Energy Savings for Today’s Healthcare Environment by Nan Schramm, LEED GA, EDAC, Fitwel Ambassador, Senior Associate

Hospitals require a large amount of energy to support daily operations on a 24/7 basis. Daily operations include critical systems and medical equipment, as well as supporting the patient experience. Previously, when a hospital attempted to reduce energy consumption, they would focus on back of house spaces. For example, changing out T12 Fluorescent fixtures to T8’s and adding motion sensors to less frequently used spaces. At the time, these small changes were at the forefront of achieving energy savings. Facility managers and designers have been collaborating on new, innovative strategies and tactics to help reduce consumption. Fortunately for the industry, technology has provided several tools.

Energy Saving Tools
In today’s market, facilities can adopt programs such as EnergyStar Portfolio Manager which provides healthcare facilities tools with which to benchmark their energy score against that of their peers. Energy Star Portfolio Manager considers a facility’s climate, weather, and the business activities at the facility. Building activities, such as MRI use, can be significant drivers of energy consumption. General, critical access, and children’s hospitals are eligible to participate. A hospital’s EnergyStar score (a 1 to 100 percentile ranking) is a framework by which a facility can compare its energy use intensity (EUI) to the national averages and that of their peers. By benchmarking energy use, and even greenhouse gas emissions, hospitals are given a tool to understand inefficiencies and a viable set of strategies to address those inefficiencies.

Another great resource is, Practice Greenhealth, an organization whose mission is “to transform healthcare worldwide so that its environmental footprint, becomes a community anchor for sustainability and a leader in the global movement for environmental health and justice”. It is the nation’s leading membership and networking organization for healthcare organizations who have pledged a commitment to sustainability and environmentally preferable practices. Practice Greenhealth provides tools for healthcare facilities to eliminate inefficient energy use while enhancing patient outcomes and minimizing costs. They believe that new initiatives such as The Department of Energy’s, Better Buildings Solutions Center, can help hospitals to identify viable, cost-effective strategies to reduce energy use.

https://practicegreenhealth.org/topics/leaner-energy

Retrofitting Lighting
Retrofitting with LED lighting can contribute to a reduction in hospital energy costs. According to the Department of Energy (D.O.E.), lighting accounts for 10% of a typical hospital’s electrical energy consumption. Now, with LED lighting retrofits or redesigns, the Department of Energy estimates that a 100-bed facility can realize $20,000 per year for operating expenses. In addition to cost savings, a facility’s carbon footprint is reduced, and less load is placed on generating facilities and backup power generating facilities.

Further savings can be achieved by substantially cutting back on lighting usage in special purpose rooms (under-used class rooms, lounges, and cafeterias). Facility operators can curtail lighting and plug loads without interrupting routine operations.

Retro-commissioning
Architects and Engineers can also contribute to energy savings for our clients through retro-commissioning. A process for recalibrating older building systems to help energy costs and improve operations, retro-commissioning often includes upgrading lighting to more energy efficient lamps and controls, and right sizing heating and cooling systems with upgrades or retrofits. Making these retrofits often comes with added benefits of noise reduction and lower maintenance costs.

Self-sufficiency
While not common, some hospitals are going off grid and producing their own energy for self- sufficiency. Sharp Grossmont Hospital in San Diego, CA is now officially off the grid having built their own central energy plant using cogeneration. Cogeneration utilizes combustion turbine generator (CTG). The CTG is powered by natural gas and has the ability to produce more energy than the hospital can use allowing for future growth. The new system also reduces the hospitals greenhouse emissions by 90%.

Eco-Charette
E4H utilizes an “Eco-Charrette” process at the beginning of a project, which builds consensus among the project team (designers, contractors, building users, owners, etc.) to focus on both the big picture as well as the details, thus arriving at an agreement on specific goals, strategies and project priorities relative to energy efficiency and sustainable design. This continual process of verifying quality systems and strategies provides for ready integration into a high-performance building project.

