising.

Dr. Fowler and his laboratory at VCU was recently awarded a $3.2 million grant from the NIH to run a controlled study to examine the use of vitamin C to treat sepsis. The study will be conducted at several universities and be double-blinded (information about the test kept from the testers and participants) as to limit bias, both intentional or unconscious.

We are excited about the potential of this research and the tremendous potential this will have on both patients and the healthcare industry.

We learned of the success and studies from NPR, in their article Doctor Turns Up Possible Treatment for Deadly Sepsis.

“Behavioral Health Is Part of Overall Health”

“Behavioral Health is part of overall Health,” said Debra Osteen, NAPHS board chair and president of behavioral health, Universal Health Services, Inc. at the start of the recent NAPHS Annual Meeting in Washington, DC. This statement came as no surprise to the many Mental Health professionals attending this yearly conference.

Speaker after speaker talked about the state of mental health care today and the need to seamlessly integrate Mental Health services into the overall medical care provided by family practice physicians and patient care facilities of all types. Because of “parity” legislation passed in congress in 2008 and the passage just last year of legislation for $1B funding  for mental health care for 2017 and 2018, one would have thought a mood of jubilation or at least a sense of well-being would have been present in the conference hall of the Mandarin Oriental Hotel Conference Center.  Instead, the general mood was one of despondence.

The increasing effects of the opioid pandemic are on the minds of all health care professionals. The number of baby boomers who are aging and will need increasing medical services is clear to everyone. Yet, no one knows or can accurately predict how the repeal of the ACA and the proposals for new Republican health care legislation currently being debated in the House of Representatives will affect the future delivery of health care services in America. Various presenters spoke about how funding for Medicaid will be decimated, how future Medicare changes might likely come about, how billions of dollars will be removed from the budget for health care and how millions of Americans will lose access to services. One questioner, at a lunch session presentation by Hemi Tewarson, acting director for National Governors Association Center for Best Practices, Health Division stated, “No matter how you slice and dice it, Congress is proposing to remove $800 B from the budget for healthcare services and nothing is being proposed to replace it.  How then are we, the health care professionals, going to deliver services to the most needy or to anyone, for that matter? ” General applause greeted this question. And no real answer was forthcoming.