Practicing ArchitecturePracticing Architecture
Is there a Doctor in the Firm? (Or a Nurse in the Studio?)
In an increasingly competitive healthcare design market, more and more architects are bringing medical clinicians and other public health professionals into their practices
By Kim A. O'Connell
Since it opened last fall, a cardiac hospital in Bulgaria is already operating at full capacity and is among the most technologically advanced of its kind in Europe. Project delivery for the City Clinic in Sofia was remarkably fast—only a year from the time Dallas-based HKS Architects was hired until doctors began seeing patients. A former car dealership was renovated to create the 38,000-square-foot, 55-bed facility, helping to expedite matters.
The other major contributing factor may have been that, from its earliest beginnings, a physician played a leading role—from landing the project to identifying specific medical needs and seeing the design through to completion. It's a model that seems to be taking hold in architecture. More and more, architecture firms are bringing health professionals into their design studios to help them create the next generation of healthcare architecture.
With the advent of the Affordable Care Act (ACA) and other government actions, and as the industry's understanding of patient-centered “evidence-based design” deepens, the healthcare field is diversifying. Among other things, the ACA includes incentives for preventive care and wellness through federal grants, and lowers or eliminates deductibles for certain preventive procedures. And with more people insured and seeking healthcare, more “boutique” medical offerings may spring up, observers say. Although large hospitals are still being built, more specialized facilities like ambulatory centers, “minute clinics” (walk-in facilities in retail stores), free-standing emergency departments, and wellness centers are creating new opportunities for architects and requiring increasingly sophisticated expertise.
Several firms are capitalizing on this trend by hiring physicians, nurses, and other health experts to work side-by-side with designers in an integrated approach to project delivery that often includes scientific research. Some firms, like HKS, have even formed in-house consultancies that include both designers and clinicians.
“There is not just one discipline in healthcare that has all the answers,” says Michael Pietrzak, M.D., senior medical consultant for HKS. “It's not just a matter of finding a healthcare professional and bringing them in.” Firms need to find people who can speak both the medical and architectural languages, Pietrzak adds. He points to the small but growing number of professionals who have dual degrees in medicine and architecture, or who have earned public health design certificates or degrees from universities such as Texas A&M and Clemson (see companion story, The Newest Multidisciplinary Trend in Architecture Education: Public Health). In addition, more than 1,000 architects and other professionals have become EDAC-certified (Evidence-based Design Accreditation and Certification) by The Center for Health Design (CHD).
At HKS, in addition to medical expertise, Pietrzak also handles international business development for the firm. It was his connection with the CEO of what would become the City Clinic that helped land the firm the job. He encourages firms to examine how clinicians and architects can both creatively expand and integrate their respective skill sets.
Jennie Evans is a vice president and clinical advisor with HKS. She’s also a registered nurse and a LEED-accredited professional. She says clinicians don't have one clear-cut path to begin working with architects, but rather both sides must identify their translational abilities to each other. Among other projects, Evans recently led a series of iterative workflow process improvements for the firm's addition to Akron Children's Hospital in Ohio. She is also currently president of the Nursing Institute for Healthcare Design, a nonprofit that will have a track at the CHD conference in Orlando in November.
What the client wants
Healthcare clients are savvy, says Whitney Gray, who has a Ph.D. in public health and is the research and innovation director for CannonDesign in Arlington, Va. Like HKS, CannonDesign employs a range of healthcare professionals, including physicians and registered nurses, who work with architects in a consulting practice within the firm called Confluence. “Increasingly, our clients are not the facility managers; they're the CEOs, and they might have a medical background,” says Gray, who is also LEED-accredited. “They want to know that this capital investment is going to have a benefit [on] population health. Too often in design, we put forth claims of what we will do in this building, and how safe and healthy it will be, but we're finding that the clients are pushing us to back that up with research.”
Gray points to an ongoing CannonDesign project in the Emergency Department at the UnityPoint Health, Trinity hospital in Rock Island, Ill., where the firm created a “Crisis Stabilization Unit” that resembles a home living room, which the firm hopes will be therapeutic for patients. The firm is now involved in a three-year study to determine the unit's success.
“Firms often see research as a marketing tool, and that's the easiest place to bucket it,” says Nicholas Watkins, who serves as a research lead for Raleigh, N.C.–based BBH Design and has a Ph.D. in social and cultural design. (He was previously a researcher for HOK.) “But we're reaching a turning point where people realize this is part of the value and delivery.”
Research has been part of the largest healthcare construction project currently under way in the United States: Parkland Memorial Hospital in Dallas, designed by a joint venture between HDR + Corgan. As part of a mammoth project team working on the 2.5 million-square-foot hospital (due for completion this year), HOK, already in charge of furnishings and equipment, has also been executing a study of the role of furnishings and artwork in inpatient care. “Parkland was really committed to having research be at [the project's] core,” says Erin Peavey, Assoc. AIA, a researcher and medical planner in HOK's New York office, which worked with Watkins and other healthcare professionals on the study.
Watkins is currently performing a study with Parkland, FKP Architects, and commercial furniture company KI to identify layout and casework solutions for new medical/surgical clinics. “In healthcare design, so much that was once in is now out, literally," he says. “Inpatient volumes and care-delivery models are shifting dramatically to outpatient settings and the home. Our integrated team is using research to define the future of medical surgical clinics at Parkland and in the industry.”
Yet bringing medical professionals in-house may not be the solution for every firm. Some firms are turning instead to standalone consulting firms, such as BioSitu in Houston, run by Adele Houghton, AIA. “Architects are taught to make connections,” Houghton says. “Designing green buildings that address population health is a gap that the architecture industry can fill.”
Other firms are focusing on getting staff trained and certified in evidence-based design, and understanding an industry driven more and more by replicable, empirical data. For example, Washington, D.C.–based SmithGroupJJR currently has 18 EDAC-certified professionals on staff.
This health expertise can even translate to other projects that aren't directly involved in healthcare, according to William Kline, AIA, director of SmithGroupJJR’s health studio. “We designed what is essentially a hotel for the Navy, called the Transient Wounded Warrior Lodge,” he says. “It is designed to house outpatient soldiers receiving care at the Walter Reed National Military Medical Center. They wanted us to do this because of our sensitivity to the patient population, even though the patients do not receive care in the building.”
Kline adds that evidence-based design is not a panacea. “But at the same time we are a learning culture. As we become more data-driven as a society,” he says, “that trickles down to all the disciplines and professions. Healthcare delivery and architecture are inextricably linked. It's a fascinating time to be in this industry.”
Parkland Memorial Hospital in Dallas, designed by a joint venture between HDR + Corgan. HOK is responsible for the hospital’s furnishings and equipment, and has also been executing a study of the role of furnishings and artwork in inpatient care. All images courtesy of HDR + Corgan.
Patient care room at Parkland Memorial Hospital.