Neighborhood Design Challenge and HCD – By Ayesha Wahid

Team Ayesha and Merielle

When E4H’s internal design competition was first announced, I was incredibly excited. Having recently finished my thesis, it was exciting to be in an environment where experimental thinking was encouraged. While my teammate Merielle and I, had little knowledge of neighborhood hospitals, the prospect of researching and furthering my industry knowledge was a welcome challenge. All teams were provided with past examples of E4H’s recent neighborhood hospitals, a valuable resource.

CONCEPT AND PLANNING

We dove into research on neighborhood hospitals, current trends in inpatient healthcare, patient experience, etc.. At this stage, we were trying to understand what we wanted this project to be, what our big idea or concept was which would eventually drive the design. We started to outline certain problems that we felt were not being addressed. One that stood out to us was the isolation that people within a hospital can feel, be it the staff, the family, or the patients themselves. The hospital can seem removed from the rest of society. Thus, the question arose – how to decrease this feeling of ‘otherness’?

We brainstormed about different social spaces – Central Park, farmers markets, the High Line, and what made them successful. We soon found that certain key words were common in all of these spaces – interaction, nature, daylight, being outside, etc. From here, our concept began to form. We realized that what made those spaces successful were the way they enabled the senses, and that they were all outside. We imagined a hospital which wrapped around a public space, offering access to everyone in the neighborhood. This space would be visible to everyone within the hospital, making them feel connected to the community instead of removed. Then came the problem of how to avoid making people in the hospital feel like they were on one side of the glass looking in. This is where the senses came in, we thought of incorporating the same elements you would experience on the other side of the glass within the hospital.

CHALLENGES FACED AND TOOLS DISCOVERED

In the early stages, it was difficult learning how to balance our daytime workload and the excitement of the design competition. In the end, it was a great lesson in time management. Being so new in the industry, we struggled with navigating medical planning and program requirements. Since the neighborhood hospital concept is still a relatively new topic in the field of healthcare design, there was only so much we could find online in terms of planning. Luckily, we were able to refer to the database of previous neighborhood hospitals that E4H has designed. This was critical in our understanding of flow and important adjacencies.

As designers, even with a conceptual project like this, we wanted to make sure that the materials we pulled were free of toxic substances. This required some extra attention to detail and further research. Design Seeds proved to be a helpful site for quickly putting together our color scheme for a graphic presentation. The platform posts beautiful pictures of nature, architecture, food, etc., and creates color palettes pulled from these images. When deciding on what graphic style we wanted to pursue for our renderings and presentation, we looked at Visualizing Architecture. This website has a diverse gallery of architectural illustrations like drawings and renderings, which serves as a good starting point for graphic inspiration and offers tutorials. Since our concept was rooted in stimulating the senses, we used a collage type of rendering style to highlight the colors, textures, etc. of the space.

PRESENTATION DAY

On the day of the competition, each team was given 30 minutes to present their design for the neighborhood hospital challenge with additional time for questions and critique at the end. The presentations were carried out over an online Go-To-Meeting held in the conference rooms of all offices. Everyone was invited companywide to view the presentations and ask questions either via the chat tool or by calling in. We were all given the exact same program, and yet each team approached and tackled it in their own way. It was amazing to see the skill of our colleagues in their planning, renderings, and design. We were the third team to present and it was incredibly encouraging to have several people from the New York office in the conference room with us while we did so. We received many questions, fantastic feedback, and great suggestions. The various judges were given a grading matrix which was used to place the different teams. Merielle and I were honored when we found out we had placed second.

COCKTAILS AND CRITIQUE EVENT AT HCD

The prize was an all-expense paid trip to the Healthcare Design Conference in Phoenix where we would get the opportunity to present our concept at the Cocktails and Critique Event. This event was organized for the two teams to present their design during a cocktail hour networking event. Clients were invited to view and critique the finalist’s projects. Each team had two concise boards with which to present when the guests came over. It was very educational to hear the assessments and recommendations from the client side of hospital design.

Taking part in the internal design competition was an amazing, challenging experience. We were able to explore new skills, make new connections and gain access to a wealth of knowledge. It is exciting to work at a firm that supports and fosters creative thinking and design and we highly recommend taking part in such competitions to anyone who is interested.

