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.

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.

“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.

The Future of the Medical Office?

Located in downtown San Francisco, Forward is an interesting new model for healthcare delivery. It is a meld between an Apple store, a high-end medical office, and a chic members-only health club.We learned about Forward, and its cutting edge delivery model by way of TechCrunch.

The idea of incorporating technology to make healthcare more accessible to the masses has been a growing trend. Health-insurer and insurance-technology startups raised more than $1.2 billion in venture funding in 2015. For perspective, that’s more than double the $570 million raised in 2014, and 10 times the $123 million raised in 2013, according to CB Insights, a data company that tracks private startups and venture capital. With venture capital dollars pouring into the healthcare industry, many predict tech-heavy healthcare delivery models will gain more traction (and market share) in upcoming years.

Is this the future of healthcare? We are excited to see where it goes…

Breakthrough in Autism Research

An exciting breakthrough in autism research was recently published in the highly reputable academic journal, Nature. Scientists have observed brain enlargement in children with autism spectrum disorder (ASD). A retrospective analysis of head circumference and longitudinal brain volume studies in two to four-year-olds indicate increased brain volume may be an early indicator of ASD. These findings suggest an earlier diagnosis may be possible, helping those with ASD and their caregivers better respond to challenges associated with the disorder.

In any given year, 1 in 68 Americans is diagnosed as having autism spectrum disorder, according to the Centers for Disease Control and Prevention.

Jacques Black, AIA, a partner in our New York City office, has completed several projects for the Center for Autism and the Developing Brain in White Plains, NY. Together with Cathy Lord, a clinical psychologist and director of the Center for Autism and the Developing Brain, he has published and presented on the unique dynamics of the built environment and individuals with ASD.  For example, when designing for autistic patients it is important to acknowledge and address their sensitivities to noise, color, and texture.

We are excited about the potential this research has for young families across the world and will continue to seek to better understand how to design spaces which address the unique needs of patients with ASD.

Thoughtful Bariatric Design

Bariatric Design SummaryAs the obese population rises, so does the demand for thoughtfully designed spaces to accommodate obese patients. Bariatric design requires a fundamental shift in how designers approach healthcare environments for bariatric patients. The scale of bariatric furniture and equipment, clearances, and ratings must be carefully considered early on in the design process to meet the unique requirements of these spaces.

The FGI guidelines provide critical clearances and ratings to consider when designing a bariatric patient room. The bariatric patient room requires a larger door, larger clearances around the patient bed and a larger turning radius within the room. The hand washing sink is required to support the weight of a bariatric patient. The toilet room requires a larger shower, more clear space for the toilet, and for fixtures and grab bars that support a bariatric patient.

While it is important to include the above information into designing a bariatric patient room, designing to accommodate a bariatric patient shouldn’t stop there. Will the layout of the headwall work with a wider bariatric patient bed? Is the toilet room sink accessible for a bariatric wheelchair?  Are the counters and cabinets suitable for a bariatric patient? A bariatric patient is more likely to have obese family members. Do the public and family areas accommodate obese family members? Are the bariatric design elements incorporated into the overall design of the building? These are all questions that should be considered when designing a unit serving bariatric patients.

The goal of bariatric design is to provide a comfortable, dignified, and safe environment for bariatric patients, their family, and their healthcare providers. To achieve this goal, it is critical to consider the larger scale and capacity needed in all elements of the healthcare environment and the impact this will have on the design.

Policies on Aging

Gables at East Mountain
Gables at East Mountain

An interesting article on Elder Rights in China was published in this month’s issue of The Journal of The American Medical Association (JAMA) Internal Medicine. Author XinQi Dong, MD, MPH outlined the policies being enacted by the Chinese government to combat changing demographics and cultural expectations for filial duty.

Historically, Chinese families have seen filial piety as the highest of virtues in accordance with the treatise Classic of Filial Piety outlined by Confucius in the 4th century BC. However, these beliefs are being challenged by the Chinese people. In a recent survey by the Center for Strategic and International Studies on East Asian retirement practices only 4% of Chinese respondents believed children or family members should be responsible for proving support to older adults – the lowest percentage of all six Asian countries surveyed.

Although the One Child Policy restricting family size from 1980 to 2015 was repealed, the unintended consequence to demographics is palpable for many young workers. The realities of one working adult expected to support four grandparents and two parents are often overwhelming. Additionally, with the increase of industry around the country, many younger people are moving away from their homesteads in search of economic opportunity.

The disconnection between historical familial expectations and existing practices has forced the Chinese government to look for policy solutions to protect and support its 123 million residents (9% of the population) over 65.  In May of 2016 the Shanghai Ministry of Civil Affairs Bureau, a governmental agency ruling the largest city in China, implemented a new policy to protect older adults and shame children into supporting their families. Children found to lack devotion to their parents are placed on a ‘credit blacklist’, a tool used by the government to prevent individuals from activities such as opening a bank account, purchasing a home, or starting a business.

Dr. Dong, a professor at The Rush University Medical Center Institute for Healthy Aging, brings up an interesting and sensitive topic for many people across the globe – how do we care for our aging family members?

It is an honor to be a part of these discussions within our communities as we design senior living facilities that address the holistic needs of residents, their families and the community. Although we are far from any universal solution, it is encouraging to participate in the ongoing dialogue regarding aging with dignity and care.