 

FINAL DESIGN

Our final design included the following elements.

A neighborhood hospital which wraps around a large public green space. This courtyard houses a gallery space with rotating exhibits of art and sculptures by local artists. It is also home to a sculptural playground of sorts, which can be used by children but may also attract the attention of adults. The courtyard has paths for evening walks and views into public spaces of the hospital.

The entry waiting area is large and open, with a variety of seating options including intimate booth seating, hospitality like lounge chairs, as well as a couple of experiential pieces. These movable sculptures house surfaces at seating and bar heights, encouraging users to move them around. It is meant to serve as a form of positive distraction. The waiting area has unobstructed views into the courtyard and a hospitality-like cafe area serving healthy foods and beverages. Ceiling height changes identify various seating areas with a beautiful green soffit. When the client walks in, they are greeted by a receptionist and then directed to check in stations which are semi-private, each numbered in a bold, graphic style.

We also kept in mind the experience of the staff. The staff quarters are placed along the main corridor with views out to the courtyard. Keeping in mind their privacy, the glazing is operated with smartglass technology which allows them to switch on and off the translucency of the glass. Staff are provided with a fully equipped kitchenette, lounge furniture, and touchdown areas. In the adjacent corridor, the wood tile extends into the courtyard to give the sense that the lines between the inside and outside are blurred.

Past the public corridor, we then enter the patient room zone. The family waiting area is centered with a large nurse station with a view into the courtyard. Here too, ceiling height changes differentiate between circulation and seating areas. Here is a spot for clinicians to speak with family members enabled by the intimate, private furniture. The columns are furred out and embedded with plants and herbs that positively impact the air quality.

The patient rooms are numbered in a graphic style similar to the check-in stations at the entrance. Rooms are placed alongside the glazing, allowing for natural light in each patient room. In addition, the doors to each room are accompanied with sidelights which allow for views into the family waiting right outside. Each patient room is framed with a wood headwall that wraps across the ceiling and then comes down in the form of a foot wall. This sculpture is equipped with sound systems which the patient can operate themselves to play their favorite music, listen to the news, listen to the ambient noise from the courtyard, etc. The television is concealed within the footwall to encourage the patient to take advantage of the other amenities. The footwall also features a moss wall which requires little to no maintenance and does not impact the air quality of the room. Diffusers are embedded into the green wall which allows patients and family to operate controls which release calming essential oils.

National Wear Red Day

E4H participated in Wear Red Day on Friday February 1, 2019. This initiative resonates with E4H as it helps further the mission of their clients to raise awareness and education to the topic of Heart Health.

Dallas, TX

Forth Worth, TX

Washington, DC

 

Boston, MA

NYC, NY

 

Nashville, TN

 

Burlington, VT

 

Wentworth-Douglass Hospital Site Visit

E4H aims to expose staff of all phases of architecture including the working construction sites. Every so often, we’ll gather a team to head out to a current project site for a visit. While on site, we’ll review lessons learned, common construction practices, as well as any interesting or unique items specific to that project.

Recently a group from the Boston office visited the Wentworth Douglass Pease MOB sites, in Portsmouth, NH. The group toured two MOB buildings in various stages of construction. Building A is a 2-Storied 25,000 SF building that is roughly 80% complete. Building B is a 3-Storied 60,000 SF building that is roughly 30% complete. Below are the lessons learned from the site visit.

“This site visit enhanced my understanding of the reality of design when implemented during construction. It reminded me of the importance of communication for successful integration of the different building elements and building systems. Having the opportunity to see two buildings in very different phases of construction was eye opening for me. It was like seeing an X-ray of an evolving building because we got to see the “veins” and “guts” that come together to create the exterior walls, the interior walls, and the floors in one building and then we got to see it further along in the other building.

We had the chance to speak to the project superintendent about the coordination it took to construct the space for a linear accelerator. On the design front, we learned that a Physicist was consulted to aid in calculating the thickness and construction of the envelope needed for this space and that there are special lasers that are used with this machine that require an extremely carefully laid out and constructed room for them to work properly. To implement the construction and design required for this space, coordination between the design and construction teams was essential to its success. To me this was not only fascinating but a perfect example of the importance of communication in the healthcare design and construction industry.”

– Kimberly Leonard, LEED GA, project coordinator

“This was a great opportunity to share the day to day activities on a construction site with our younger staff, who would not normally be introduced to a project at this phase until later in their careers.  Observing projects during construction gives a greater appreciation for the effort needed to design, draw, and coordinate thoroughly.  Everything included (or not included) within the drawings and specifications makes its way to the construction site.  It is a good reminder that a project is not finished once the construction documents have been completed.”

– Ray Boudreau, project manager

“It was great to visit the two sites and seeing the projects in their respective stages. I’ve never been to a project site so early in the construction phase as Building A, so it was definitely eye-opening to see how much coordination our projects require from the start, even before the interior walls are even laid out. It was also interesting to learn about the how the future growth of the building was accounted for in the design, as well as how the exterior building finishes were an impact.

Since Building B was much further along, the most beneficial part of this visit was to see the details that we draw in 2D back at the office installed in real life. Other lessons included materials transitions (and how to clarify trouble points on our drawings) and a review of what to check for during punch lists.”

– Marissa Walczak, interior designer

“After the transition from the familiar theoretical realm of learning in school to now seeing firsthand the Wentworth-Douglass Hospital Pease project under construction is certainly an exciting new way to understand the development of design and construction. While walking through the site and hearing from fellow co-workers on how they addressed and reviewed certain challenges was remarkable. It seems that every site will offer a few lessons and to enhance our skills.”

– Shannon McManus, project coordinator

 

2019 Healthcare Facility Design Trend Predictions

Healthcare Design is an ever-evolving topic as systems must continuously adapt to meet complex regulations, reduce operating expenses, integrate emerging technologies, keep up with the quickly changing, consumer-driven landscape, and deliver world-class care to their communities. E4H Environments for Health Architecture, partners closely with health systems to develop an approach to these diverse challenges. The partners at E4H Environments for Health Architecture developed the following list of national design trends that will impact the healthcare design industry in 2019.

Designing for Resiliency
Healthcare facilities function 24/7 which requires them to be sustainably designed in order to maximize resources and reduce energy use/costs. With global warming’s effects quickly shifting the dynamics of our geography, the need for resiliency has made its way to the forefront of design discussions. How will the physical facility perform in the face of a natural or man-made disaster? What is the role of a hospital building to provide shelter and care to a community ravaged by a hurricane, flooding or wildfires? Can our buildings continue to function when all the municipal systems (water, power, sanitary services) around them are compromised?  What protects the safety of patients and staff when there’s an active shooter on the premises? These questions help us think beyond the standard disaster-preparedness drills to ensure the designs we develop thoughtfully address the needs of patients, staff, and their community in a time of unprecedented stress. New operational protocols require new plans, different physical barriers, and an innovative approach to the use of materials. Many E4H projects have been impacted by natural disasters such as Hurricane Sandy, this year’s Hurricane Michael in Florida, and the 7.0 Magnitude Earthquake in Alaska.

The Expanding Role of Genomics in Healthcare
Genomic research is impacting many fields of medical research and is emerging as a key disruptor in healthcare delivery and patient treatment. With rapid technological advances and decreasing costs associated with DNA sequencing, a more accessible diagnostic tool, genomic research has provided a new lens into difficult-to-diagnose and rare diseases. Additionally, Polymerase Chain Reaction (PCR), a mature molecular technology, is being refined through improved techniques, new assays, and much higher throughput capabilities than ever before. We are seeing more molecular testing being done in the clinical lab, with many hospitals creating entirely new Molecular Pathology departments. This genomic data is opening the doors to greater predictability of drug efficacy, an increase in personalized medicine and targeted therapies, resulting in improved patient outcomes. E4H Clients such as the Dana Farber Cancer Institute are at the frontier of translational medicine in healthcare.

AI and Virtual Healthcare
Healthcare delivery has spent the last decades working to transform a process that is heavily dependent on data, and make it work smarter. Hospitals and health systems have been working hard to convert and optimize their databases to improve patient care and streamline processes. Artificial Intelligence is now poised to become the next evolution of healthcare data management, analysis and prediction.

The ability of AI to analyze data and predict outcomes and trends will have impacts not only in the clinical fields, but also operational and the physical environments. AI has already begun to demonstrate its ability to assist clinicians with diagnosis and prevention of medical errors. As this technology matures, it will have a profound impact both on care delivered at healthcare sites and in the virtual realm allowing for more informed diagnosis, smarter monitoring and alerts, and outcome predictions based on patient specific data. As facilities incorporate AI into their operations, it will allow them to look at the effect of the environment on patient, staff, and materials movements. Which will provide them with the opportunity to refine their operations through scheduling to enhance throughput and eliminate waste. This insight will help better inform changes to the physical environment to better suit their needs based on the data that they are able to extract about the flow of material and people within their walls.

AI will provide facilities with the ability to better predict their needs for supplies and deliveries such as medical supplies, food, linens, pharmaceuticals and energy based on patient scheduling.  This will help facilities further reduce the costly footprint of onsite storage through better managed just-in-time deliveries.

Due to the growing need for patient data and medical records to be shared across a network of healthcare entities, blockchain integrations systems have seen a push in digital health as well. Blockchain has the potential to revolutionize healthcare by allowing the sharing and analysis of critical patient data in real time to improve quality of care. Blockchain also increases the ease of information sharing between healthcare providers and patient, thus making data much more secure which allows facilities to better manage their inter administration and IT workflows. It is vital for healthcare systems to become aware of the increased efficiency new technologies can quickly implement, for not only healthcare providers but for all end users alike.

Post-Surgery Accommodations
Health systems are constantly looking for ways to decrease operating expenses. One popular method is to alleviate the real estate footprint. This can be accomplished by moving administrative staff and outpatient services to off campus locations. A newer, growing trend is to move recovering patients off site to a nearby location where transportation is provided to and from the hospital if need be. This model is a convenient option for the patient, caregiver and provider. This allows for the patient and their family to have a sense of privacy, improving the patient experience as well as the rate of recovery.

Memorial Sloan Kettering’s 75th Street Patient Residence accommodates patients with blood cancers and disorders as well as patients receiving a bone marrow transplant. The residence offers fully furnished apartments with on-site concierge services to assist with care coordination. Transportation to and from Memorial Sloan Kettering’s Hospital is available.

Wellness Integration
With the healthcare industry shifting its focus to preventative, population health, wellness has gained significant momentum over the last several years. Wellness incorporates the entire body and all systems as why functional medicine is the science of health, focused on the person and restoring the body’s natural metabolic processes; where traditional medicine is focused on disease.  Wellness is an integral part of delivering holistic healthcare.

As reimbursement continues to shift to a model that encourages preventative healthcare, we are seeing a shift in not only delivery of care but the physical aspects of the hospitals themselves. This growing trend can be seen in healthcare facilities across the country in the form of community gyms, yoga studios, and dietary kitchens fully loaded with cooking classes. This allows the health systems to make use of unused space, keep patients engaged and accountable for their healthcare by providing other interactions besides checkups and/or emergency situations. This shift provides an opportunity for the hospital to build relationships with the community. Many E4H clients offer nutritional services, full gyms, and community programs to promote wellness such as Covenant Health Lifestyle Centre in Lubbock,TX.

Boutique Medical Centers
There are two primary factors driving the rise of boutique specialty care centers, or precision medicine, nation-wide. One, a new and unique generation of informed healthcare consumers who expect quality, convenience and customization for all their needs, the other an advancing platform of technologies permitting providers a greater range of services bundled at a single point of care.

Millennials prioritize the enrichment of their health, lifestyles and experiences. Their decisions are based off quick and convenient platforms such as Google reviews, Yelp, Zocdoc, and several others that allow consumers to select a facility based off reviews vs a physician referral. Millennials are quick to express unmet expectations which has caused the healthcare systems to expand their service offerings. This new generation responds more readily to a successfully branded, boutique environments of clinical care.

Convenience is a pillar of retail success which suggests that healthcare systems will have to pivot in order to thrive in this arena. Healthcare providers are trying to diversify, differentiate and deliver their product distinctly to stay competitive. Fortunately, advances in technology and flexible design, have afforded clinical providers the means to offer broader ranged and more complex services in a single exam or treatment room; services that may have previously necessitated multiple visits to multiple locations. E4H projects such as the Hospital for Special Surgery Orthopedic Center Of Excellence in Palm Beach, FL offer full diagnostics services, ambulatory surgery, rehabilitation, and sports performance programs in one location.

About E4H
Committed exclusively to the design of innovative health facilities, E4H Environments for Health is a national architecture firm focused on improving outcomes through inspired design. Our team of future-focused strategists and visionary health and life science architects create flexible, state-of-the-art facilities designed to enhance the well-being of our clients’ patients, staff and families. With more than four decades of experience, we provide value to our clients through the design of LEAN, economically and environmentally sustainable spaces. E4H’s unique SmartDesign process fosters collaboration and drives next-generation solutions to complex challenges encountered in today’s health landscape. Combining experience with for-profit and non-profit institutions allows us to provide efficient, speed-to-market solutions for our clients.

 

For more information, visit www.e4harchitecture.com.

E4H Cares | Holiday Warmth and Gift Giving

E4H Cares recognizes that the holidays can sometimes be a difficult time and hopes to provide assistance to those in need. Our offices selected different causes to contribute gifts, food, and time to, as described below. We would like to extend our wishes for a bright and healthy 2019!

Boston, MA: The Boston office sponsored 20 individuals – 7 women and 13 children. Each individual asked for specific items such as clothing, blankets, or toys. We were happy to provide all requests, in addition to more, totaling 40 gifts. Household items such as laundry baskets, soap, and shampoo were also donated to the Alternative House.

Portland, ME: The Portland office supported the Barbara Bush Children’s Hospital (BBCH), where $140 worth of toys helped stock the Snowflake Station. At the Snowflake Station parents of the BBCH patients were able to pick out gifts for their children. Some of the donations will also provide therapeutic play activities in the Child Life Department.

Nashville, TN: The Tennessee office prepared 20 lunches for The Oasis Center volunteers who are working at the crisis center.

Dallas and Ft. Worth, TX: See our recent blog post regarding The Salvation Army Angel Tree.

Burlington, VT: The Vermont office donated $400 worth of toys and gifts to the Ronald McDonald House, proud to support the children and families who are facing childhood illness.

Washington DC: The DC office delivered $450 worth of gift cards to Fort Belvoir for “Operation Sugar Plum”, a program which assists eligible families assigned to Fort Belvoir by providing gift and food cards during the holiday season.

E4HCares Participates in the DFW Angel Tree

This week the Dallas/Ft. Worth, TX offices raised a grand total of $5,146! We had a total of 20 Angels, and several bags of toys and clothes for the less fortunate.

The Salvation Army Angel Tree program is designed to raise gifts to assist families who are in crisis as a result of difficult circumstances and who otherwise wouldn’t have the resources to celebrate Christmas. Angel Tree gives donors the opportunity to make a difference in the life of an underprivileged child, teen or senior citizen. By adopting an angel, you can bring a smile to someone’s face this Christmas.

We have a total of 20 adopt-an-angel(s). Standard angels consist of wants and needs and are the more traditional angels. They include specific information about a child including clothing sizes, toy preferences, etc. We also provide for Forgotten angels, these are more generic and allow their team to fulfill angels who may have been picked up but not returned. Any additional money or items from the Standard adopt-an-angel will be given to the forgotten angels.

 

“I have headed the program the last 3 years, because I was an “Angel” for several years as a child. Not only did my family rely on these generous donations every year, but I have vivid memories of opening up my gifts and thinking it was a Christmas miracle! No child should be left out on the joys of Christmas morning. And the Angel Tree program (and many others) can help these children feel loved and valued- unlocking their potential for a brighter future.” – Amanda Robinson

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.